Burnt out and just getting started

[danarooo, BSN, RN]

I am a new SOC nurse, and new to HH. I am already feeling extremely burnt out. I spend my day driving around hunting patients who about half the time won't answer their phone, don't want me to come until afternoon or aren't home and we have to make 3 attempts before we can finally call their Doctor and say we can't get a hold of them/they aren't returning calls.

The driving isn't a big deal, the problem is that patients are hard to get a hold of and sometimes the information is bad or they end up being a duplication of services etc...there just seems to be a lot of problems getting my 2 to 3 SOC's a day. On top of this, I spend ALL my evening charting my SOCs - and there is so much duplication it's maddening. I have to have the patient sign twice in my computer but then sign a paper copy of the contract, then fill out multiple paper forms, then I have to send a report email to multiple people and part of the information from the patient packet received (and forwarded to all the people on the report email) I still have to type out in the report. It's tedious and frustrating.

My husband is getting very irritated which is unusual for him, he's usually really laid back. I spend zero time with him in the evening because I'm charting until bedtime, stressed out and don't have time to do basic things for myself such as go to the store to get snacks to put in my car!

How is anyone doing this day to day? I like the job, I HATE the unrealistic expectations and fact that I work hours and hours five days per week. I want a life, I want to be able to come home and RELAX, to de-compress and rejuvenate myself. I want to go to the gym, go to dinner with my husband or be able to run to the store. Is anyone doing start of care in HH able to have a life? Why is it so hard to find a good paying job that isn't made more stressful then it should be, full of drama or their is bad management who doesn't care if they work you into the ground?

[amoLucia]

I can't give you any answers to your questions, but you do have my support and best wishes. I know HH can be oh, so tough. It was tough for me eons ago in the days way back when we made home visits in caves! Paperwork was a killer then writing on papyrus with feather quills (boy, am I old!)!

I don't know how to tell you to be less conscientious or how to cut corners. Somehow others do it, but I never had any luck doing so.

Thank you for your concern & care for a tough population in a tough field.

[Libby1987]

I've been thinking about your situation. While I think 3 SOC for a newer nurse is not great practice I also think given your situation (read about the difficulties breaking into nursing) you might want to focus more on learning a solid nursing trade and worry less about work/life balance. Your husband could be more understanding that you are trying to build a career and you could reduce wearing your stress on your sleeve every night.

If you're not maintaining 2-3 SOC per day, then you shouldn't be charting into the night every night. Pull into a coffee shop and power thru the charting so you can give your relationship some attention. It may not be a lot but an hour of undivided attention may go a long way.

It takes a good year to get the hang of it, more to become proficient. I'd stick with it while trying to move into a case mgr position.

[amoLucia]

Have to ask - what's an SOC?

New admission?

[Libby1987]

Have to ask - what's an SOC?

New admission?

Yes, start of care.

[gibsongirl]

Get out and try someplace new. I work at a place similar to what you describing. I've been doing perdiem for 3 years because I can't do it full time. I take 4-6 points a day. I still have the problems. It does not change. It's likely a poorly managed company. Things that could increase your productivity are ignored. You'll read here that there are better options in home care. I am looking for better work-life balance myself. My husband is tired of sitting next to a mentally absent wife, documenting away!

[danarooo, BSN, RN]

Thank you all for the input, I really appreciate it. I feel that there is a combination of things happening. Some bad management, intake not gathering enough info for us -- I mean really --- taking a referral for a patient who doesn't have a pcp...come on! The report emails are total bs. Why the packet can't just be sent out to everyone and a note on the start visit would be fine but if other people can't click a link to open the start packet should they be caring for patients? I'd say no.

I'm getting bogged down in the minutia, and trying to get ALL the info before I turn over to case manager so I've got to stop that. I'm likely by far way more detailed then the other SOC nurses, but to me that is sorta scary. If someone were handing me a patient I'd never seen with major health issues it's would be nice to follow a thorough SOC nurse. I do need to pull over and power through more often. I think I could do this job and do it well but I'm sure having some serious growing pains right now trying to really learn the ins/outs.

I did have trouble initially after nursing school finding a job, however that was 4 years ago and I've done teaching to include taking patients into clinical in assisted living and special needs pediatrics with lots of serious and rare disorders/diseases, vents/trach's etc...so I'm fairly comfortable (with what I know of course) but I do have so much more to learn for sure. I like HH, and some day I'm looking forward to case managing - I think it will be good for me since I'm anal retentive and organized (for the most part).

You guys are all great and I love being able to come and sound off. I appreciate all your wisdom and advice. Lord help me I'm just trying to hang on for dear life at this point!!

[toomuchbaloney]

My primary recommendation is my most frequent recommendation; practice point of service documentation. Document on company time, not on your personal time.

I second what another poster said...drive to a local coffee shop and document as much as you can before the next visit.

Practice this, practice it some more, make it habit. You will not regret it.

[nutella, MSN, RN]

I think one of the problems is that pat often do not get D/C until afternoon. By the time they come home they are tired and often have "stuff" to do next morning. If any possible call the pat you will admit the day before and just tell them the time you will be coming out - Like "Hi , my name is xyz, you got discharged from the hospital and I will be at your house tomorrow at 10 am to admit you to nursing. Please have all medication bottles and discharge paperwork ready on the table for review". If you come in at 8 am and they hand you paperwork for same day admission it cane hard to get a hold of them, especially if they do not pick up or call back. I found that if I give a specific time on their voice mail they will call back if they are not at home more quickly because they do not want the nurse to just show up. I will basically say my name, agency and that I will be out at their house at xyz time, please have medication bottles and D/C paperwork available.

While I am sitting in the agency I try to get a medication list from the D/C paperwork and make little piles for each patient so I have everything ready when I am in the house.

If it is a late admission you may not be able to finish it all but put in VS, care plan, allergies and medications and finish next day.

Talk to your manager about it - if you have never done homelier it will take you much longer in the beginning. Make sure you always have everything you will need or may need in your back like paper measure tapes and flashlight.

When I admit an OASIS pat I know the dataset and try to structure the admission because a lot of patients get side tracked and go back and forth without answering the questions. If possible I have them sit down on the table with their medications and the list, go over the list and give them a bottle to read it to me and ask if they know what it is good for. That way I can assess vision and knowledge together.

When I do not admit for myself I outline the problems and plan for those in a structured fashion easily to read like this :

1.

2.

that way they can follow up on everything.

You are not expected to be perfect but it has to be a safe admission and all the paperwork that is legally needed needs to be signed.

The other thing - if you have to call the PCP office and are on hold and so on, waiting for a re-call..... I have a hands free set in my car and keep the admission info in a folder so that if I get called while on the way to the next pat I can take the call.

Working late at home charting will most likely not work out for you or your family. If you are working 8-4 pm planning needs to happen in a way that the first admission is seen at 10 or even earlier imo - the only way this happens is that when the information is run by the admission dpt they actually tell you that you have an admission for NEXT day so you can call one day ahead. Once people are used to that thy will most likely try to accommodate you.

[gibsongirl]

How frequently do you schedule visits?

[Curious1alwys, BSN, RN]

Why is it so hard to find a good paying job that isn't made more stressful then it should be, full of drama or their is bad management who doesn't care if they work you into the ground?

I am not in HH but am asking myself this same very question these days. And I was thinking about HH. Oh well.

I am sorry I have zero advice for you but my heart goes out to you. I'm still looking for the "right fit" too. HUGS!

[Curious1alwys, BSN, RN]

It may not be a lot but an hour of undivided attention may go a long way.

he-he I think I know what you mean by this! LOL:cheeky: