Burnout?

Hi Lenora. I think you are seeing the effects of change or more aptly industrial chaos on home health care. This, I believe, is unprecedented. Don't apologize for the length of your post. I rarely express myself in one paragraph or less.

I'm frustrated by not being able to provide the quality attention to my clients as I've been able to do for so many years. Until approximately four years ago when OPPS hit, I was able to sit down and learn not only the how of my client/family but the why, when, who, what, and how much. HHC is supposed to be set up as the most personalized care that a person can receive. Yet, we have been inundated with a heap of federal government rules and regs that have put a greater wedge between us and our clients. Yes, there has been waste in HHC like the hospital, but to impact it to the point where alert, oriented people are forced to go to NH because they have no other means of support is tragic. I don't know if HHC will recover from OPPS and oasis. From what I've read, anything dealing with the overall management of a condition or disease is going to community or population-based management. HHC is no longer considered cost effective for the masses of people who need short term or even long term support in a home environment. The mentality today is to herd everyone together in an outpatient facility and throw information at them. So much for individual attention and instruction. Home health is considered part of the medical model of health/medical care. Somehow, the home health industry needs to find a way to make a clean break with the one-dimensional, domineering medical model so that HHC workers can actually have a chance to help stabilize those with illness and conditions as well as help those at risk.

I'm with you, as long as I'm doing trench nursing, I'd rather do it in the home or on someone's job. I'm going to give OPPS a little more time to see if, in fact, it's leading us down that slippery slope as in the hospital setting. If I don't start seeing any light at the end of the tunnel, I'll have to decide if I want to stay in patient care.

Hi LenoraRN, Many Home Health agencies, have incorporated oasis into there own assessment forms and computer forms, for instance where I work the OASIS assessment is 16 pages long, also include ER plan, payment agreement, med profile,standing orders, carepaths,485, directions, significant clinical findings, HHA care plan and coordination of service with whatever therapies, were talking 20 or more papers to fill out, 2 hours in home and 2 hours out at office just to get all that together, its unreal! Now the problem isn't doing it, its not getting paid to do it, $40.00 for an admit where I work, thats $10 an hour, no thanks, Even contigent nurses won't do admits because "Its not worth my time" to quote a few, I agree that home care can be the most fufilling place to work for a nurse, but the fact is you are never done. Its a 24/7 job, even when your on vacation, you get called about a patient! OASIS Maybe isn't a big deal to those who are paid hourly, and or salary, if they don't force you to work overtime without compensation, but where I work, the full time nurses work 10-12 hours a day, just to make a fair living, and every other weekend. I have heard of some great Home Health agencies to work for, but I think they went out of business, last year.

Originally posted by LenoraRN:

In reading some of your posts, I feel as if the majority of the home health nurses posting are experiencing burnout. Now, I'll probably get a ton of back-lashing for saying that, but I can take it...*S*

Why does it take hours to do an OASIS assessment? It generally takes me around an hour, hour and a half max to do an admission start of care, including OASIS. For the most part, it's just a check box; how long could that take? I'll bet the majority of you have computerized systems...the agency where I work is not, which makes it that much more time consuming. However, I still find that I'm not spending a lot of time on the paperwork. Is it redundant? You betcha...a hell of a lot of redundancy. Is it a pain in the bahonkas? Yep, sure is. Does the government know what they're doing? Probably not, but eventually it'll more than likely go back to the way it was, or change again. That's the good and bad of home health...if you don't like change, you won't like home health, because it is changing from day to day, week to week, etc.

I was an ER nurse for over 5 years before I went into home health and worked as a home health nurse for 5 years before moving to a different area. I went back to work in a hospital, in the ER, and finally found a position as the clinical nurse supervisor for the agency I work for. I didn't know how good I had it until I went back into the hospital setting! Working long hours, having patients yell at you b/c the wait is so long, having people stand over you, telling you that what you're doing isn't the right way....nope, wouldn't want to leave home health ever again, unless I was burn out....and I ain't there yet.

Sorry, didn't mean to make this so long...

Mijourney,

I wholeheartedly agree with you. We, as nurses, need to unite together to get something done about all the bureaucracy there is today in healthcare. I witnessed it in the hospital, doing med/surg, when I had so much paperwork, I didn't have time to spend w/the patient. Now it's almost the same in home care. And you're right...I remember a time in HHC where, when the patient came out of the hospital, you saw them daily for 21 days then 3 times/week. If they were hospitalized w/in that time, when they were discharged, you saw them at the same frequency. Not so anymore...you're lucky to be able to see them once a week, and all b/c the government is trying to cut spending w/home health, when if they truly stop and think about it, it will save them money in the long haul, as HHC is ultimately less expensive than nursing homes, ALF, rest homes or retirement centers. I realize that they're trying to put the spending back to the states-so that M'Caid will pay instead of M'Care...but I have seen so many elderly get cheated out of their retirement, having to spend it on a spouse, who is in a facility, just so when the money is all gone, they can go on M'Caid. What's the use in having a retirement fund, when you're not going to be able to enjoy it in the long haul?

I'm off my soap-box now...lol.

Northnurse,

I understand your frustration...at the agency I work for, they decreased the amount of paperwork for the admission. We have an admission booklet that has the information about the agency, safety etc in it. Then we have a secondary payor form, an indigent form, consent form, all the advanced directives stuff, and then the OASIS and 485 information. Our 485/OASIS is incorporated together---it's 20 pages long. And like I said, it takes me about an hour to an hour and a half in the home, then another hour in the office to do. I would suggest talking to the big honchos to see if you could incorporate some of the papers/info together to lessen the paperwork. I agree wholeheartedly with you that the pay for the amount of paperwork is terrible, but then, you have to consider...is the stress level, hours, etc of more benefit than working in a hospital environment? Just something to think about...*S*

I appreciate the great discussion, y'all!!

To LenoraRN and others, I have been in home care for the last 11 years and seen the paperwork multiply like rabbits, I also see the nurses notes that sometimes come from referring hospitals, and quite frankly, most of them are checkoff notes, not much of anything written, even the admissions are checkoffs and 1 page to boot, I am seriously considering a position change to a major medical ICU/CVU, and would like some input of paperwork in these units, I do believe most of the insurance and orders are all done by clerks or unit secretaries, a little information regarding would be appreciated. Thanks NN

Originally posted by LenoraRN:

Mijourney,

I wholeheartedly agree with you. We, as nurses, need to unite together to get something done about all the bureaucracy there is today in healthcare. I witnessed it in the hospital, doing med/surg, when I had so much paperwork, I didn't have time to spend w/the patient. Now it's almost the same in home care. And you're right...I remember a time in HHC where, when the patient came out of the hospital, you saw them daily for 21 days then 3 times/week. If they were hospitalized w/in that time, when they were discharged, you saw them at the same frequency. Not so anymore...you're lucky to be able to see them once a week, and all b/c the government is trying to cut spending w/home health, when if they truly stop and think about it, it will save them money in the long haul, as HHC is ultimately less expensive than nursing homes, ALF, rest homes or retirement centers. I realize that they're trying to put the spending back to the states-so that M'Caid will pay instead of M'Care...but I have seen so many elderly get cheated out of their retirement, having to spend it on a spouse, who is in a facility, just so when the money is all gone, they can go on M'Caid. What's the use in having a retirement fund, when you're not going to be able to enjoy it in the long haul?

I'm off my soap-box now...lol.

Northnurse,

I understand your frustration...at the agency I work for, they decreased the amount of paperwork for the admission. We have an admission booklet that has the information about the agency, safety etc in it. Then we have a secondary payor form, an indigent form, consent form, all the advanced directives stuff, and then the OASIS and 485 information. Our 485/OASIS is incorporated together---it's 20 pages long. And like I said, it takes me about an hour to an hour and a half in the home, then another hour in the office to do. I would suggest talking to the big honchos to see if you could incorporate some of the papers/info together to lessen the paperwork. I agree wholeheartedly with you that the pay for the amount of paperwork is terrible, but then, you have to consider...is the stress level, hours, etc of more benefit than working in a hospital environment? Just something to think about...*S*

I appreciate the great discussion, y'all!!

Hi. I agree with everyone's responses. My employer is reviewing our paperwork for adjustments.

After reading topics from hospital nurses, I don't think I want to revisit that arena. They may not have the paperwork volume, but they don't get to provide the care that the patient needs either. The pay that they receive is inadequate for the herculean efforts that most of them are required to make in patient care. I came into HHC years ago to be able to have more one on one with my clients/families. I have received, over and over again, patients from the hospital setting that I had to either do intensive work with to keep them out of the hospital or send back to the hospital because they were simply not appropriate for the home setting.

Even though it's slipping away, HHC nurses still have more autonomy than those in a hospital setting. That's one of the things I liked about home care coming in. Now, I have to decide if the industrial chaos in patient care is worth suffering through for the client/patients's sake. With the large boomer population (which includes me) beginning to retire, I don't think that chaos will be short term. The thought of going part time or going agency is sounding good about now.

Hi Mijourney, Does your agency use a point system for productivity, I just recieved a copy today of the plan that my agency is implementing with a salary model, frankly, I am appalled with it, the more hours you work the less points you get, I can't believe that nurses in other agencies would put up with this blatant attempt to prevent overtime pay. It's really quite disgusting the ways they continue to try to not pay nurses for what they do. And if you can believe this, a memo said they want us to do our paperwork in our cars in the patients driveway as much as we can. So as not to give more points and overpay us for doing paperwork at the office, YES its true! I for one am not sticking around to find out how they will "Tweak it" for our needs as one manager told me. I think I would rather do 3 12's and be done in the hospital, then put up with this disrespect anymore. NN

Originally posted by Mijourney:

Hi. I agree with everyone's responses. My employer is reviewing our paperwork for adjustments.

After reading topics from hospital nurses, I don't think I want to revisit that arena. They may not have the paperwork volume, but they don't get to provide the care that the patient needs either. The pay that they receive is inadequate for the herculean efforts that most of them are required to make in patient care. I came into HHC years ago to be able to have more one on one with my clients/families. I have received, over and over again, patients from the hospital setting that I had to either do intensive work with to keep them out of the hospital or send back to the hospital because they were simply not appropriate for the home setting.

Even though it's slipping away, HHC nurses still have more autonomy than those in a hospital setting. That's one of the things I liked about home care coming in. Now, I have to decide if the industrial chaos in patient care is worth suffering through for the client/patients's sake. With the large boomer population (which includes me) beginning to retire, I don't think that chaos will be short term. The thought of going part time or going agency is sounding good about now.

In regards to paperwork, it is a curse we will never be rid of, neither in the hospital or in home health. At our agency, we as staff RN's got together and "requested" that the Supervisor ride with us on a typical day with at least 1 admit + 6-7 visits. They were also "requested" to do the paperwork. Imagine what happened! Those supervisors who hadn't done patient care or field work for a while very quickly found out how much work is needed to climb the peperwork mountain. It is easy to say the p/w burden is easy when the supervisor sees only the individual forms one at a time. The realityof doing it all, plus getting, like others, only $40 for it was a wake-up for many of the supervisors. I now am a supervisor myself in a small agency. We adopted a paperwork reduction plan that consolodated as many forms as possible, and made as many forms into checkoffs as possible. Our recent State surveys were both outstanding, so it can work. My Nurses aren't as overwhelmed either. Doing p/w in the driveway of a client's home is not new, but not allowing time at the office is a MISTAKE!