Happening again

caliotter3 · Apr 2, 2012

Only you can decide if you are unhappy enough to leave the job.

AnnemRN · Apr 3, 2012

Does anyone else work this much? Seeing 6 to 10 pts a day some are 40 min away. Some I have to see 3x/wk due to CHF issues, have to take labs etc. Last two weekends saw 3 pts on sat and still doing charting on sunday to catch up and get ready for next week. I left this company over the summer because of the constant issues. THey did hire a LPN to help with visits but still going crazy. I do not see the other nurses in my company doing this much. Full timers taking time off, having time to babysit grandchildren. I am always calling on my CHF pts to check wts, on weekends, picking up meds for pts who have no family. Maybe I am not cut out for this?

I was a part time employee for a home health agency and found that I was in fact working more than the full time staff. I thought because I was part time I would not be depended on so heavily, but found out quite the opposite.

The full time staff was treated like they were gold. They made out their own schedules and could limit patient visits to 4 a day. I on the other hand was seeing 6 to 7 patient's all over the place. I would pick up my assignment and gather my supplies, make telephone calls and then be gone like a flash. The full time staff would still be in the office for another 1 or 2 hours after I left. The visits included recerts, post hospital, I'v's , blood draws and wound vac's. My days were never 8 hours, but the full time staff were able to go home on time. I finally got fed up and left.

MauraRN · Apr 5, 2012

I am full time and my days sound like yours; 14-15 hrs a day 7 days a week, get paid for 40 hours. Needless to say, I am actively looking for another position.

kcmylorn · Apr 11, 2012

I don't mean to sound like a party pooper- but, being this busy is a good thing. Your jobs are secure, unlike the hospital environment- getting cancelled= no pay; the hospital work is hr worked/ hour paid, not salary.

Home health seems severly short staffed also. But I think they are more willing to do something about the short staffing- hiring more nurses. The hospital is not about hiring more nurses to solve their problems- those hospital mogels could care less if a patient dies due to inexperience or short staffing.

I just interviewed for a Home Health position after 30 yrs in the hospital and I'm looking at it this way:

Healthcare reform is here- that's a given. The hospitals are not going to be the big benefactors of healthcare reform, much to their dislike. Hospitals are doing nothing in the right direction to controlling healthcare costs. Their continuing in the same upper managment spending sprees that got the healthcare industry into this mess. The CEO's are not cutting their salaries, bonus or perks, they continue to keep their wives and mistresses and themselves happy and well pampered. The nursing stafff is paying the price for this along with the patient's in cutting nursing staff and patients are receiving shotty dangerous care.

CMS has cut hospital reimbursement because of this problem and I believe that is the method to the CMS's maddness. I don't think that the hosptial can squeeze the CMS into surrender. I think it's the other way around. The hospitals were given a chance to change their spending ways. The CMS is not going to tell them how to run the business. If the hospital board of Mistrustees want to spend it's millions mostly on a 1 CEO salary and run the operation with what money is left over- then that is their business. The CMS is not going to give them anymore money to run the hospital. The CMS does a lot of good for alot of vulnerable people, they are the governement and they want to keep it that way or they will become extinct and I don't feel the government wants that. The CMS is not in it for profit. They are there to give what funds they do have to the most amount of people in need of those funds. I guarantee you- the head of the CMS is not making anything near the CEO of a hospital. So Healthcare policy has been revamped via the Health and Human Services and is now focused on out of hospital care and managment of patients to control the runaway healthcare train. The move it to keep patients out of the hospital and to get patients out as quickly as they can- ready or not, those home health patients acuity is going up and so are their numbers. There is no way to fake cutting corners either the agency wont get reimbursed or the patient will end up right back in the hospital.

The majority of this responsibility falls on the nurse's shoulders- patient education. If more nurses are needed, I bet Home health will find more nurses to do the job If not- their reimbursement dwindles. Home health is close to a pay per visit - the nurse is paid to see "x" number of patients /week. I think if more nurses are needed, more nurses will be found. The hospitals can afford to hire and pay more nurese, the CEO just doesn't 'want to' part with his money.

I think Primary Care- aka clinics should brace themselves also for more patients aka needing more nurses. One nurse can only see so many patients. I think it will be like a run on the banks of the 1920's- if it has started already. The healthcare reform started when Obama took office, it took another step when he handed Community Health Centers $144 million in April 2010 and the hopsitals got ZERO, the state insurance exhanges have started- United Healthcare, Amerihealth, to insure some of the uninsured and underinsured- there were 45 million- they won't be going to the hosptial for that primary care or home care. I think the doors are slamming on the ear aches and cut fingers to the ED. These 2 insurance companies are employing nursing case managers, disease managers and telehealth nurses to direct patients to the appropriate level of care. JMHO

I also think the jobs will be in any facet of Public Health- nursing or otherwise- the Master's in Public health degree.

AnnemRN · Apr 11, 2012

I don't mean to sound like a party pooper- but, being this busy is a good thing. Your jobs are secure, unlike the hospital environment- getting cancelled= no pay; the hospital work is hr worked/ hour paid, not salary.
Home health seems severly short staffed also. But I think they are more willing to do something about the short staffing- hiring more nurses. The hospital is not about hiring more nurses to solve their problems- those hospital mogels could care less if a patient dies due to inexperience or short staffing.
I just interviewed for a Home Health position after 30 yrs in the hospital and I'm looking at it this way:

kcmylorn,

I just saw your response today and felt I had to respond. Yes, everything you said is true, except I wondered if you realized that CMS actually started seriously looking into home health in the 1990's because of widespread fraud by home health agencies. As a result, home health is no longer reimbursed by CMS per visit. In fact, many home health agencies have closed over the years because of the cuts in home care dollars. I have been in home health since the 90's and have seen several agencies in my area close because they couldn't break even. The lump sum received has to be shared by all the disciplines so, it can be a losing proposition.

Even nonprofit agencies are closely looking at the bottom line because they don't want to lose money. Please don't think that nonprofit agencies are beyond overpaying their CEO's because they aren't. I know of nonprofit home health and hospice agencies whose upper management make big bucks and even get kickbacks for saving the company money off the backs of their nursing staff. They will run you ragged and overload your assignment and then demand that you do it all in 8 hours. It can be quite ugly and detrimental to your health.

The ones who say they've found their niche and their home health agency treats them well are rare. Many times after you've finished your visits you will have several hours of paperwork or computer work left to do at home in which the agency wants you to do for free. I know several nurses who left the hospital because they thought home care would afford them time to pick their kids up from school or to throw laundry in the washing machine and found out they actually had less time to do the things they wanted to do and ended up going back to the hospital.

GoECU · Apr 11, 2012

I worked home health for a year and got tired of seeing patients all day and charting all night! I enjoy hard work, but this was overkill. I had no family time and was always trying to dig out of the hole of charting that never ended! I do miss some aspects of it....but So glad I moved on!

kcmylorn · Apr 11, 2012

I have always heard- the paperwork in home health is god awful and it's CYA.

I've only interviewed- I don't know if I'll get it. Or if I want to take it. I applied for an advertised fulltime position and when I went for the interview, I was told there were no fulltime positions and they proposed a half home visits and half visits to patient's in other facilities to make a full time position. I was told I would be expected to see 6 patients/day and it was a salaried position. I was told the charting is via computer. it's the cell phone use I worry about- I hate using my cell phone now and I don't use it. Any smart phone would confuse the hell out of me. I have clung on to my landline phone. I never believed home health was easy- to the contrary, because the nurse is on their own. But after 30 yrs, that doesn't scare me. The part that does scare me is -seeing patients in their home. That is what has kept me in the hospital setting and away from home health years ago.

I want something I can spend 10 yrs at and then retire with as least confrontation, staff interactional( demonic possessed) BS as possible. Let me get in my car and drive to where I need to be or let me go to an office and close my door with a big sign 'DO NOT DISTURB" on it. I am just not into the hospital BS anymore. I have zero tolerance for the queen bee or top dog act. My feeling now is "keep your insecurity and feeling threatened to yourself or go see a psychiatrist, get some meds and tell it to someone who cares" Nursing is tough enough with out the added burden of staff and managment insecurity.

RN1263 · Apr 12, 2012

Today is the last day of my field home health RN position and I couldn't be frinkin' happier! After almost 5 years of late night charting, weekend work, nasty homes, ect.....I'm OUT! And if you are with a busy company NO it doesn't get better, the better you time manage the more work gets dumped on you. At least that's what I have experienced, can't speak to all HHA of course.

I will still be in home health but doing referrals out of a hospital with very little patient contact and no management responsibilities...yey!

emilysmom,RN · Apr 12, 2012

Well it is 11pm still doing paperwork. Did take a couple hours off to go out with co workers then home for 3 hours of 2 SOC and 6 visit notes. Was able to kiss my kids goodnight. Do not see any light at the end of the tunnel. My husband wants me to get a job that has no homework. Had a nurse quit was a hospice nurse and just could not deal with the many visits per day and all the paperwork. AHHHHHH. Sending resumes out yet again. Now to try to get some rest to start all over again.

Does anyone else work this much? Seeing 6 to 10 pts a day some are 40 min away. Some I have to see 3x/wk due to CHF issues, have to take labs etc. Last two weekends saw 3 pts on sat and still doing charting on sunday to catch up and get ready for next week. I left this company over the summer because of the constant issues. THey did hire a LPN to help with visits but still going crazy. I do not see the other nurses in my company doing this much. Full timers taking time off, having time to babysit grandchildren. I am always calling on my CHF pts to check wts, on weekends, picking up meds for pts who have no family. Maybe I am not cut out for this?

cocot · Apr 12, 2012

My advice is to do what you can- but not make it your life- you Will get burned out at that pace.

I work full-time 6 visits per day (sometimes more)- I know I can't do all the paperwork (computer) work in 1 day- if I were to try I would never see my kids or husband and I'm sure they would just put more work on me. I noticed no one is breaking the door down to get into homecare but there are good reasons to stay-

Autonomy

Different patient relationships that are rewarding

Using more skills- when I worked in house I was only seeing 1 type pt ex neuro- and now in 1 day I may see 2 cardiacs, 1 neuro, 1 hip replace, 2 wounds etc. I think I have had more experience and better relationships with my patients.

I can't see being trapped in house hoping my relief gets to work on time or a large snow storm keeps me in house until the next day ( this has happened to me), can't see dealing with the CYA fear for 8 hours

For now I see 6 pts - I deal with 1 patient at a time- and I have down-time between the next visit- in my car listening to music or talking on the phone.

Try and do as much writing in the house - yes type and talk- the patients understand it they don't too bad

Know when to turn it off so you can have staying power.

RN1263 · Apr 12, 2012

Do not see any light at the end of the tunnel. My husband wants me to get a job that has no homework. Had a nurse quit was a hospice nurse and just could not deal with the many visits per day and all the paperwork. AHHHHHH. Sending resumes out yet again. Now to try to get some rest to start all over again.

I also saw no light at the end of the tunnel....also my company started adding additional stuff to be done by field staff (not patient care related) that just made my day and life harder then it already was. So, I decided I had enough!

All the things I could think of to "manage" my time was always squashed by management adding additional patients to my schedule.

I tried only working 9 or 10 hours per day and letting my charting back up...that didn't work cuz by friday then they wanted me to work all weekend catching up. I tried talking to management and that didn't work. Then when I finally put my 2 weeks notice in they seemed shocked... What did they expect? I'm sick of the abuse!