Burnout in HH

[1999nurse]

I started home health case mangement last year, in December.  I am so burn out that I am quitting.  they want me to stay part time or PRN and say I'm doing great, but I am so tired, stressed, and feel so over worked I think I want nothing more to do with this company.   

Is this normal?   We have no social worker, so I do that stuff.  I do my own SOC's, ROC's, recerts, plus routine visits.  Also, all the "CM" stuff, phone calls, doctor's (who don't return calls).  Med recs are a joke when doctors don't call back, or won't until they see a patient.  I drive about 100 miles a day because I cover 3 different territories for our company.   I am salary, and when I missed a day lost pay.  To keep up I had to chart every night and all weekend.  The last weekend I worked on call, I had 3 scheuled SOC's, and a ROC.  She moved the evals so I could chart on Sunday.  Monday I had 2 more SOC and and eval, and drove 125 miles.  I also almost drove into a tornado.  No warnings about storms in the area were given out.  Our admin said she was "too busy" that day.  (if you aren't from the midwest, by the time you hear a siren there is a tornado on the ground). My husband helped redirect where I needed to drive.  I could see it from where I was.  

I am tired of either working 70-80 hours a week, or being totally behind.  things get missed or not done because I cannot handle a caseload that was up to 28.  No matter how many starts there are, I still have a full visit load daily.  If a visit cancels, they want us to call and see someone else's patient, or move another to that day so they can add more later to mine.  I'm being taught by another RN who says to just move missed visits so they can't overload you later in the week.  Why should we have to do this???  

Also, and more seriously, I found orders put in with my name on them.  That I did not take.   I may report this to the BON.   this is more serious.  

I have a job to do private duty.  I did this 20 years ago, and some how the pay is the same.  I am sick of hospital work after 22 years.  I am frustrated at how nurses are treated and overworked.  Other industries don't overload a new employee for over a year until they get better at it.  I did 17 years in labor and delivery.   I know how to manage time and multi-task, and I've always been good at documentation.   I can't work somewhere I don't feel like I can do a good job.   

I see my clinical manager work every night for a couple hours, and do scheduling every Sunday.  I am not working anywhere I need to do nothing but sleep and work.   I am too old for this.  I lasted 3 months.  I had many talks with the manager in the office that I can't work all day (8-6), and then chart every night and every weekend.  And take call at least 5 weeknights a month and 2 weekend days every month.  And the weekend call is almost guaranteed SOC's.  like 2-4.   

I wish I had started with a different agency.  I don't mind some driving and enjoyed my in home visits.  The rest of this has been ridiculous.  I'm starting to make myself physically ill from all the stress.  

[caliotter3]

There are too many deal breakers all added together in your post to justify quitting this job.  If they couldn't see hiring at least one other person to share the burden with you then too bad for them.  I would definitely not stay PRN with them, or part-time.  Frankly, I might want to forget even putting them on my resume, thus causing more PTSD symptoms.

[amoLucia]

(((delivern)))

I'm agreeing with you that you're being taken advantage of. I don't believe that it is being done maliciously, but with today's health care climate (ie doing more with less) everybody's being dumped on.

Can you just resign & move on? Maybe hold on & begin a new job search? Your health & mental wellbeing has to take precedence. You comment that you've tried to discuss things with your management. Things don't look like they're about to change, so the next decision is up to you.

Maybe try that PVT duty position. It can buy you more time, or you may just enjoy it better.

Whichever way you go, take care of yourself. And good luck.

[TheReluctantRN]

I've been working home health several years now, I'm a certified Oasis Medicare nurse.  I've worked at several different agencies and I feel like to be successful at any of them, you have to set boundaries as to what you want or will accept for work/hours, etc. They won't always honor your wishes and sometimes you will be labeled as difficult, but seriously-- we are not robots and we can only handle so much.  Your recovery is important and you need to have that time to be a good home health clinician or nurse in any setting.  Home Health has some good qualities like setting your own schedule (mostly) and not being stuck indoors for 8-12 hours a day.  But there are many downsides as well.  

 One of the biggest, that I seriously question the legality of it, is the on call rotation at most of these home health agencies.  I question whether asking a clinician to work 40 hour weeks and being on call for the entire week they are working is even legal.  I'm going to look into it more, because I have never had many on call situations where I was working practically two weeks straight for a lousy extra $50 or $25 a day and was being called all day and night and was hardly able to sleep because of having to see patients all hours of the night an hour away, which means a two hour drive.  I have had many nights where I am completely sleepless working all the next day and then again.  Home health can be tough.   

[1999nurse]

I wondered about that as well. In other areas of nursing it can’t be done,  it I didn’t know if that was hospital policy, or legal.   Years ago I did private duty, and I know we always said it was illegal to work 24 hours straight.  I once had the nurse to follow me unable to make it.  I remember “timing out” and sleeping 4 hours at my clients house, and then going back on the clock.  
it can’t be the safest thing for anyone involved.  

[caliotter3]

In my state at least, there is a labor law/regulation that limits the number of consecutive hours worked straight or with a limited "down time" between the end/start of two work periods.  Believe the latter is called a split shift.  Just like screwing workers out of overtime, I am certain the agency employers have figured out how to massage the system to make it look like it is "legal". I just don't see the on-call baloney.  Hire someone to be on-call as their "shift", and let the fully employed day nurses get their rest. 

[DallasRN]

Go!  Leave!  And as they say, don't let the door hit you... ?

Seriously, I admire you for hanging in there as long as you have. Sitting here thinking - driving 100 miles a day at avg. 40 mph would mean about 2.5 hours of driving time alone.  

I did home health with a a few different agencies in my area.  I really tried hard.  I wanted to enjoy it.

Altogether, lasted about a year and ended up hating about 364 days of it.  Ran myself ragged, never felt like I was doing a decent job. So much needed to be done for the (mainly) senior population but no time to do it.  Once I was out of THAT home and on to the NEXT home all thoughts of the PREVIOUS home would leave my head.  Felt like I was a rat on a wheel going round and round but going nowhere.  The time spent on documentation is absurd!  Twice as much time documenting as is spent on patient care. Admin doesn't care.  Sadly, I found the companies (those I was familiar with but others per friends) really did not care a bit about the staff or patients.  They simply wanted to line their own pockets.

Some people love home health and have different and positive experiences.  I didn't.  My personal time, my home life, my R&R, is important.  And professionally, my ability to provide good (at the minimum) patient care is crucial.  I didn't find that in home health. I now work part time (but I'm old, too! ?) at a small non-profit agency for seniors, make far less money than I did in HH, have 100% supportive co-workers, no call, no weekends, get lots of respect from staff and our clients, have a great personal life & time to do things I enjoy.  Not everyone can afford the huge paycut I took (nor could I prior to my Soc Sec), but if you can find something - anything - you can survive on, enjoy and makes you feel valued it's worth it.  Good luck! 

[1999nurse]

I did leave.   Thanks for the validation, if nothing else.  I'm glad I am at a point that I can take a job paying a whole lot less, that hopefully will be a lot less stress.  

[amoLucia]

OP - good for you. And good luck as you move forward.

[guest1143647]

I am torn. I thought HH visits would be less stressful than PDN but boy was I wrong!

I am only a month into HH visits and want to quit. What do I do?

I have the gut feeling it is not for me,but it has only been a month.

On one hand,the pay is great. The benefits are excellent! HH skilled vists stressful though. I also think about PDN. and how I had not gotten a raise since 2008,and paying $600  monthly for health  benefits. Of course,this makes my decision more difficult. 

 

[amoLucia]

Runsoncoffee - you prob have NOT yet found your 'groove'. It takes time to acclimate to any new job. You're still prob experiencing separation & loss from your old job.

Personally, I never would think HH to be easier than PDN. Both have posives AND negatives. I guess that it all depends on how good is the employer.

[TriciaJ, RN]

On 4/1/2021 at 8:43 AM, delivern said:

I did leave.   Thanks for the validation, if nothing else.  I'm glad I am at a point that I can take a job paying a whole lot less, that hopefully will be a lot less stress.  

Are you sure it's paying a lot less?  You said your HH job was salaried.  Did you ever do the math to see exactly what you were making per hour?  At this rate you could pick up some PRN work for extra money and still be way better off than you were before.

I'm glad you got out of there.