Do you rotate patients? HELP

Specialties Home Health

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I work for 2 different agencies. One of those agencies rotates patients, meaning you are hardly ever assigned the same patient. We typically don't receive our schedules until 6 or 7pm the night before the visit. I have been with the company for a little over 6 months but the way they do scheduling is really starting to drive me nuts.

My nights are pretty much a mess. I don't get my patients until sometimes 7pm at night, then I have to route them, read the 485 and then try to call them all to schedule visits. Then I cross my fingers and hope everyone answers. If not I am up calling in the morning to try to reach them. If I can't reach them I have to make the call as to if I want to do a "drive by" to see if they are home or skip them and cross my fingers they don't call me later in the day now wanting to be seen and thus throwing off my entire schedule. Sometimes I am up till 9pm scheduling patients EVERY DAY.

Another issue is supplies. Since I don't see the same patients every day it's always a mystery as to what supplies i am going to need. I cross my fingers that the nurse that saw them before has done their charting so I know what they last did or at least respond to my e-mail or phone call when I call for endorsements. My car looks like I robbed a medical supply store. It's a HOT mess.

My other agency I work with does it different. When we are assigned a patient they are ours until they are D/C or we request a change. This is totally stress free and I love it. The only down side is I don't get as many patients and 99% of them are once a week patients so i typically only average 12-14 visits a week.

The agency with the crazy scheduling I typically have 7-9 patients a day (7 days a week if I want but I choose to only work 5 days). I love the patient load but the scheduling is driving me INSANE.

I'm thinking of dumping this agency and then signing with 3 or 4 other agencies so I can have my own patients even if that means working 3-4 agencies just to get in my 30 to 40 visits per week.

For those that work home health how many agencies are you working with. Also can/do you tell them the patients you won't take. i.e., being a single mom I would rather not take daily patients.

Specializes in Peds, Oncology.

I precepted with a home health nurse for 6 wks in nursing school many moons ago, but she did the same thing, called the morning of and informed the patients of what time we would be there. Left it at that. We saw 5-7 a day and she was full time. After you factor in the hours you are spending at night working, are you still making a decent salary?

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Specializes in Wound Care.
Honestly, I dont give them an option. My phone calls go something like this "hi this is C with the visiting nurses. I'm coming to see you today, I will be there between 12-1. See you then". Very occasionally I will have someone refuse, and even then I can usually gently convince them. If the absolutely will not than the visit gets bumped, and either I see them if I'm working, or someone else picks them up if im not, or the visit gets cancelled. The thing is, if you are seeing medicare clients they need to be home bound. The only valid reason for refusal is doctors office or church. My agency is pretty strict with this. If someone refuses you because they are going to have their hair done they are reminded that according to medicare (and most private insurances) they must be home bound and available when we come. Period. If they are capable of leaving the home for hair, lunch, shopping etc they are discharged from care and set up as outpatient for their needs. As far as I know the vast majority of nurses in the agency call the day of visit and tell, not ask, the client when they are coming. It seems odd to me that your clients dictate their visit schedual. You are the nurse.

eta: when they don't answer the phone I leave a message stating " this is C from the visiting nurses. I will be there to see you between 12-1. If this is a problem please call me at 555-5555. If I do not hear from you I will be there between 12-1". If there is no one home when I get there it gets charted as a missed visit. Aha, medicare requires home bound and the vast majority of our clients are medicare.

I do this for the most part. However where I run into problems are when I get the following excuses:

1. I dont want to be seen before 9 am or 10 am. because I'm sleeping..or heck I had someone tell me 2 pm

2. My daughter, son, husband, caregiver, second cousin wants to be here. They are available between XYZ

3. I don't shower until after 11...can you change my bandage then

4. I actually had someone tell me today they couldn't be seen before 12 because thats when here soaps are on..lol

As for just showing up. I don't like to do this since

1. If they are not home I don't get paid

2. I have had 2 people fall while trying to get to the door because it was an unannounced visit and no one was home to open the door for them

3. I have been cussed out (this one does not bother me as much but it's still annoying).

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Specializes in Wound Care.
After you factor in the hours you are spending at night working, are you still making a decent salary?
to be honest I never really thought about the time spent charting. I usually chart while watching tv or while sitting in the park watching my daughter play so I never really thought of it as something I'm not getting paid for but I guess I really should
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I do this for the most part. However where I run into problems are when I get the following excuses:

1. I dont want to be seen before 9 am or 10 am. because I'm sleeping..or heck I had someone tell me 2 pm

2. My daughter, son, husband, caregiver, second cousin wants to be here. They are available between XYZ

3. I don't shower until after 11...can you change my bandage then

4. I actually had someone tell me today they couldn't be seen before 12 because thats when here soaps are on..lol

As for just showing up. I don't like to do this since

1. If they are not home I don't get paid

2. I have had 2 people fall while trying to get to the door because it was an unannounced visit and no one was home to open the door for them

3. I have been cussed out (this one does not bother me as much but it's still annoying).

I guess maybe I'm just not willing to be as accommodating as you. I get lots of excuses too, and I tell them that I am available at XYZ time or not at all. Usually they would rather have me at a less convinient time than not at all. I'm not paid per visit either, but even if I were if I call into the office they always have more visits that need to be covered. I think, though, that the only way to deal in this kind of situation is to be less accommodating. Did you work in hospital care at all? I learned quickly in acute care that letting my patients run my day made for an awful outcome for me. Same at home. Yes, everyone wishes they could be seen exactly when they wanted to. But, I have 6 hours, and 5 visits, and not a ton of wiggle room for complaining. If you don't want me to come when you fit in to my day geographically (cause I'm not driving in circles), and time wise then I won't cone at all.

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Don't get me wrong. If it's feesable for me to move someone around to accommodate them I will. But I won't make my day a lot more difficult to work around someone's game shows or desire to sleep all day.

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Oh well, that's no good. I'm paid hourly, and you better believe that includes anytime I spend charting at night at home, or reviewing charts in the morning etc. anything work related gets logged and I get paid.

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I'm PPV and while I do have some long days charting I also have a lot of 3/4 days. I look at my earnings at the end of the year.

I'm like Chrissy, I manage my visits. And I accomodate when and where I can. I rarely have cancellations, even when another nurse's patient tries to cancel. Out visits are necessary and I've gotten good with persuasion.

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Specializes in Wound Care.
I guess maybe I'm just not willing to be as accommodating as you. I get lots of excuses too, and I tell them that I am available at XYZ time or not at all. Usually they would rather have me at a less convinient time than not at all. I'm not paid per visit either, but even if I were if I call into the office they always have more visits that need to be covered. I think, though, that the only way to deal in this kind of situation is to be less accommodating. Did you work in hospital care at all? I learned quickly in acute care that letting my patients run my day made for an awful outcome for me. Same at home. Yes, everyone wishes they could be seen exactly when they wanted to. But, I have 6 hours, and 5 visits, and not a ton of wiggle room for complaining. If you don't want me to come when you fit in to my day geographically (cause I'm not driving in circles), and time wise then I won't cone at all.

I guess because I am still with only one agency I tend to let my patients run me out of fear they will call the office and request another nurse who will do the schedule they want...and then I'm left with nothing. I do however like your thinking. I am in the process of getting 3-4 agencies under my belt then at that point if someone does not like that time frame I give them I can suggest (without fear) that maybe we can find them another nurse who is welling to accommodate the times they need.

You would be AMAZED (or maybe not) at how demanding people will get. Sometimes I want to tell people if your scheduled is that important maybe you need to go to the wound care clinic every day. I need to treat it like a doctors office...this is the time I have take it or leave it. People get spoiled in HH

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When doing visits, I had one gem who kept moving up her time a half hour or hour at a time. Her preference was that no one come at all, but the agency insisted. And the TV stayed on during the visit. Certainly wouldn't allow the nuisance nurse disturb her shows! One reason why I quit doing visits.

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It's less common for patients to behave like that, but my admin backs me up which makes a huge difference.

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I guess because I am still with only one agency I tend to let my patients run me out of fear they will call the office and request another nurse who will do the schedule they want...and then I'm left with nothing. I do however like your thinking. I am in the process of getting 3-4 agencies under my belt then at that point if someone does not like that time frame I give them I can suggest (without fear) that maybe we can find them another nurse who is welling to accommodate the times they need.

You would be AMAZED (or maybe not) at how demanding people will get. Sometimes I want to tell people if your scheduled is that important maybe you need to go to the wound care clinic every day. I need to treat it like a doctors office...this is the time I have take it or leave it. People get spoiled in HH

do you have a particular supervisor you report to? Maybe discussing time issues with someone in managegement might put you at ease. My supervisor was very clear initially that I do not have to rearrange my day in a way that makes it harder for me because of client request. I should honor them if it works for me, but not if it doesn't. And honestly, after the origional grumble most people are fine. People can be demanding, but I'm not one to put up with a lot of nonsense. I would absolutely say something along the lines (in a very sweet voice) "I'm sorry, but this is when I am available to come see you. if it hard for you to fit a nurse visit in your schedule, maybe it's time for us to set you up for outpatient treatment so you can have more control over your appointments." I think people test you the same way a child will. If you let them they will control the whole encounter. Remember, you are the professional with the skills they need, you run the show. Be flexible but don't be a slave to your clients.

I have only ever had one client kick me out, and she was schizophrenic and completely out of control. I couldn't leave fast enough!

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When doing visits, I had one gem who kept moving up her time a half hour or hour at a time. Her preference was that no one come at all, but the agency insisted. And the TV stayed on during the visit. Certainly wouldn't allow the nuisance nurse disturb her shows! One reason why I quit doing visits.

I guess agency's differ, because I can't see our agency keeping this client on. I have seen clients refused by the agency for a history of treating staff badly, dangerous home conditions etc. In my agency staff comes first, if we are unsafe, or uncomfortable we don't go. Difficult clients get rotated so one nurse isn't stuck with them. If someone is not home for 2 consecutive visits we discharge. There are lots of things about the agency I don't care for, but reading on this board about what others deal with is interesting. My agency is a nonprofit with a very long history in the area as well, maybe that makes a difference?

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