Burnt out on HH after 6 months

twokidsmom,rn · Oct 12, 2011

I know exactly how you feel. I was seeing 40pts a week and working every weekend all summer. I found a company that promised me 6visits a day. So I changed companies. BUT I am going back to the other company.

The new company is also a hospice and when your on call one night a week you can be called to hospice pt anywhere and any time and when your oncall one weekend every 7 weeks the same thing.

Also they have you leave report and you have to depend on the other nurses that see your pts to leave you report. I am a case manager and have to decide to DC pts that I have never seen? My old company hired 3 nurses after I left. My old boss called me and asked me if I wanted to come back if not she would give my territory to someone else. I decided to go back as long as we will have help. So I do not have an answer for you. The grass is not always greener. Good luck on your decision.

caliotter3 · Oct 12, 2011

Do they guarantee not to cut your wages for the next five years or to lay you off? If you are overworked with no relief in sight, I would just start looking for something else.

KateRN1 · Oct 13, 2011

Just when you think things in home care are settled, they change. For an idea of why salaries are frozen, take a look at the newspaper. Republicans want to privatize Medicare, or at the very least make major cuts and add copays for home care. They want solid evidence that home care is a better option than hospital or SNF care and we're not doing a very good job of giving them that, as a whole. Home care agencies have received cuts in Medicare reimbursement the last two years, some areas as much as 12%, and I think maybe more. Agencies are being asked to do more with less reimbursement. Hospitals and SNFs are sending patients home sicker with fewer resources, home care agencies are trying to pick up the slack, and nurses in all areas are being overworked and underpaid. I don't know that the hospital environment would be much better, but I haven't set foot in a hospital in years. I'd rather stick with home health because I see the baby boomers coming. The home infusion benefit is being looked at seriously (finally!) and we may see more home infusion patients with drug coverage rather than all IV abx going to the SNFs and rehabs.

Home health care nurses and agencies need to become OASIS and outcomes experts to survive in this environment. Nurses can't be lazy and expect someone else to cover their keesters, and agencies can't afford to let sloppy documentation slide. Time management and organization will be more important than ever for field nurses as well as agencies. Efficiency is the key for everyone.

momsnurse1 · Oct 15, 2011

Kate,

I agree with you that the world of home care is changing rapidly but the thing that keeps bothering me is the types of patients that are being brought onto home care services. People with transient diagnosises that are usually one time and not recurrent such as UTI, pneumonia w/o other comorbities, are provided with services, same as end stage diagnosises because they fit the "homebound" status. However, people that can really use our services, new diabetics, new CHF, new COPD, wounds that patient may not be able to care for themselves are denied services because they are not homebound at time of diagnosis. By denying the patients that are truly in need of education and support aren't we just taxing an already overtaxed system? I recently wrote a paper for one of my classes that that stated "We send the dying to their grave with all of the knowledge about their disease and no time to use it while giving those that can use the knowledge no time." If the purpose of home care is to be pro-active and preventitive and to prevent rehospitilization, we as a system are not focusing our energies in the right places. I believe this is why the home care system is failing so quickly, right message, wrong audience.

skater95374 · Oct 15, 2011

I started out as a nurse in home health. I worked as an RN Case Manager. The work load was hideous! It was nothing for myself and other case managers to work 60+ hours each week. However, I liked the work better than the hospital environment but I am just burned out with it right now. I'm looking at other options. I'm having difficulty finding work but I do have the option of trying out correctional nursing for a temp agency. I'm completing the final paperwork this week. Am I crazy?!

ariane69 · Oct 16, 2011

any input for new lvn who wants to get into hm health? :nurse:

skater95374 · Oct 16, 2011

Ariane,

Congrats on becoming an LVN!!! If home health is what you feel you would enjoy, go for it! In my opinion, you don't need hospital experience to be a home health nurse. As long as you understand the basic principles of nursing and can take vital signs accurately and assess the situation at hand, you will be just fine. I was an intern at a hospital for a year and worked med surg for 3 mos before taking a position in home health and was SO glad I left the hospital!!! (I hate bedside nursing, I like my patients to be mostly ambulatory.)

I did have some acute situations in which I had to call 911. They were usually respiratory issues or BP going downhill due to sepsis. All together in the last year and a half, there was maybe 10 - 15 times I had to call 911. I felt home health gave me more time to get better at my assessment skills and not be rushed like it is when you are in the hospital. When a new grad is trying to learn, they don't need to be bothered with the high demands of being on a busy med surg floor. (Maybe it's my perfectionist attitude and when I am learning, I don't need to feel pressured or hurried or having to multi task. Guess I'm not very good at learning and working at the same time. Good thing I wasn't in ER! LOL) I saw home health as an extension to my training in school because you are basically working on one patient at a time. You don't (usually) have 10 people talking to you at the same time.

I was warned when I started home health that I should have hospital bedside experience first. However, I went with my gut instinct, chose home health and it felt right for me. The reason I feel it is okay for new nurses to do home health is because most of the time you are really not dealing with acute situations. That leaves more time to assess the situation and contact others for their expertise. And as an LVN, I'm sure you had a lot of hands on training, so you must have some experience which will help you. :nurse:

All I can say is go with what your heart is telling you and you will never be wrong. When I went with what other people were telling me, I felt like I really was messing up. Everyone said to do med surg first. When I worked med surg, I dreaded going to work. I hated it. I didn't feel comfortable because there were too many acute situations and there was still so much I didn't know or was familiar with although I was an A student in school. Actually, now that I do have some experience under my belt, I would feel comfortable going to work on a med surg floor. LOL. Guess that's a first! But leave it to me, I tend to do everything against the grain anyway.

How do you feel inside about your skills and what is your heart telling you?

Hope this helps. Good luck, I wish you the best!

KateRN1 · Oct 17, 2011

If the purpose of home care is to be pro-active and preventitive and to prevent rehospitilization, we as a system are not focusing our energies in the right places. I believe this is why the home care system is failing so quickly, right message, wrong audience.

The purpose of home care is, and always has been, to assist patients and families with getting through the acute phase of an illness or the acute exacerbation of a chronic illness. It has never been a preventive service, other than trying to prevent rehospitalization in the subacute phase.

If you look at UTI and PNA as "one time illnesses," then you are missing the boat. The havoc that a UTI can wreak is unbelievable, especially when you realize that some simple teaching will go a looooooong way to preventing recurrence. Ditto PNA. Teaching some good pulmonary hygiene habits can prevent another bout of PNA later on.

I have no issue with patients being required to be homebound, never have. Patients who are not homebound are capable of receiving their healthcare services at a clinic or physician's office, why would they need to have those services come to their home when they are perfectly capable of going to those services? There are classes and rehabs for every chronic illness under the sun and patients who can access them, should. I have a chronic illness. Should I receive home care services for teaching about my condition, despite the fact that I can easily get to and from my doctor's office? Home care is for patients who are essentially confined to the home for a reason.

Really, I don't see home care "failing." We are facing the same issues that we have faced since the Ladies Benevolent

Society first began home visiting services in the US: who deserves, who gets care, who pays for the care, and what about the chronics? The players are different, the scene looks different, but it's really the same theater that it has always been.

Ariane, congrats on your graduation/licensure. I would recommend a solid foundation in nursing before beginning in home health care. SNF or sub-acute experience will prepare you very well for the kinds of situations you will find yourself in with home health care if you're looking to do intermittent visits. A new grad can do well with shift work, learning the basics with a stable patient who requires nursing interventions at home. I never recommend home care to a new grad as it is extremely overwhelming for experienced nurses, to throw a new grad into (intermittent visit) home care is to do him/her a disservice. Best of luck to you.

Isabelle49 · Oct 17, 2011

My salary in HH hasn't changed in 9 years, except to be reduced.

KateRN1 · Oct 17, 2011

If you want to increase your salary in home care, increase your value. Pursue education on your own, become intimately familiar with Medicare rules and CMS guidance, become a COS-C or HCS-D or both, attend seminars, join the Home Healthcare Nurses Association, join your state nurses association, ask for more training in specialty areas like cardiac or pulmonary rehab, show that you are a team player by asking for more in-office training or participating in committees if your agency has them, offer to do chart audits and then utilize that information to improve your own practice. It's not always about skills, although skills are very important. In home care, quite often your knowledge and your ability/willingness to transfer it to others is what matters most.

mommy1975 · Oct 24, 2011

Your story sounds painfully familiar. I too, have been a HH Case Manager for 6 months and am burnt out. For me, the problem is more the Management of the Agency (or the lack thereof). They figured out I could do a really good job with a normal case load, so why not keep adding and adding my load until I do a job that they feel is good enough to get by. However, I am very uncomfortable the patient load.

I too, love Home Health nursing, and would like to stay in it. I just left the agency that overloaded me, and moved on to another, and things have been going great.

I also work agency on the weekends sometimes to keep up my bedside skills. This has helped me to appreciate certain facets of both kinds of nursing. And, at any time, I could go back to bedside nursing if I wanted.

However, I feel the management can make or break any job-and the economy effects every aspect of health care, SO-I say, look for a different HH agency, or a different ROLE in a HH agency.

Good Luck!!