Feeling overworked. Is this normal?

[Jessica1019]

Hey guys,

I worked in a clinic for a year before switching to home health and I've been with this company for 4 months. During the interview I was told that I would have 6 -7 pts a day. I was also told that my patients would be "grouped" together in areas as we have a 50 mile radius that we cover. It started out just like that after trained: I'd have between 5-7 patients a day (a mixture of everything from wound care to admits) and one day I'd be in town with all of my visits and the next I'd be 40 miles away with all visits within that area.

However, the last two weeks have worn me down completely. I'm not sure what happened, I'm assuming the census is up, but I feel like I'm burnt out already.   Last week was rough, but nothing compared to this week. I'm waking up every morning with a random visit an hour away and the rest are within my town which puts me very far behind on time. They even pulled a patient from a nurse that works in an area 45 minutes away and gave her to me the morning of the visit and me nor the nurse can figure out why as that was one of her regulars. I'm also getting around 10 visits a day. Today I have 2 admits, 5 skilled nurse visits, 2 recerts and a discharge. 

Is this a normal amount? I'm curious if they were just "easing" me in after training and this will be the norm from now on. 

[Peachpit]

Unfortunately, this is normal for home health, at least most of them, now.  Most home health agencies/home health recruiters, paint an idyllic picture of productivity/points/salary/mileage etc but once "out there" it is a vastly different scenario. Which is why 90% of nurses leave home health within a few years or less (you can see multiple posts about this on allnurses.) Myself included. I worked home health years ago, it wasn't perfect but it sure wasn't like this. Nurses and therapist are overworked consistently, patients are short changed on care and the afterhours documentation is too much and, HCHB and the OASIS is just..ridiculous.  Staff become so stressed about meeting productivity/points the work/life balance ends up suffering not to mention the extreme amount of mileage each week.

In most places there are home health/hospice agencies on every corner. The competition is fierce among them for referrals/patients so at the end of the day, it's a business and businesses are all about the Benjamin's - not the realistic expectations placed on staff and promises of coverage areas goes out the window. 

Some people here will tell you to hang in there, that it gets better with time (partially true I guess) but many of those who give that advice are nurses who have made their careers in home health and these issues, plus others, don't bother them much if at all. 

Good luck and if you do decide to leave home health and go to another type of nursing, don't feel badly. Home health, in my humble opinion, like hospice and dialysis, are flavors of nursing that a nurse either loves or hates. There isn't much in between. 

[Hoosier_RN, MSN]

Peachpit said:

Unfortunately, this is normal for home health, at least most of them, now.  Most home health agencies/home health recruiters, paint an idyllic picture of productivity/points/salary/mileage etc but once "out there" it is a vastly different scenario. Which is why 90% of nurses leave home health within a few years or less (you can see multiple posts about this on allnurses.) Myself included. I worked home health years ago, it wasn't perfect but it sure wasn't like this. Nurses and therapist are overworked consistently, patients are short changed on care and the afterhours documentation is too much and, HCHB and the OASIS is just..ridiculous.  Staff become so stressed about meeting productivity/points the work/life balance ends up suffering not to mention the extreme amount of mileage each week.

In most places there are home health/hospice agencies on every corner. The competition is fierce among them for referrals/patients so at the end of the day, it's a business and businesses are all about the Benjamin's - not the realistic expectations placed on staff and promises of coverage areas goes out the window. 

Some people here will tell you to hang in there, that it gets better with time (partially true I guess) but many of those who give that advice are nurses who have made their careers in home health and these issues, plus others, don't bother them much if at all. 

Good luck and if you do decide to leave home health and go to another type of nursing, don't feel badly. Home health, in my humble opinion, like hospice and dialysis, are flavors of nursing that a nurse either loves or hates. There isn't much in between. 

The truth! I did it PRN for a couple of years, still do occasional. It's a mess!

[Jessica1019]

Peachpit said:

Unfortunately, this is normal for home health, at least most of them, now.  Most home health agencies/home health recruiters, paint an idyllic picture of productivity/points/salary/mileage etc but once "out there" it is a vastly different scenario. Which is why 90% of nurses leave home health within a few years or less (you can see multiple posts about this on allnurses.) Myself included. I worked home health years ago, it wasn't perfect but it sure wasn't like this. Nurses and therapist are overworked consistently, patients are short changed on care and the afterhours documentation is too much and, HCHB and the OASIS is just..ridiculous.  Staff become so stressed about meeting productivity/points the work/life balance ends up suffering not to mention the extreme amount of mileage each week.

In most places there are home health/hospice agencies on every corner. The competition is fierce among them for referrals/patients so at the end of the day, it's a business and businesses are all about the Benjamin's - not the realistic expectations placed on staff and promises of coverage areas goes out the window. 

Some people here will tell you to hang in there, that it gets better with time (partially true I guess) but many of those who give that advice are nurses who have made their careers in home health and these issues, plus others, don't bother them much if at all. 

Good luck and if you do decide to leave home health and go to another type of nursing, don't feel badly. Home health, in my humble opinion, like hospice and dialysis, are flavors of nursing that a nurse either loves or hates. There isn't much in between.

Thank you for taking the time to reply. I'm on the lookout for another job as we speak. I hope I can hang in with this one until then but it's becoming more and more difficult to push myself to go. Looking at my schedule for next week is already making me anxious. ? 

I just wish they would have been honest with me from the beginning vs painting a picture of "flexibility". There's absolutely no way I could move my visits around if I had a doctors appt or anything because then I'd be working until 7-8pm at night (not including charting times). Their only recommendation is to move visits to the following day that aren't time sensitive. 

UGH! I'm just over it. Thank y'all for letting me vent. 

[LmilkoHHN]

My number one pet peeve with my job is when the company accepts more and more referrals without being able to staff the current amount of clients. Patient outcomes suffer. Clients complain that they are feeling "rushed". I've been employed by my agency for 6 years now and am at the point of looking elsewhere but I do love home health. I've changed to part time status so I have enough time to sit at home on my days off and complete my charting on my time. The company has taken away all office time, nurses are not permitted to spend any time charting in the office, have no access to a landline to make calls. Calls to the physician and patients must be made by cell phone and those are only provided to full time nurses. My salary hasn't changed since the day I was hired and bonuses that were once reserved to Christmas are now exclusive to new hires. What would work best for me would be if I were paid by the visit and allowed to make my own schedule according to the demographic. 

[No Stars In My Eyes]

Home Health was my favorite nsg job......MANY years ago. We had to do our charting at the patient's (in the home or in our car in the driveway). Only paperwork after the day was through was the mileage reports. I expected to be out and about for 12 hours, sometimes a bit longer depending on how many patients I had or where I went. I do remember doing BID visits for patients who were MILES apart from each other, so I just accommodated those when I had 'em. Fortunately I loved to drive, and I had a wonderful
'Home-Health-Dog' who accompanied me every day I worked, which made the rides more fun. And of course, back then, gas wasn't as outrageous as it is now.

I hope you find something where you aren't so  overwhelmed or over-loaded. Unfortunately nursing has changed a lot since I retired.