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!!

[renerian, BSN, RN]

Welcome Ro. I love home health. I just took a hospice job that is turning into a nightmare.....

renerian

[sjsap]

Hello Ruth- I too, started in home care just this past July, and love it. I work in the metrowest area, but have been sent into the Boston area towns for a few patients. I am finding it a wonderful job for the most part- the downside is the manager of the agency is so anxious to grow the business that she doesn't say no to any referrals- or get them screened properly. The upside is I am using all the skills I have acquired over nearly 30 years in the nursing business, from when I started as an aide through the last 20 as an Rn. I invested in a palm-type device to help me keep track of my appointments and information- is the program Healthwyse very hard to get used to? Did you have to buy your own Palm? Is the program available at any computer stores or is it something the agency has? All of the agency charting is on paper which I find very tedious. Enoy chatting with you!

[outbackannie]

Welcome Ro! I did Home Health for 8 years until Medicare came out with PPS which made all the agencies in my area close. I still like to keep in touch with the forum; however, as I am doing Parish Nursing which is very similar. I also work 2 days a week at the hospital here which helps keep me up to date on new things.

[magic]

Hi,

I'm new on this board but not new to home health. I have 9 years experience, took a 3 year break, now back again. Currently field staff. Having problems with "productivity". I can't believe with all my experience, I am not going to cut it. I do my assigned schedule but have too much unproductive time according to my supervisor. Not sure what I am going to do. I love doing the visits. I think I have a handle on OASIS and case management. Any ideas.

Magic

[RoAbreu]

Hi Ladies...

OutbackAnnie: Ooh, Parish Nursing. I have wondered about that, too, I got a nondenominational minister's ordination so that I could go in and do energy work like Reiki with people and have it be "off the clock" as far as nursing, and have been wondering how Parish Nursing works as far as counseling, support, etc.

SJSap: I'm working for HHVNA out of Lawrence, and they have contracted with HealthWyse so they provide the PALMs (they are HP Jornadas) and the support for the software, upgrades, etc. Since I started with one, I really have no comparison, but I am getting used to it and since I'm very used to Windows it's not hard to do, OASIS and everything is in there. There are bugs, but then I guess there are always bugs with Windows :-p HealthWyse is based out of Boston, I think, so they are probably in the book... and I'll bet they would love to talk to your agency if the boss is interested in that sort of thing.

Magic, I'm curious what your caseload is, and what is expected of you. I am new to home health, and I'm slowly building a caseload; they don't expect me to go too fast at first because I am green and learning the system and case management. The regulars run around seven a day, I think, which I hope I can get up to in a decent time parameter... I'm doing three to four now. Is there a lot of travel involved with your patients? If you're doing your assigned schedule I don't know why it would be a problem? Where are you working?

Renerian: so what's the nightmare with your hospice job? I have been curious about that, too, with my ministerial, hypnosis and energy work background, those seem better applied to palliative care than what I'm doing, though I'm liking hh fine. We have a hospice attached to our VNA and I was curious. Is this your first hospice job?

[renerian, BSN, RN]

Okay here is the scoop. I am in graduate school and have five kids. My new company expects me to do all visits, HR, QI, orientation of all staff, intake, all oncall, all night, holiday and weekend visits. They also want me to cover call for the parent agency which is 2 hours away. The want me to purchase all universal precautions equipment for staff. They have no supplies and will buy none and keep any in the agency for staff to use, they want me to pay for mandatory conferences(two so far which are over 700) and the UP equipment which is at 350. They told me I did not have time to watch the 15 orientation/training tapes to just take the 15 tests without watching the videos, I am expected to work 8 hours the next day even if I worked all night and of course I am salaried. Basically they want me to work like a dog and they said they expectation is 60 to 70 hours per week......

I just submitted my resignation...........oh and yes they told me I cannot have a copy of the medicare hospice regs nor can I have a policy or procedure manual for the office staff. I also have to do all consults, opens and revisits, death visits........the list goes on and on....

renerian

[RoAbreu]

Kudos for dropping them like a hot potato. They're trying to get you to do the work of six people and pay you for one. That is ridiculous. It seems like to me they are a liability suit waiting for a place to happen.

Who oversees hospices, JCAHO? Somebody needs to go poke their head in and check out their system. Their expectations are not only extreme but dangerous.

[LoisJean]

Hi and Welcome to all of you! Ro, you're a gal after my own heart! And, magic: what exactly is meant by "productivity"? Are they saying that you work too fast? Please help me understand.

Peace to all

Lois Jean

[sjsap]

I hate that word "productivity"!!!!!! I think your case load should be acuity-based instead of quota based. Some patients take more time and expertise than others- something I have noticed in the few months I have been out in the field. I wish there was a different way of handling the patient load so it wasn't so much like flat rate- or piece work. Plus, the different agencies all get a share in the referrals, I remember that as a staff nurse, I had a book of listed agencies for Massachusetts and I could pick and choose what agency to use for my patients. How did the "productivity" quotient come about? I can't believe a nurse designed the practice! I try hard to keep my name in the mind of the staff person who assigns cases to the field staff, and remind her when I am low for my census. Unfortunately, I am per diem, and they give the regular staff first dibbs on any referrals (as they should) and I get what is left of what others don't want to do because they involve a bit of traveling. I am thinking of signing up with a couple of agencies to keep the cash flow in the black in my checkbook, but I think I may need a couple of more weeks or a month to make sure I am able to organize a multiple boss workload. I have the problem where the paperwork consumes a lot of my afterwork time. How do you experienced nurses get it all done in a short period of time? I got a fax in my home so I could fax orders to MDs from here so I could be home for my kids, but when I am doing paperwork, the kids feel like I am not really home. Joanne

[sjsap]

Ruth, Thank you for the info about Healthwyse- my boss is so cheap I have a name tag done by a label maker, so I don't forsee her investing in a palm system! I love computer gadgets and I would have a great time using my PDA more for work- it is a Handspring Visor Pro- plenty of memory to handle those window based apps!

Renerian, I wish you all the best in what ever new position you get- it sounds like that hospice job would have you end up being a customer- haven't they heard of the law about 40 hour work weeks????? My boss also is the kind of employer who expects staff to be fully functional with no training- she only paid for 3 hours of orientation- but a seasoned staff nurse took me under her wing and has been helping me learn the job- I still screw up the paperwork and get called into the office to fix stuff- but I see it as a learning experience for not only me, but the boss as well! I told her I am very trainable, just need the training! regards to all, Joanne

[NRSKarenRN, BSN, RN]

Dropping in to welcome all newcommers! Appointed Manager of Central intake for my homecare agency and in charge of straingtening out info in new $5million computer system...intake does all front end loading of info with ONLY 8 hr orientation.

As usual...learn as you go.

Wuill sporadically posting over next week asshould be straigtend out by then.

[NRSKarenRN, BSN, RN]

Renerian:

Here is link to Center for Medicare/Medicaid Services' Hospice Manual:

http://cms.hhs.gov/manuals/21_hospice/hs0-fw.asp

Link to all CMS paper Manuals:

http://cms.hhs.gov/manuals/