Are nurses required to do HHA visits in your agency?

caliotter3 · Mar 11, 2012

My very first agency about 20 years ago asked me to fill in for a HHA visit once, explaining that they really needed someone to do the continuous care shift that was rather far away. The staffing coordinator was very apologetic and offered to pay me a couple of dollars more than their usual HHA rate. Since I really didn't want to do it because it was too far away for that kind of money, I was happy when they eventually called back and said the shift had been cancelled. That was the only time they ever asked me to do a HHA shift. To be quite open about the matter, if I was told that I would be paid my regular licensed nurse rate of pay, fine, I would do HHA/CNA shifts and visits, same as if I were in a facility and asked to do CNA work for licensed nurse pay. Where there is a problem, is paying me CNA pay. Only if I were desperate for work and had been originally hired in a CNA capacity, would I accept such a proposition. I have applied as a CNA before. Never got hired to do CNA work. So, as usual, it boils down to how badly a person needs a job, whether this is acceptable to them, or not.

Debra,RN · Mar 11, 2012

They expect the nurses to do nursing and HHA visits on the same day. I was scheduled to do 5 nursing visits and 2 HHA visits on the same day and the HHA visits were not clients I was seeing for nursing visits.

caliotter3 · Mar 11, 2012

No, I don't think this bodes well for keeping your brain "separated". Nurse one day, HHA the next, would be a better way to handle this. What if you get pooped on or splashed on during bathing, at a HHA visit? How are you supposed to keep changing your uniform throughout the day, not to mention that you get more tired from doing the HHA work? I wouldn't mix the visits, but that is me.

leahwalt80 · Mar 12, 2012

I would be checking with my board of nursing to make sure that you are working within your scope of practice. In some States you can't work " beneath" your license which you would be doing if they were paying you at the HHA rate. Worth checking into. Not worth losing your license over!

KateRN1 · Mar 13, 2012

I have done it and enjoyed every minute of it. I admitted a patient who'd had shoulder surgery and requested a HHA 2W2 just until the cast was off. They were short a HHA, so I was asked by the staffing coordinator to do the HHA visits and I happily agreed. I got paid my regular per visit rate for both the RN and HHA visit, but had less documentation and was able to do a really thorough skin assessment, as well as a really good ADL and safety assessment.

When you are working as a HHA, you are not working "below your license." Part of your training as a nurse is to assist patients with ADLs and personal care needs definitely within your scope of practice. Instead of feeling insulted, try looking at what you get out of it. How they pay you is another story. You are required to act to the level of your training and education. They should be paying you for what you know, not what you do.

jhanes · Mar 14, 2012

We have new administration in our agency and they are making the nurses pick up the overflow from the HHA's. Does any other agency do this? I question whether they can make us assume the role of another discipline. I have worked for this agency for 3 years and have never had to do this.

I have worked for numerous Home Health Agencies and a couple have asked me to do HHA visits in an emergency, but at my regular hourly rate. I did it to help out an employer that I liked. I would not consent to do the visits at a HHA rate unless I was absolutely desperate or if it was a charity case, would result in a HUGE favor in return, etc. As a Director, I sometimes have to use a nurse for an Aide visit or a shift, and I pay them their regular hourly rate. Because nurses make so much more than Aides, it makes no sense to have the nurses do Aide visits. Your HH Executive needs to recruit/hire/train more Aides before he/she runs off the Professional Staff (and goes OOBiz)!

Wishinonastar, BSN · Mar 14, 2012

Pooped on or splashed on? No more likely than at a nursing visit. Caths, ostomies, etc. are routinely done by RNs, plus the decubiti that we go to dress and find a bit of a mess to clean first. Our aides wear plastic aprons for most things anyway. I have seen LPNs be required to do this but not RNs. Nothing surprises me these days. I agree that I might do it for my regular pay because work is work. But I would not like it if it happened on a regular basis. That is not only a poor use of resources but also a symptom of something bigger amiss within the agency.

jhanes · Mar 14, 2012

a famous man (andy capp) once said, "do a job once and it is a favor. do it twice and it becomes your job."

katern1 is right. i don't mind doing personal care if needed and do not consider it beneath me at all, since i started out as a nursing assistant years ago, but don't take advantage of nurses by making them take 7 sn visits a day and also do the hhaide visits. actually they can't take advantage of you unless you let them. one other aside on this issue: if the nurse is ft and doesn't have 40 hours worth of visits, then doing a few hhaide visits in order to help meet one's productivity can be a good thing for one's bank acct.

TexasDew · Mar 15, 2012

Regardless what "hat" the agency wants to assign you are a RN and therefore are expected by law to perform the job as a RN not a HHA. Tell the agency to pay you as in your contract or find somebody else. Your contract was (or should be) for a RN not a HHA. If they fire you file a grievance with the department of labor in your state. I am an RN and I tell them what I will do not vice versa...never had an issue finding a job and most of the time when the agency finds out you will buck the system they fade off in the yonder. Also if they pursue it talk to an attorney...especially if you hired in as a RN. You are not their property to pay more or less..visits are at a certain rate..period. If you are salaried then it depends on your contract...but this sounds like they are wanting to change your pay rate.

Owloveyou · Mar 22, 2012

I am so glad this topic came up in the email. I am the lone LPN at the HHA. We have at this time ONE staff RN and ONE LPN doing visits. They can't seem to keep anyone. The two of us have been there over three years, besides us, they can keep a nurse more then a month. Kind of tells you what crap we put up with, literally. So, when our FT aide went on vacation they'd use one from another office, and have me fill in one or two while she was gone. This was ok, but I would have liked to be asked if i'd do it. So, they fire the FT HHA and use an aide from another agency. When the borrowed help was on vacation, I did the weeks worth of aide visits. Ok, so this was a rough week, and thanks again for not asking me if I'd be willing to do it. Then we had about 15 or so HHA visits a week. The "borrowed" help soon would no longer help because she wasn't being appreciated. So, guess who now has ALL of the aide visits! They tell me, "Do you know anyone that could help?" No, unfortunately I don't, so one would assume they'd go posting ads, since they pay me the LPN salary for HHA work. The HHA job is no joke, it doesn't take a lot of education, but it takes a LOT of core strength and more patience then i've got. I haven't seen ONE ad for this job anywhere that I should so this leads me to think that no one is going to apply if they don't know its open! It's been two weeks that i've been doing aide visit and nursing visits. The aide visit take me MUCH longer to complete then the SN visit, so in essence i'm getting paid less because i'm not able to do as many visits in the day. Then, I go to my aide visit today and the wife is standing in the driveway, waving at me with her sunglasses on and keys in hand. I get out and she yells, "everything is out for you, i'm going to get my oil changed, I won't be back just let yourself out." Ok, so I do this, walk inside and find my bed bound patient COVERED in BM. It was very obvious it was old b.m. i've worked in the nursing home long enough to know the difference between fresh, and hours old. So, she likely let him stay in it, knowing that I would be coming this morning. Add 15 more minutes to an already hour long visit. This just pushed me over the edge. I already have a hard enough time telling people "NO I am just the aide today, I can't change that nasty bandage that obviously needs to be changed, let me call the office to see if a nurse is available." Then, I have to refuse to answer any other questions, like medication related questions. Of course, I find things likely only nurses would notice, which then causes me to have to call the office to call the MD, because i'm just the 'aide' I can't assess things like increased edema while i'm there, cause I can't take orders as a HHA! Sorry this is long, and i'm ranting because i'm coming off a 10.5 hour day of 4 aide visit and 4 sn visits. I called our HR department twice today because I want to know if I can be TOLD to be the HHA, because that wasn't the job that I applied for and I don't remember it being on my list of responsibilities that I signed when I was hired.

caliotter3 · Mar 23, 2012

Well, I guess you can expect what my response is going to be. I would drop daily, if not more, hints at your agency and I also would seriously consider whether staying with this agency is what you want to do for the long haul. Maybe a job search for yourself is in order. Good luck.