Employee retention

[anticoagulationurse]

Sooooo, the more posts I read on here the more I think it isn't just the company I work for that seems to not give a rip about employee retention. I have been so disgusted for the 2 years I have worked in HH that nurses just come and go and I wonder what is wrong with me for sticking around. I have assumed it was something about the company that sucks and why so few nurses stay. There are only a few nurses who have been there longer than I (2 years is not long!), and the ones who have are all part time or out of the field working in the office full time.

I really love the work I do, but I can see how it isn't for everyone. I am just now postulating that maybe the retention problem is related to the work itself rather than the fact that I assume the company sucks and I am the only fool who hasn't caught on to it. Unlike a lot of the other nurses who have come and gone, I keep to myself, do my work faithfully, chart on time, stay out of trouble and try to do a really good job at all times. It seems some people can't handle it, expect to be able to squeak by un-noticed or get so buried in work that they end up giving up and quitting in frustration. Even so, it amazes me how hard it is to get fired from this job! There are a lot of variables, lots of nebulous ever-changing things about HH that I can see how some might find it frustrating - but it's that which keeps me from getting bored! It's also very easy to feel unsupported out in the field, and like every day on the job is risking your license, until you wrap your head around the nature of the work and realize that isn't true. I could see insecurity chasing many nurses away. There is a lot of alone time, which I can also see many nurses getting bored with. I love it. There is immense responsibility and personal accountability which I can see many nurses taking advantage of and/or not taking seriously and therefore finding themselves seeking work elsewhere.

There is also a lot of disorganization that seems to be imposed from external sources (incoming orders, triage calls, ever changing schedules, lack of patient continuity, etc), which can be extremely irritating and I could see how that could chase some nurses away. There is a lot of flexibility required and pretty much never get off work at an expected or regular time. I can see how many nurses would not be able to make this work.

So, after two years I am wondering if maybe it's the nurses not the employers who affect their own retention in HH. I also know it is so much easier to blame external sources for one's discomfort or dissatisfaction and therefore perhaps blaming the "lousy company" and management on poor employee retention is the pot calling the kettle black.

What do you all think?

[kids]

I could not agree with you more.

(It's late and in my sleep deprived state that is all I can muster.)

[4evernrs]

You have hit the proverbial nail right on the head!

[caliotter3]

While I have seen poor nurses and poor nursing care in home health, I can't blame the behavior of employers on the nurses themselves. It is akin to blaming a woman for her own rape. Nothing I have every done warranted how I have been treated by home health employers, so I won't take on that mantle. Poor day coming or going when I had to pay an attorney to send a cease and desist letter to an employer.

[annaedRN, RN]

Well said anticoagulation nurse! While that may not be true in all cases, I defintitely see that alot. I orient new nurses. We have a pretty thorough orientation - they are usually with me a month or so. And even after that, I touch base frequently. So, if they all go through the same detailed orientation process- why do some turn out to be great HH nurses....and some not so much? Yep - the nurses that are organized, learn to chart as they go and stay on top of the paperwork, the ones that learn to manage their caseloads efficiently...they are the ones that stay and often "find their niche". The ones that are charting on admissions from 4 days ago or do not write down reports, or forget to order supplies, etc...they miss sup visits or cert dates, they have QI after them, they start feeling overwhelmed, they tend to burn out quickly. I think that if a HH nurse does not find a organized system to plan the day with - and use that system consistently - that it is only a matter of time until they are in trouble...whether or not it is a good agency or not

[KateRN1]

I think it's a mixed bag. I've seen a lot of nurses and therapists go into home health thinking that it's great hours, flexible, and basically an easy job. True, the hours are generally better than hospital shifts, but you find that your time is not your own--particularly when on call. It's flexible, but not always in the way that benefits the nurse or therapist. As far as being easy, well, we all know that's not true.

Anyone who has a need to feel superior, can't meet patients on their own terms, and can't gauge and adjust to interpersonal relations is not going to make it in home care no matter how organized and efficient they are. I see so many new grads coming to this forum who just don't get how intricate it all is and the vast body of knowledge we have to have. But even the nurse with the best interpersonal skills and the greatest body of knowledge is not going to succeed if s/he cannot maintain organization and stay on top of all the details.

And then there's the documentation. Someone once wrote here that OASIS is "just answering the questions." That's a clear indicator of someone who hasn't quite gotten it yet. That OASIS assessment drives our reimbursement and if it's not scored properly, we lose money. The more money we lose, the less likely we are to stay in business. I remind people in my office from time to time that it really is that nurse out in the field who pays our salaries, regardless of who signs our paychecks.

At the same time, it's up to managers/directors to provide staff with the tools they need to get their jobs done. We can't expect them to know how to do their jobs if we don't take the time to train them from the beginning. We can't expect them to function as case managers if we don't take the time to teach them what case management is.

Like any area of nursing, some burn out faster than others. Sometimes there's a personality conflict or a management-style conflict that makes the burnout happen faster than it would've otherwise. Sometimes it's a matter of going through the same interventions over and over, only to see your patient decline despite your best efforts. And some people are just ready for a change sooner than others. No harm, no foul.

[anticoagulationurse]

Awesome - Thanks everyone! I am trying to understand 1) IF there actually is more turn over in HH than other nursing specialties (that is my perception!). 2) why? I think I am getting there. Keep your comments coming.

[caliotter3]

I can't say that I have noticed a higher turnover in hh, but then, I am involved with extended care, not intermittent type work. I strongly suspect that a good portion of turnover would occur when nurses find that they can not pay their bills due to lack of work to keep them busy and with a paycheck. Personally, I am headed toward seeking a regular type job because I can't deal with weeks, months, and in some cases, years of no work. Does not do me any good to be signed on with six agencies when five of them have provided no work in more than 18 months. That does not cut it in anyone's book.

[tewdles, RN]

I cannot say if the turnover is greater in HH as compared to other specialties...

but my experience is this, some HH and hospice agencies are so concerned with the bottom line and the visit that they lose all concern for the well-being of their professional staff. This results in RNs, PTs, OTs, SLPs, MSWs developing "compassion fatigue" and ultimately ends with very unhappy staff and high turnover. There are inherent stressors in any nursing job, but with HH and hospice one of the stressors is driving/traffic which can also be very dangerous for the hurried stressed professional.

[Intern67]

What do you all think?

I think it really depends on the company you are working for. If they have good management, manage caseloads properly and work hard to keep well trained people on staff, you have good retention.

The HH and hospice company I work for has many "seasoned" nurses who do good work and have very good attitudes.