Hate Home health job

Been there,done that, ASN, RN · May 12, 2015

I feel the same way about home care. The required documentation takes many ( unpaid) hours.

The measly mileage paid nowhere near covered the use of my car.Don't know where you are, but I'm in Michigan.. many days of inclement weather to try to get to the patients.

However, 6 weeks seems a little premature to make a decision. A BIG factor is the agency you work for. There are hundreds of them, some treat nurses better than others. Hospital home care agencies are MUCH better employers than any privately owned.

What type of agency do you work for and what did your orientation consist of?

Farawyn · May 12, 2015

When I did homework I ha a cheat sheet that I would jot things down on then fill it out later. After 2 weeks or so I knew what the OASIS consisted of. That was back in paper days. I'm actually thinking of doing some per diem home care now and your post is giving me food for thought.

Libby1987 · May 12, 2015

It gets better with experience and if you work for a professional organized agency. I average 8 hrs/day, make an average of 104K/yr with approx 20K miles/year, most reimbursed at .45/hr.

What nursing field could you jump into and not be pulling your hair out at 6 weeks? I can't think of any bedside position. With HH it takes a year just to get comfortable and a few to become efficient and competent will all aspects.

You learn to streamline, multitask, and organize. And you start to have repeat situations, many become routine.

nutella, MSN, RN · May 12, 2015

Hi,

when I started in home care (hospice and palliative care), it took me more than 6 months to find a system that works for me.

The pros for me are that I am very independent (which I love, I am that kind of nurse), I am in charge of my schedule, I use all my skills from basic care to access of ports and pumps and so on.

When I was new I had a huge learning curve about home care and the specifics of it, including OASIS, specific differences in care at home, and organizational skills. The last one is very important because it will make all the difference in management of your case load and how you get your work done within time.

You probably have a laptop I assume? Get a mouse to make your work faster, it helped me a lot, I even use it in the car and in the patient's house. Try hard to document as much as possible at point of care. The way I document is that I open the computer with the home visit to enter at least vital signs and as much info I can enter with the visit. A lot of documentation involves check boxes, easy to check off when you have a mouse and can scroll down. Whatever I can not document in the house I document right in the car. Now that I have practice it does not take me forever. In the beginning I did a lot of documentation in the office after all the visits because I had so many questions. Now that usually do not ave questions anymore I finish the docu and note for a patient right after the visit in the car - I park in the shade in summer...sometimes I have to drive a bit after the visit and park half way to the next patient, wherever I find a good spot to stop.

The more complicated documentation for certification / OASIS I safe for the office because I need to focus more but I still get as much done right with or right after the visit.

I used to schedule my last visit for 2 pm when I worked until 4 pm and started my day with day with the first visit right at 8 am. Good cases to schedule for first thing in my opinion are dressing changes or long-term clients. In the beginning I got some resistance about the last visit at 2 pm but with every new patient I would review my availability for visits - they are supposed to be home bound in order to receive home care - so 2 pm or earlier should not be a problem. That way you still have time for documentation left overs, some phone calls and such.

Boundaries - do not give out your cell phone number to patients. I give out the agency number and if somebody needs to reschedule or talk to me they call the agency. Let doctor's offices know when you expect a call back. I give my cell phone number to doctor's offices and other health professionals but never to the patient.

Get a "hands free" device so you can pick up the phone while driving safely. A lot of doctor's offices that call back call while I am driving and that way I can talk to them on the phone while I get from A to B. When I have to document I do that once I am stopped safely.

Think ahead for the week when you plan visits and plan twice a week for M/Th or T/F , 3 times a week for M/W/F and once a week W if you are full-time - that way you can even out somewhat once you have your own case load.

Invest time at the start of care. My first 2 visits are usually longer because I want to get the best idea about the pat and what I have to do and to outline the care / teaching. I am very structured in my notes and that way I can go back to the first note at any point to review if all what I outlined is done or if something is left to prepare for discharge.

Have snacks in your car and some water ... Usually I eat something around lunchtime, I usually eat while I document a visit in the car. In the beginning I often felt I had no time to eat and felt rushed to complete the visits but being hungry and thirsty did not help my mood and I felt more exhausted.

Compile a binder with cheat sheets - info about OASIS, phone numbers of doctor's offices and hospitals, elder service and so on, forms to use (medication lists). That way I do not lose time while searching for phone numbers.

Find a trusted mentor. Once you are off orientation you will still need to ask questions for some while. I had questions more frequently for the first half year, after that occasionally and after a year I was ok. But still, there are times you want to discuss a case, what to do and so on. A good mentor you can call on the road is really important in my opinion. Of course you also have a manager/supervisor you can call but a successful home care nurse who knows the business is essential.

If home care is not for you it is not for you and you should move on. After 6 weeks it is hard to say though. Perhaps above strategies can help you a bit. It really takes half a year at least to get even used to home care and getting the hang of it. It probably take at least one year to get truly comfortable and secure in decision making in home care.

Nrsasrus, ASN, RN · May 13, 2015

Wow, helpful advice nutella. Thank you. I am still in orientation at a large home care company (hospital affiliated). I am very excited but the more I learn the more my head is spinning. I hope I will be more confident about what I'm doing in 6 months!

EfhJOY1996 · May 13, 2015

I am an RN for a large home health company, get paid per visit, we use the point system and we use OASIS. When I first started I was full-time and I quickly went down to part-time because I was way too overwhelmed. I then went part-time which ended up being overtime for me, 40+hrs per week. Now I am down even more part-time (13 points per week) which is around 25-32 hours per week which gives me more time with my family. I was charting way too much at home and getting quite irritable regarding the at home charting. I have worked with this company doing home health for 7.5 months and I can say charting gets way quicker once you start anticipating the OASIS questions. I agree with the earlier poster and will take some of their advice with me regarding organization. I still feel unorganized and it's quite frustrating still when the office puts last minute visits on me when I have already planned my day out or when patients cancel or cannot be tracked down..it gets really irritating. But if you can afford it I say try it out very part-time or prn that way you can learn at your own pace. I think the point system is insane and that is probably why so many people quit. They need to go by hours IMO. All that said I am unsure about it myself just d/t fact that they expect you to "stay productive" within the point system but they do not promise you guaranteed hours in return. Even when I worked 40+hours per week I did not get benefits or paid time off because I was technically part-time. They need to restructure the system if they want nurses to stay..just my opinion. :up:

babynurse73 · May 13, 2015

Oh poo. I hope it gets better. I can't imagine having to go back to the chaos of the hospital!

Sent from my iPhone using allnurses

Wendy

nutella, MSN, RN · May 14, 2015

I hope it will be helpful.

I can not even say often enough how important it is to find a mentor who is willing to get back to you during the work day and does not mind!

It worked out for me well because the nurse who oriented me was great, we got along just fine and she never gave me the feeling that my question was stupid. I called her more often in the beginning with questions like "would you send this patient to the hospital ..." or "what would you do.." and as I got more secure in home care I called less often. I still sometimes bounce something off, it is important to have a good working relationship with at least a couple of nurses who are experienced in the field.

My manager is great and also available for any question but having a mentor helps so much, especially when you write notes in the beginning and when you learn how to plan your day...

nutella, MSN, RN · May 14, 2015

Wendy, I agree.

I enjoy being independent, in charge of my day and one patient at a time. It works for me just fine.

JackieAnn · May 15, 2015

i am ready to get out too. Been in hh 5 months and the critical care I used to do. Really looking to get back to hospital before I am not hireable. I make great money but the charting comes home with me everyday and the miles are pretty bad too since I already drive 20 miles to get to office and my area. Not sure what I was thinking...

When I signed up for this.

Libby1987 · May 15, 2015

* .45/mile. Geeze.