Exempt in Homecare

Whispera, MSN, RN · Aug 16, 2009

Your posting is very difficult to read, and I'm not sure I understand all of it. But, you're saying you don't get paid for mileage or travel time, and have to be on call all the time for $1.00 per hour? And that your blood pressure is high and you have migraines?

I don't think how you're being paid is legal. If it's legal, it's surely not fair. There are only so many hours in the day and we don't work for free 20 per week!

I think you're overwhelmed by your job. I'm glad you talked to HR. Maybe she can help you make changes that are more healthy than the work you have now, and still stay where you're working. If not (and I don't say this often, since the job market isn't good right now) start looking for a different job. Your nerves and health otherwise are not worth sacrificing!

Tampa121 · Aug 18, 2009

Yes, i do need to edit it, many typos, etc. thank you,kathy:nurse:

Home Health Columnist / Guide · Aug 18, 2009

Under IRS regulations:

Exempt employee = Salaried staff.

You are paid a yearly salary for the position, not entitled to overtime.

Non-exempt employee = Hourly staff

Paid by hour, entitled to overtime.

See previous post:

https://allnurses.com/nursing-activism-healthcare/when-ok-exempt-211951.html#post2104959

I see your working for a small agency as exempt employee and ONLY RN supervising an LPN. Home Health Agency standard is 6-7 visits/day with 30-32 visits/week average. Not your fault if unable to make productivity due to lack of patient visits nor lack of staff for weekend coverage. To make this work as sole RN for agency, trade off should be that some weeks you have 24 visits, to accommodate weekends when you need to see patients ----that's the flexibility of SALARIED work.

If they don't pay mileage or reimburse less than IRS requirement, you can deduct on own tax form by keeping written mileage records.

Health benefits $280/month average cost what I've seen posted @ AN (comparison my salary deduction $225 biweekly PPO plan /family 4; others choose HMO plan $120 biweekly /family 4).

I started in homecare with new start-up agency, working hourly per diem which worked well for me as just started family. They averaged about 30 visits/week for entire agency with IV infusion (could be 15 min chemo disconnect to 8hr infusion visit for hydration/ blood administration) or 12 hrs when private duty case needing coverage. Mileage averaged 75-125 miles/day. So when I came to current agency and staff complained about 30 miles in a day was amused.

Going hourly per diem is in your best interest; however state regs may require they have a full time RN on staff. If there are other agencies in your community, they probably need you more than you need to work for them to point of your health being affected. I highly suggest investigating other companies in your area requirements so that you can write up a list, compare then use that as room for negotiating on your behalf. If they are unwilling to compromise, at what point are you willing to leave? Think that out ahead of time.

Best wishes in your decision.

Tampa121 · Aug 19, 2009

Thankyou for all your very helpful info. I had gone on the site you directed me to. But, my big question is how can they make me have a standard quota/productivity and make me work weekends to meet it? It doesn't sound fair to me. So, from my perspective why be salaried? A garanttee paycheck a wk, I thouht if you worked your 40hrs and worked 6 hr or 8 in a day you still got paid, I have never been Exempt, just hourly, got paid well for the time I worked and OT after 40. I sure will try to negotiate. I need to think what I am able to give the company in hours ie:45, 9hr days but with all the paperwork that comes along with case conf, care coordination, and 6 pts, how can i accomplish that. I agree hrly per diem for a couple local agencies would be best for me. We are getting busier by the day, so for the time being I will have the RN visits, that's until they hire a FT RN.I do get mileage 44 cents a mile Mon-Fri. I love caring for pts in their homes with the parakeets, music, roaches(no kidding), they are there but I try not to get too skeeved by them!!! So, clinically I am very happy! Lots to think about and want to be professional and mindful "they" are running a business offering a service to the pt and family. Many, many thanks Karen for taking the time to weed through the my long messge poorly typed! BTW Does SOC-2 visits, ROC's and Resumption=1.75 , just wondering, she hasn't told me, she's not sure!! Do you know the standard for Florida? I'm sure I'll find a away to make it work!!

Home Health Columnist / Guide · Aug 20, 2009

In my area a visit is a visit ---do not have SOC = 2 visits, feeling is some visits could be 15-20 min if BID wound care case , Average admit is 1 1/2 -2 hrs with paperwork so that would equal out.

Of course my average admit was 2-2 1/2 hrs with paperwork; 30-45 minute teaching /coordinating visits rarely got the 20 min except when doing IV chemo infusion on established patient.

RE weekend mileage: we were allowed to count mileage from office front door to patients home for first patient visit even if did not go to the office if a distance away.....see if they will accept that.

Tampa121 · Aug 21, 2009

Hi Karen, I started negotiating today. Started off kinda lousy in am with my supervisor, but when director got involved per my request, we moved forward. I asked her to pull my charts and briefly read my care corrdination notes, case conferencing with other clinicians, MD etc.,and my detailed documentation on my SOC's, ROC's, etc, updating care plans each time pt comes out of acute care, etc, new med lists, orders, you know the amt of paperwork. She said I am very thorough and detailed and she can tell I care about the safe care I am giving. Have made numerous suggestions re: infection control, offered to be part of a nurse practice team, so nurses for the company can make and hopefully institute changes. Let me ask you this-Is it acceptable practice to bring my scale into each home to weigh my pts who need weights, place paper towel over it and have them stand on that? I have many pts who cannot afford their own scales. Also, shouldn't each pt have their own disposable thermometer, medicare will pay, we have them, but my stingy super keeeps them under lock and key and only orders 4 at a time. She expects us to use the same one for every pt?? Of course with the plastic shield that comes off in thier mouth half the time, then clean it with alcohol pad. And, shouldn't every wound care pt have their own scissors, not that i use mine for each wound and cleanse with alcohol and go on to next. They do not provide a bleach solution for us!! Not even nursing bags!!! Finally, with my request they just ordered the cheapest Hopkins, only 2 nurses me and RN, (I don't think it was that expensive-cheapest Hopkins is around 30.00, haven't come in yet. State is due from now to Christmas, so I think they are getting a little more concerned! They shoud be. How do you feel about ear thermometers, with probes like we used in hospital? I am going to buy my own, with the Swine flu on the Horizon, I think it's a better choice than the oral, cheapo. I ordered my own O2 sat machine, we only have one and half the time the LPN keeps it in her car!! She went away for 4 days and kept it!! Of course, I had to admit a sick COPD and O2 sats were ordered!! Let her get away with that one. I don't care to deal with drama, so buying my own stuff will make my job easier on me. And want to buy a PDA, to keep track of my appts, visits, sups, addresses, tel numbers, schedules for revisits, sups, also Diversion 60day sups with HHA present, etc, need big screen, am half blind and stylet, too clumsy with finger touch. The Director got me em access and internet per my request. My super said, "you're the only nurse who works for the company that has it, other than managers!" Now I caN EM AND HAVE DOCUMENTATION RE: COMMUNICATION BETWEEN ME AND THE cARE MANAGERS ON dIVERSION SIDE, MULT PT REQUESTS FOR EQUIPMENT, ETC. THEY SAY "WILL YOU CALL FOR ME". If they are able I ask them to, "Well, I can never get a hold of her". Gotta get some more sleep, no paperwk. and I thing the director is allowing me to complete all my extensive pwork tomorrw with a couple of visits. You know , no vist, SOC in the computer at corporate, they can't get paid!! Progress, not perfection. Last thought, I asked her to come up with a reasonable amt of hours she wanted me to give the company per wk because I have a life outside of work, need to work out 3 days wk sec to HTN and Osteoporosis, etc, no go out with friends, but necessary stuff. I told her today I will not be married to this job, because it's gonna be here long after they bury me with a coke(pepsi) and a smoke(cigs). LOL, my 2 deadly vices! and, adding to HTN!! Happy friday!

Tampa121 · Aug 21, 2009

Ok, my supervisor this morning hung up on my when I told her Lynn, Executive Director and I had a productive meeting last night-final straw, there are plenty of agencies in Tampa area, I got the names of 2 with reference/referral from a Therapist, Called Baycare HC yesterday who had called me , but their recruiter is on vacation until 8/31. My super told me she has to cancel her vacation next week d/t all of her work. But, I called to review my schedule, (changes daily) and mentioned my mtg with lynn, non- specific, just that Lynn offerd to buy me a file for my car, I told her thanks but I have 2 of them Everything i have whiteboard to track acute hospalization, bullentin board for notices and my mail file folders, stapler, etc I have bought and not asked for them to pay! Oh, and Roloodez, is the only thing they bought. So, it's time to go per diem. I will give 1 week notice, not my problem they have no RN. Can I go effective immediaely, they will have the visits. ? Thankyou for the input, I guess yesterday was too good to be true! I do believe when 1 door closes another one opens.

caliotter3 · Aug 21, 2009

Don't be surprised if they don't take you up on your per diem idea. Most employers just get rid of a person that speaks up like you have.

Tampa121 · Aug 21, 2009

So, how much notice do i need to give them? I want to give only 1 wk, want to really one day! I am overwhelmed, being treated unfairly by my supervisor, rude. 66-70 hrs a week all over Hillsborough Cty, They are messing up big time with Infectous disease, they saw a pt for one year or longer who's bedrm was infested with cockroaches and did nothing, no mention in notes, etc. You mean to tell me the LPN and HHA didn't see them! They were all over his colostomy and dsg supplies!! I bumped it up to my bosses boss and then my boss called him, that's after I cleaned his rm, got rid of all contaminated supplies. He has open wounds!! 6 of them!! I got told by super a few wks ago to rewrite my note! I didn't. If it's important enough to be on the OASIS, re: does home have insects/rodents then my documentation stays and I copied it for me. I called her and told her I was home doing pwork, which is ok for LPN, but not me. I wrote up my letter stating I respectfully submit a change from FT RN Exempt to Per-diem in 1 wk. That's enough isn't it. I am still on probation so no vaca time, etc. Let me know what you think. Being the only RN for a company is horrible, will never again. Now I know what and whom to ask at my next interview!I'm leaving to see a pt in 1 hr. Thanks so much, Cali.

caliotter3 · Aug 21, 2009

To be quite frank, at this point, I would give them a written two week notice and resign. I do not think you can expect to be able to deal with this on a per diem basis. JMHO.

Tampa121 · Aug 26, 2009

Hi everyone,

Just wanted to say thankyou for all your advice. I will continue to work for them as per diem nurse and apply to other companies, also. I know what got me all twisted was having to schedule Diversion HHA visits all over county, get there and have either member or the HHA not be there. So, I decided to just do the Medicare SN visits. They will only pay mileage if over 20 miles from office, so I'll keep my mileage for tax deduction. This week, I am completing all paperwork that I got behind on. At this point, I don't care if I make quota or not, just want to complete paperwork. I am going to buy a PDA. I feel much better having made the decision to work for a couple of agencies. And, will apply to ones that have more than one RN. Then, I will have the time to have a life!! Thank you all so much for your support. I would not have been able to make the decision I did without the help of all you fellow HH Nurses. :nurse: