HELP! New to HHN and sinking....

stbernardclub · Dec 22, 2004

If I were you, I would pretty much tell this company almost your entire post your wrote here. It gets to the heart of the matter, and you could say that your hoping you do not have to make a job change in the near future :)

shammy · Dec 22, 2004

Welcome to HHN. I too am new so can't offer ANY advice. Only been doing HH since Sept 13th.

I am paid per hour not per visit because of that very thing. But per visit is an option if I ever become a zip in, zip out nurse.

But I can tell you that visits do get quicker. My repeats use to last an hour. Now they usually don't. But if I have lots of teaching to do they can last that long.

I will be checking back to see what the more experienced HHN say.

DallasRN · Dec 22, 2004

If I were you, I would pretty much tell this company almost your entire post your wrote here. It gets to the heart of the matter, and you could say that your hoping you do not have to make a job change in the near future :)

Thanks stbernardclub, but I've already done that. Yesterday, in fact. Another nurse that started at the same time (and also very experienced in hospital nursing) had the same discussion with the manager. She's as helpful as she can be, I think, but basically, we've both been told..."Welcome to the world of home health nursing." I'm having a hard time this is the world of HHN because there sure wouldn't be many of them out there!

Honestly, I'm more discouraged than I think I've ever been. I've finally found a line of work I love, and I honestly think I could be great at it, but I can't afford to do it. If something doesn't give soon, I'm going to have to go back to comp case management. :crying2:

renerian, BSN, RN · Dec 23, 2004

I have seen alot of great nurses leave home health for your posted reasons. Been there myself.

Let me know if you talk to your manager and how it pans out. Good luck.

renerian

DallasRN · Dec 23, 2004

I have talked to my manager in detail, renerian. First before I posted here and briefly again yesterday. I even told her about this site and this post.

Basically, her hands are tied in terms of salary, reimbursement, etc. She is as supportive as she can realistically be and is giving me as many cases as she possibly can. Also, she goes out of her way to help - taking supplies and things home to her house (she lives near me) so that I don't have to make unnecessary trips to the office, etc.

I understand that these agencies are allowed only X amount of dollars to treat patients (Medicare), and those dollars are eaten up quickly leaving the agency losing money in many cases. Therefore, the real problem is with Medicare reimbursement. But still...I have to pay my bills, too, and as a R.N., with years of nursing experience, I just can't see working for what turns out to be about $10.00/hour if I'm lucky.

My frustration stems from the very fact that after several years, I've found an area of Nursing I absolutely love, feel that I could be really good at HHN (part of the battle in any job), found a wonderful manager...what could be better? Except I can't afford to work this type of job! I keep thinking I have to figure out a way to make this work. I know part of the problem lies with me in terms of newbie organizational skills, taking too much time per visit, but darn! I hate to cut corners but guess I'll have to start if I hope to continue. Seems that this is a universal problem with HHN's.

payday · Dec 23, 2004

You need to find an employer that reimburses for mileage. If not. you are working to replace a vehicle. Some HHA's offer $40/visit with no mileage. If you take two hours to open (and don't forget the pre-paper work, post phone calls, follow up) and drive let's say fifty miles, what are you really making an hour. We also had mounds of other paper work associated with the visit besides the OASIS. Clinical pathways, care plans, case conference write ups. I know you figured that out.

I am saying this for others considering HH. I've seen experienced nurses who have been doing this for years still take their paperwork home to finish the day. I cannot afford to work for free . These issues need addressed my management because nurses have mortgages to pay too.

Some cases take longer, sometimes you cannot cut corners and do your personal best, particularily when the elderly take so many meds. Doing med reviews with them can take an hour if they are on three pages of meds and cannot even find them in the home.

Good luck, I'm glad you like it and hope you can resolve this.

letina · Dec 23, 2004

To Dallas RN:

I'm a Home Health Nurse in the UK (here we call it District Nursing) and like you, after 20+ years of nursing I have finally found a job I love and wouldn't do anything else now.

I sympathise with your predicament re the pay and I just wanted to ask you this - is all HH nursing in the US carried out via agencies? The reason I ask is that maybe you could consider working for a hospital who employs HH nurses, that's what I do here, and that way you get a salary, guaranteed pay no matter how many visits you do. Or does it not work that way in the US?

DallasRN · Dec 23, 2004

You area absolutely correct, payday! I am reimbursed for mileage at $0.30/mile after the first appointment of the day. But as far as the homework...yeah, I know! Tons of it! Phone calls, faxes, etc., etc. And the cell phone bill! It's growing by the day. Non-reimbursable, but you can't survive the field without it.

Paperwork...that's what I'm doing right now - yesterdays paperwork because I was on the road all day or in the office. And only saw TWO patients! One early then to the office followed by one late and then home at 5:30. Nothing inbetween other than a stop for gas at $1.80/gallon! Followed by phone calls to arrange visits when I got home last night.

DallasRN · Dec 23, 2004

I really don't know, letina, about the hospital stuff. I think some hospitals do employ HHN's, but I suspect the rate of pay is rather poor for the amount of work required. The other issue I have is that I love working for the person I'm working for. She has 27+ years HHN experience and is a wonderful teacher. I know you can't have everything, but gosh! I really want to keep working for her and be able to pay my bills, too. It's such a catch-22.

I don't begrudge the extra "homework" too much except when it eats into my entire day and I look back and realize I've worked all those hours for pay at around minimum wage. You know...the issue is so far above the agencies. It really has to do with the value of nursing in general and of course, Medicare. They are screaming and begging for nurses, yet they refuse to pay decently. That's pretty much across the board. And I'm sure most nurses already know what I've discovered. These docs turn the patient lose to HHN and almost forget them! Wash their hands of them, so to speak. That's frustrating, too...having to call a doc 3-4 times to get any type of response.

payday · Dec 23, 2004

Hospital based HH dept.'s and county based ones seem to reimburse for mileage and provide use of a cell phone more than privately owned HH agency. They also are more likely to pay per hour which is nice. You are paid for driving time. Down side, may require call.

Per visit pay really sucks -though the per visit rate may sound fantastic to a new nurse. I worked for an agency for about two weeks before I figured out that they were really making off like bandits and I was screwed. No mileage either. One nurse drove over 100 miles (some time spent lost) just for one client.

Per visits folks, if they won't pay mileage, request a certain mileage radius, like 15 miles -that will cut down on gas. Also, pack supplies for several days and store in your car to cut down on trips to office.

I am beginning to believe from reading these boards that nurses are last on the totem pole of respect in the healthcare field yet they are the driving force that holds it all together and makes it possible for the "suits" to stay in their offices.

payday · Dec 23, 2004

P.S. ask the billing person how much they are reimbursed for a MEDICARE visit, it may shock you!