Calling all HH Nurses, roll call

[hoolahan]

Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field.

I have been a nurse 20 years, 17 in critical care, mostly cardiac critical care, and the last 2.5 years in HH, or asthma disease management , which I also had to leave because I hated to be in a cube farm all day.

I still love HH, even though PPS is the pits, even though the OASIS would make good kindling for a massive bonfire, and even with all the rest of the paperwork, it is the most rewarding nursing I have ever done!!

PS, I went back to my former VNA who is now paying $30/hr, yes, you read that right, to work 3 out of 4 weekends. Since weekends work well for me, it's a good deal.

Let's hear from all the HH nurses out there. Out of all those registered members, there's got to be plenty of us on this BB!!

[heather.ccrn74]

HI Everyone. I am new to this forum and the allnurses.com site. I need your advice. I have been a critical care nurse (ICU/ED and flight nursing) for over 15 years now and a medic before that. I have seen/heard/done things in my career that have really taxed my morals and ethics as a health provider. I LOVE being able to make a difference in a patient's life and help them in a time of need. But, working in academic healthcare facilities, where cutting edge technology and "evidenced based practice" are the key terms...I believe my poor patients have become nothing more than science projects. What recently drew the line for me was listening to an older couple sob over their adult child that was dying in the ICU (where he had been on life support for months). The parents cashed in their retirement, sold their house and everything they owned to be closer to him and to provide the top notch care that medicine could provide. This patient was in full organ failure from the day he entered our ICU. With numerous ethics consults later, we still had him attached to EVERY life saving measure we could provide. (because the family relied HEAVILY on the physicians telling them he would get better) All of the nursing staff were becoming emotionally exhausted taking care of this patient, because we ALL felt (except the physician) that we were delaying the inevitable. Well...months later, he finally passed away and the staff all knew it was God's wish. What hounded me for months after, why do this to families? This is just one example of the same theme I have witnessed over the years. What are we, as healthcare, trying to prove? Can't we accept that sometimes death IS a part of life and instead of "flogging" a patient to death, can't we provide care and comfort to that patient and family to help prepare them for the "other world.?"

Anyways...enough about my moral distress I am feeling...my question is this: I still want to be a nurse. I WANT to help patients, but I believe sometimes being HOME is the best place for patients to get better. I now have a family with small children and I don't want to work nights, every holiday and every other weekend any more. A friend told me to check out homecare and what I have researched, I find interesting!!! I would love to hear from any old ICU nurses who had reservations about making that leap from "critical care" to homecare. What led you to decide to go from critical care to homecare and how did you feel about making that decision??? I just need support to know that I am NOT alone in my moral distress!!! Many a shifts, I have come home crying "what are we doing?" and it has slowly taken pieces of my heart out questioning, "Am I REALLY HELPING these patients?" Because it feels alot like torture to me.

Thank you for all your support. I have lost my resiliance and hope that HH will help return my passion for my career!

[*bettie*]

I wish I had critical care experience like you. That will bring extra perks in home health infusion. Last week I was at a patients, walking out of the building and I saw a lady struggle to walk in. After a conversation, I determined she was not receiving care. Long story short, after a year of decline and depression she is now on the path to improved quality of life. We are working on a new place to live( that's the case manager, social services) on one level, physical therapy, nutrition and medication management. Now she has goals. She hasn't walked her dog in months. Hasn't been to church. Is it always or even usually like this? No, but it is nice when it is.

[twenty4seven]

To Heather.ccrn74, I have too been a cc nurse for about 7 out of my 14 years of nursing. My last was in burn ICU. Last March I had a pretty bad break to my arm (outside of work) and was concerned about going back to lifting heavy burn patients with 2 hour dressing changes. I do love CC, but also feel the same way you do.

While I was out on STD for my arm, I applied for a HH job. I was hired and started in June of last year.

I will start off by saying that as far as the patient care, I love it. I love all of my patients... Some have even become like family to me.

However, I don't know that I can keep on in this filed. I literally work ALL THE TIME...hence my username. At my yearly checkup yesterday my blood pressure was 170/110..... I have never had high blood pressure.

I fear that my health will continuously decline If I keep this up. I am so conflicted.... My patients really count on me, and I feel like I would be quitting them if I leave. Not sure what to do at this point.

[nurse.j., ASN, BSN, MSN]

Hi all! I just interviewed with a smaller HH company for a Case Manager/Field RN position. I originally was offered a job with Gentiva...but turned it down due to really bad reviews from people...but I don't know a lot about this smaller company other than it seems like they really have their stuff together, growing census and happy employees (have a friend who just started who says she loves it). I have never worked HH so the change would be huge from hospital nursing but I am ready for the change, learning curve and flexibility in schedule. The only thing I'm a little nervous about it the compensation. They start all new employees out on a PPV model basically to see what your productivity will be like and then after some time if you're up to their quotas you can switch to a salary + bonus pay scale should you choose. Do most newer HH nurses make ok pay? I'm worried it could take a little time for me to get to a place where I'm seeing 6+ patients/day and then I'm broke :/ other than that, the opportunity sounds amazing and I'm so ready to leave the call lights, juggling of 6+ patients all at one time, stress of 12+ hour physically and emotionally draining shifts in the hospital. And start making a DIFFERENCE in patients/family's lives (:

[Libby1987]

Hi all! I just interviewed with a smaller HH company for a Case Manager/Field RN position. I originally was offered a job with Gentiva...but turned it down due to really bad reviews from people...but I don't know a lot about this smaller company other than it seems like they really have their stuff together, growing census and happy employees (have a friend who just started who says she loves it). I have never worked HH so the change would be huge from hospital nursing but I am ready for the change, learning curve and flexibility in schedule. The only thing I'm a little nervous about it the compensation. They start all new employees out on a PPV model basically to see what your productivity will be like and then after some time if you're up to their quotas you can switch to a salary + bonus pay scale should you choose. Do most newer HH nurses make ok pay? I'm worried it could take a little time for me to get to a place where I'm seeing 6+ patients/day and then I'm broke :/ other than that, the opportunity sounds amazing and I'm so ready to leave the call lights, juggling of 6+ patients all at one time, stress of 12+ hour physically and emotionally draining shifts in the hospital. And start making a DIFFERENCE in patients/family's lives (:

Our new hires without hh experience are paid hourly for roughly 3 mos then go PPV. PPV when you're new just isn't reasonable.

[YogaloverRN]

Hi Nurse J,

I have been practicing as a HH Field Nurse for 7 years, started out Baylor which is really rough, cause you get everyone that could not or would not be seen during week, (gotta go to ends of county), and then part-time, and now PRN. I love home health patients, however, working in uncontrolled environment, and no increase in pay for 7 years, I am ready to change back to hospital. I really loved the opportunity to see one patient at a time and with a small company, I think you will love it too. Everyone needs a change from time to time, the only way to see is to make the change. I am keeping my prn status so....if hospital is too rough, I can ALWAYS go back. Just my 2 cents, good luck, have fun!! Oh and advice from one whose friend has been doing this a good while, "don't do salary"!

[nurse.j., ASN, BSN, MSN]

Hi Libby1987 & YogaLovaRN! Thanks for your reply. Yeah I believe its a base hourly + PPV once I'm on my own....they haven't offered me the job and given the numbers yet...but I'm certain it will be a pay cut at first and I'll have to.make sure its something I can afford. I'm just afraid it may take me a little to get used to things and be a really good to make that better money. But I'm excited for the change and my heart has been pulling me to HH for a little while now. My ride-along is Tuesday to make sure its what I will like and what I'll be really in for.

[Libby1987]

Hi Libby1987 & YogaLovaRN! Thanks for your reply. Yeah I believe its a base hourly + PPV once I'm on my own....they haven't offered me the job and given the numbers yet...but I'm certain it will be a pay cut at first and I'll have to.make sure its something I can afford. I'm just afraid it may take me a little to get used to things and be a really good to make that better money. But I'm excited for the change and my heart has been pulling me to HH for a little while now. My ride-along is Tuesday to make sure its what I will like and what I'll be really in for.

Here's a rough formula for how PPV will pan out..

If you're PPV and do utine revisits are paid at $60/visit, then you'll roughly be making $40/hr at the end of a good day. ie expect each revisit to take 1 1/2 hrs for visit, drive, calls and charting.

For an open/admit, you'll need to be paid $130/visit to work out to $40/hr as they take roughly 3 hrs of total time.

So 1 1/2 x hourly for revisits and and 3 x hourly for admits. And figures in the middle for high tech and Recerts/Resumes etc.

Makes sense?

That's all based on an experienced HH with good time mgmt who isn't tied up with questions re resources and protocols throughout the day. Amd not a crummy schedule sent all over the place.

Some mgrs can assign and adjust assignments to keep everyone in a territory with some overlap into their adjacent neighbors' territory, others just can't seem able to figure that out and make changes as new admits come in. I have run into someone coming way over in my outlying area to do an admit and then I get a call mid morning sending me up into their outlying area. A new mgr will need their staff to help them out on that while keeping in contact with each other to make sensible changes until the mgr gets better familiarized with the area and scheduling.

As a new HH nurse you will be dependent on your mgr and coworkers to maintain logistically sensible assignments which is essential when you're PPV.

[nurse.j., ASN, BSN, MSN]

Libby1987,

I'll post what sort of #'s they give me and have you guys let me know if I'm being low-balled or not. I know it can take some time to get good, but I feel like after I learn the ropes, I can be pretty efficient. I'll keep you posted! Thanks for your help and input!!!

[angiegirl30]

Libby1987,

I was looking at your numbers and they are amazing. I just started a HH position this week and they are paying me 37.50 per visit. I'm new to home health so I'm sure that had a little to do with it but I do have over 20 years critical care experience. I hope with experience I will get paid a little more. Is that something one asks for during their evaluations, do you know?

[nurse.j., ASN, BSN, MSN]

I've been working as a HH RN Case manager now since March and I am now salary + bonus if I go over my required 25 pts a week. When I was on PPV, it was $100 for an admit, $75 for recert/resumption of care, $60 for a discharge and $42 a reg visit. Are you sure that's not an hourly rate they are paying you? Because 37.50 a visit is really low. Where are you at? I'm in WA and I know Libby is CA.

[angiegirl30]

Yep, it's per visit. I double checked. There is no differentiation between admits, resets/ROC, discharge or a reg. visit. I'm in Ohio, by the way. I'm also not compensated for charting or driving time, or mileage. No holiday or weekend pay. But I'm supposed to be available for my patients 24/7. Only receive on call pay if it's my weekend in call, which makes no sense. We are to be available all the time!!? I'm just so confused by this pay system. I don't know if I'm being taken advantage of or if I just need to suck it up.