So the moment of truth is here. I have been offered a home care case management position in a reputable agency. 40 hours. It will be a pay cut but I have been unhappy at the hospital for quite some time. I posted a while back and got several responses from nurses who just started their home care career. I have not heard from some of you as to whether or not you made the right decision. I would love to hear from you now. Was the switch from hospital to home care a good decision or do you regret it? I truly appreciate your comments!
Thank you so much for the detailed and thoughtful reply. From your answer, I suspect that you are an awesome home care nurse! I will take heed to all of your words of wisdom☺ï¸
So I'm new to all nurses, but thought I would give you my home health experience.
My my background is hospital care, 12 years med surg, 3 outpatient. I went to home health as an hourly per diem employee 6 months ago. I find it flexible to fit my kids schedule and rewarding in a way I havnt felt in years.
Since I am per diem I provide the agency with my availability calender monthly. I work one weekend a month. We are emailed schedules the evening before. Since I am per diem I don't case manage. This gives me the disadvantage of not knowing my clients terribly well, but I am a care partner in a specific area which means I do get repeat visits. When my area isn't heavy I might get assigned to another. I have found that they will absolutely try to take advantage of my time if I allow it. I provide the agency 6 hour blocks of availability. Depending on where I am driving and the types of visits I can generally manage 5 visits and all my charting in that time. I am frequently given assignments where there is a lot of driving, or a lengthy admit with 4 visits, that I know I can not manage in my 6 hours. I will refuse those assignments, and I have a director who is very supportive about this. I absolutely refuse to let my life suffer for my job. I think the first and most important thing to do in homecare is set boundaries. I don't know how being salaried effects your work schedual, but I would be upfront with them. The only reason anyone puts in 60 hours a week and only gets paid for 40 is because they allow it. It is very similar to the phenomenon that happens in the hospital. Nurses stay an extra 2 hours to catch up on charting, but clock out and never get paid those hours. I absolutely refused that practice when in that position. If I had a day that required me to stay late, you better believe I was getting paid for my time. I'm not a martyr, and I'm not a hospital volunteer.
Home me care is challenging and stressfull in its own way. There certainly seems to be a lot of turnover. I enjoy the work, the schedule is very flexible, and I love being out and about. You see some things that just really make you want to cry, vomit, scream. You meet some wonderful people, and some scary people. You really have to be able to leave it behind when you go home or else it could very easily overwhelm you. It is a whole world in itself. Good luck with your decision!
I do home health and hospice, and even though I love the nature of the work, I was at first very miserable, broke, and fairly certain that I was going to have a stroke before I was 40. I have learned some valuable things, and here's my Ultimate Guide to Enjoying Home Health:
Work for several agencies at once if you are Per Diem- Donn't give one agency a monopoly on your time. This way you can be a little more picky on accepting patients and you can keep your service area within a reasonable distance of your home, or in less trafficky spots. This also gives you more job security as the patient load fluctuates throughout agencies, you have more control over keeping steady income.
Become super ultra organized. I made myself a huge binder with reference to data like lab values, wound assessment, and common home health and hospice diagnoses and interventions. No matter how much experience you have or how good you are, your brain will be fried after a long day of work and traffic, and it helps to have the data right in front of you so that your mind can go straight to the critical thinking and planning.
*Like previous posters have said, you must to do your charting in real time, otherwise you will be charting when you should be sleeping or spending time with your family. I have learned to put nothing off. I used to try to see several patients in a row and then block out time for charting and giving reports, but something always gets in the way, there is just no way to plan other than to expect the unexpected. So I do spend part of each visit with my face in the computer, or the paper chart, depending on the agency, but I still manage to find some time to visit to listen and engage with the patient and give a thorough assessment, and even though this makes it feel like the visits are longer by charting on site, my days are anywhere from an hour to three hours shorter by forcing this habit of finishing all charts and reporting on the patient before even thinking about the next patient.
*Also regarding organization, the back of my car is literally a mobile supply closet, with everything I might need for visits. My nursing bag is huge and organized as well with everything from my paperwork to paper towels, hand sanitizer, small trash bags etc. so that I don't have to spend a lot of time asking the patient and family for things when it comes to my infection control measures, wound care etc. I pretty much just need to find a workable surface and I have everything that I need in my bag. I went to a lot of trouble to invest in specific plastic bins to organize things in a way that makes sense to me personally in the back of my trunk and my car used to literally look like a trash dump, so I finally got into the habit of always bringing my supplies from the visit and putting them directly into their place in the trunk, and keeping a food trash bin in the car for eating on the road.
*And I also used to do a lot of drive-thrus for coffee and food, BECAUSE IT'S SOOO TEMPTING when you drive past all of your faves all day, and you technically have the time to stop if you want to. and I now save sooooo much money and time by taking a little extra time in the evening or early morning to prepare food for myself, and I bring a couple large thermoses as well as a reusable Starbucks cup with all of the coffee and tea that my heart desires, as well as lots of water and lunch and snacks, because for some reason I just get so hungry out on the road. Any "quick" stops are surprising time suckers. Making my own food has also helped me to stay healthy and lose a little bit of weight and I spend so much less.
if you are a contractor, which you almost always are per diem except for very rare cases, take advantage of this and keep all receipts and write everything off on your taxes. I mean literally anything that you bought that you're using in the course of your workday. You are essentially your own small business, the government is taxing you accordingly, so it is literally giving money away if you do not write off the same expenses that any other small business would write off.
And last but not least is boundary setting- Of course when you are brand-new you don't have a lot of options, you are at the bottom of the food chain, and that's natural in any job. But after almost 3 years in the field, and garnering a good reputation from coworkers and from patients and families, I was able to start demanding more. I now set a bar for what I will accept in pay, including additional mileage for distance or extremely complicated cases with a lot of wound care and/or complicated family dynamics. So it pays to work hard, go the extra mile, but then do not let a company or administrator run you into the ground.
Like previous posters have said, the turnover is very high. These companies are not stupid. Whether they are clearly willing to let people go in order to find new people to abuse, at least half of the companies that I've worked with are smart enough to see that when you have someone who really knows what they're doing and can save everyone's butt in certain situations and/or train other staff , and help them pass survey; often times they will be willing to pay that extra bit, meet your demands, because they are after all saving so much money by being cheap in any way they can, unfortunately. Remember, since they have chosen to go Per Diem in order to be cheap, that also gives them the disadvantage of not having control over their nurses' time. Most of these companies are extremely disorganized and chaotic when it comes to having nurses available for distance cases and after hours cases, or they have a lot of turnover very suddenly. This is why working for several agencies is important, that way you won't feel desperate when one company is asking a lot of you and you know it's because they have a nursing shortage, you can turn the tables and say "sure I'll do these visits for you for X amount of additional pay and mileage, etc." Any visits that go over 1.5 hours, or are so outside of the area that my round trip plus visit is 2.5 hours total time from the next patient or the agency office, I get authorization for increased pay for my time. They'll agree when they know that you are thorough and you won't end up costing them time with QAPI problems or having to send out another nurse because you missed something, or if they simply have no one else to go.
I often am not fond of some of the agencies that I work for and their practices, but I have learned that regardless of Home Health, SNF, Hospital, almost every nurse I know is burnt out and feels that the company they work for is money over people. So instead of trying to take on the whole system myself, I just try to give the patients my absolute best, and take comfort in the fact that regardless of what else they experience in healthcare, that they at least received quality, genuine care while I was assigned to them. And then I make sure to take care of myself as well. I have friends and family who depend on me, so I am not doing anyone any favors by allowing some money hungry company to burn me out and make me a less effective mother, friend,etc.
The $$$ -I've done the math on my current status, and I am making approximately $27 an hour as an LVN in Los Angeles in home health and hospice after my travel and other expenses are figured. This includes factoring in unpaid time at the office, meetings, and the rare occasions that I do have to go back into the chart when I'm not "working". ( RNs can make $50 per hour after expenses, based on their visit rates at my agencies, if they follow the same system. But of course they have a more volatile schedule since the nature of their visits are different and can be harder to anticipate ) This does not include any benefits, so if you did the math on what I'm paying out-of-pocket for my health insurance and considering the lack of vacation, sick time, and other benefits, it would probably be the equivalent of $25 an hour at a salaried position. Another major plus is that I have a lot of flexibility and freedom, even though I don't have paid vacation, I also don't have to miss work to see my son's school performances, attend his field trips, or attend any other important family gatherings or other things in life that matter. Essentially all I have to do is reschedule my patients and I can still get my hours in around my personal life. Also pays big time to make allies at your companies, cover for them if they do need to have you see their patients for a day or week, and it'll get you some extra pay, and then you can rely on them to see your patients at times that you can't or don't want to reschedule if you are going out of town or sick etc.
As much as I want to pull out my hair a lot of the times, I hear the same complaints from my friends who work in hospitals and SNFs about horrible management, unpaid time, and stress, so based on the overall freedoms I enjoy in the field, I can never imagine going to a salaried position again.
I just printed this bad boy out and put in on my fridge!!! EXCELLENT post. Thank you
I was in an acute setting for five years at the start of my nursing career. I went to clinic nursing for 6 years after that. I learned a lot from both, but was very unhappy, actually pretty depressed. The entire reason I wanted to be a nurse in the first place was to make a real difference. So in short, I would say that coming to home health care was the best decision I made! It is not for everyone. I'm finding that I am getting very good, solid skills in what I call REAL nursing. I absolutely LOVE IT!! Lots of work and learning in the beginning, of course. I will retire being a home health nurse...that's how happy I am. Good luck in your endeavors...what ever you choose.
I've been working per diem since December- and I love home health- the only problem is that the pay is unstable- one week I'll work 20+ units- two weeks in a row I had one unit-and there's not another agency within my driving zone that I could easily sign up with for per diem as well. Home health offers so much freedom!! If you're child is sick mid-day you can pick them up- reschedule PTs that you're able to for the next day without missing a beat!! And you can be there to tuck your kids in at night. It's not an emergency service- so yes there's after hours on call but you're not expected to ride in white hat flying to save the day:). Patients are sick and need you- they sometimes have no one else- that's rewarding- you always leave the day feeling like wow I was a good nurse today!! Unfortunately for me- I'll be back at the hospital bc I need more pay stability- but if you're guaranteed 40 hours a week then I think you will love it!! Always stay safe- never go to an environment where you feel like you're in danger! One place I went had four pit bulls outside that wouldn't let me out of my vehicle- I called the pt an they wouldn't put the dogs up bc that was there babies. I respect that- but I am no good to anyone if I get injured!! So called supervisor told her the situation and she understood So always keep safety in mind!!
babynurse73
142 Posts
Uptheladder 12.....
Thank you so much for the detailed and thoughtful reply. From your answer, I suspect that you are an awesome home care nurse! I will take heed to all of your words of wisdom☺ï¸
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Wendy