First job home health RN advice

[Fnp9090]

Hi everyone,

I just started a home health job part time as I am trying to find other options as an RN. The actual nursing part of home health I enjoy alot actually, but idk if it's just me, but is anyone else who's doing home health have unpredictable pt loads and schedules?

The company (very small company) that hired me usually would have the manager text me the day before and go "oh can you see X pt today" and usually I can accommodate, but it fills me with so much anxiety about making plans cause if I know they are gonna do that I can't. THEN there are days I don't get any messages and filling the day up with trivial things feels so unproductive.

Then if I have to say no, because I did try to fill my day up and it ends up the pt can't meet me due to a conflict in our schedule, I feel terrible for saying no to the boss that I won't be able to. I keep thinking the boss will look negatively at me

It's my first job outside of school, and I just want to be a good worker, but this lack of stable pts and unpredictability is a bit unsettling. Any advice would be appreciated

[poko, BSN, RN]

I live in Canada and work in Home Health. I have for four years now. It is definitely the most unpredictable job. But we can say no to a point. We get out schedules the night before, but as our days go on we get new referrals from the hospitals, or someone calls in sick, or patients call with needing an extra visit due to a problem, or we call patients and they decline or cancel visits. This causes constant shifts in our workday. With that said we are only expected to be available for the duration of our shift (day 0800-1600) and after that any changes are dealt with my the next shift.

is this the norm in HH? I would say it’s a common theme and it definitely happens often, which is why people tend to leave. I personally don’t mind the erratic scheduling, but it’s not for everyone. There are good days where everything aligns to your planning. And bad ones where everything changes on a whim. I try to keep an open mind despite feeling reallly frustrated at times.

all the best to you :)

[NRSKarenRN, BSN, RN]

Unpredictable schedules is hallmark of home health, especially in a small agency when you are not case managing -- happened to me as I started in small start-up agency. Eventually, I transitioned to agency with 2000+ patient census and had better control over my schedule; still patients cancelled, had doctors appointments,were hospitalized or just MIA --unable to be found.

I worked 9A-6PM after getting kids to school. When I covered for nurses who were off, I would get 8 patients scheduled for visits that day at 9AM and sometimes would spend over 1 1/2hr trying to contact clients often to wind up with just 2 accepting visits, then would get additional clients to attempt contact. THEN, be out in the field at 4PM, getting call from Manager to pick up 2 clients 45 minutes away! So you have to set limits with Manager for what you can do in one day. 30 yrs later, still love Home Health!

[BarrelOfMonkeys, BSN, RN]

It is unpredictable. Although when I worked in a facility the rule was if an admission came on your shift you own it fully. In that facility I worked until 11pm and when that admission came in the door at 10:53pm I didn’t leave for hours. That happened several times a month. In HH my schedule is extremely flexible and while not “9-5” it is nearly what I make it to be (generally 7:30-3:30 other days it’s just a short afternoon) That said, I don’t have to work OT, weekends, holidays, nights or even evenings - unless I choose to. My unpredictability comes when as has already mentioned: out in the field I have been contacted and asked to pick up client load from another nurse (I never have to but often I say yes) or an open or I’ve got missed visits and now have to reschedule them another day along with rescheduling my current day if necessary. Still, a far cry from 16hr shifts in a facility because someone called off and I got mandated or when I was expecting to be home for dinner that night but got stuck with an admission I wasn’t expecting at the end of my shift. I definitely was trying to keep organized when I started and it was a little challenging but now it’s so much easier and my schedule is what I make it to a very large degree.

[guest1048932]

My friends who work home health always have predictably unpredictable schedules! They know that they will be working certain hours, then have the option to pick up more patients as needed. Like you said, there are cancellations and pick-ups. My friends very rarely work past their schedule for the day unless they chose to pick up a patient. They don't worry about saying no to pick-up, but they also do say yes to pick-ups when they can.

One of my friends works 8-4 Monday-Friday, but she usually has at least one no-show every day. She takes this time to fit in another patient if she can. She gets her patient assignment confirmed the night before usually. While it is unpredictable, home care offers a lot of flexibility, and as far as my friends have told me, they are never forced to see a client or stay past their scheduled hours. The most frustrating thing for them is when they have a no-show and are stuck sitting in their car or popping back to HQ for a while because they can't fit in another patient in that time.

Hope that helps!