HELP! What do you think I should do, fellow HH nurses?

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Hello (home health) nurses!

This really applies to all nurses but I posted in the HH forum because that's where I'm currently working and I'm sure more of you here will understand where I'm coming from when I talk about knowing Medicare regulations etc for those of you who deal with Medicare/OASIS etc. It's a whole other world. I'm gonna try to summarize my situation to make this easy reading, bare with me! Thanks!

I've been a nurse for a number of years but just started in home health a little over a month ago. Tiny company. When I started, there was a DON, 1 PT, 2 PTA's, 1 LPN. I was hired to take the place of the field RN leaving. So that makes 2 RNs including the DON. Well, not more than 2 weeks later, the DON quit. I took over the DON position. However, the administrator HAS NOT hired another field RN to take my previous job role, even though he initially said he was. I have been in the field 2x a week and in the office 3x week, doing both field RN AND DON duties. Even though it's a small company, it's very unmanagable as I either have to go home on the days I see patients and chart on them til 8pm + and have no life, or if I wait to chart in the office the next day, I'm not really able to get everything I need to get done when you include DON duties.

Additionally, the administrator/owner is the whole problem here. It's why the previous RN quit. He's why the DON quit. He doesn't know what the heck he is doing to put it lightly, micromanages, AND ASKS HIS STAFF TO LIE ABOUT DATES/TIMES ETC IN DOCUMENTATION for the sake of getting medicare submissions approved and not denied. He has me doing one thing, then another and another, and has the audacity to ask "oh have you done x yet?" when there's no way in heck because I'm so busy doing a million other things.

To add to it, I honestly have no idea what the heck I'm doing. Medicare is new to me. Their standards, rules, CHAP regulations... everything. And I have no one to sit down and show me what to do. And like I said, the admin has NO CLUE. He even asks me questions and I'm like, why don't YOU know??

In conclusion, I feel I'm in a terrible position. It's one of those jobs that looks great from the outside, you get in there working a few weeks and realize it's a horrible situation. I'm swamped with duties, both field nursing and DON. To realistically get everything I need done, I have to work into the evening at home or even weekends. I did not sign up for a 24/7 job. I LOVE MY PATIENTS. They are not the problem. I know being DON means you may still see patients occassionally, but I am the ONLY RN doing not only supervisory visits, recerts, SOC, but also doing regular visits on patients as well as our LPN sees patients in whole other county. I cannot realisitcally do my job as DON and see patients regularly. He keeps changing the way he wants to pay me, too. Which is sketch to me. I'm paid salary, and he was going to PPV for sup visits and recerts. Now apparently he's going to pay me for ALL the visits I do on top of salary. But I'm not even sure it really compensates for me working weekends, after hours, and charting. I'd prefer a position where I get paid overtime.

Anyway, no amount of money could make me stay here. I don't like that he has asked past and current employees to lie on their documentation. Regarding pain, time, dates, etc. I thought I'd wait until he hired another RN and leave, but idk if he is and I can't MAKE him, so it's really not my problem then if I leave and he has no RN staffed, right?


Can anyone tell me how this will or will not effect me as far as my license goes? And how it works in home health? What is considered abandonment? I don't mind giving a notice, as I want to make sure I secure another job first before I leave. But I am in my probationary 90 day period so I'd like to leave before that. And I'm just wondering how it will affect things considering I am the only RN employed. If I leave, and he patients can't be seen because there's not an RN, that's not my fault, correct? I feel this company is falling apart with the way this guy runs it, and it's only a matter of time and I don't want to be here to see its demise. On top of that, I need a job with benefits, PTO, etc anyway. and I can acutally make more money as a STAFF RN somewhere rather than bust my a$$ here being DON AND field nurse working 24/7 and stressing. I come into work with such anxiety now and want to cry. It'd also be in HIS best interest to hire another DON who knows what their doing, I'm not experienced with HH OR Medicare. I think he just wants SOMEONE or ANYONE in the DON seat just so he can say he has one. (Idk if a DON is like a REQUIRED thing or not in home health)

What is your advice? Have you ever had to leave a job and put them in a tight situation with little or NO appropriate staff? I just don't want anything to affect my license and I'm not sure how abandoment works in home health, it's not like you assume care when you take report. You have scheduled patients. I don't want to eff anything up for myself, I just want to get out of here ASAP, while keeping my license intact.

THANK YOU FOR READING!! I truly appreciate it. ?

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You are on the HH Titanic. I have been there. Please locate the nearest life raft and give 2 weeks notice ASAP.

No, you will not be charged with abandonment.

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2 hours ago, Oldmahubbard said:

You are on the HH Titanic. I have been there. Please locate the nearest life raft and give 2 weeks notice ASAP.

No, you will not be charged with abandonment.

Haha!! Thank you for your response. ?

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Although much of what you describe could be asked of you at another agency, it is unlikely that the "entire" condition exists at another agency in your area. Get yourself hired at another agency and serve notice, or, serve notice anyway. You can not be charged with abandonment. And check with your local Labor Board informational website. You will probably find a statement to the effect that two weeks notice is not required by law, it is just customary. If you are in an at will state, you can leave with 24 hours notice, "Today is my last day, I am resigning effective now, I won't be in tomorrow, here is my written resignation," might be acceptable and applicable here. You don't owe this guy without a clue two weeks if you can get hired without his input, which he won't be pleasant about anyway.

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Specializes in Adult, Gero, NICU, Peds, wound medicine.

Get out. It's not your responsibility that he has no other RN too see pts. That is a sinking ship and I think a violation of labor board to pay both salary and PPV. It is where I live.

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@anrn1995 @caliotter3 thank you for your replies! I plan on hardcore job hunting/applying places this week. I am one to give up to a month’s notice if I can for an employer I respect and if it’s possible for me to wait that long to start a new job. However, I feel a dire need to get out of this one and fast, which is why I asked about abandonment. The RN whose place I took that I mentioned, before she quit, tried to professionally give 2 weeks notice and apparently this admin just wouldn’t accept it and started arguing with her and even demanding to know how much she was going to get paid at her new job, which obviously she didn’t feel comfortable discussing. He couldnt take “no” for an answer. I’m told it was a whole ordeal and that they were in the office arguing for quite a while, which is why the previous DON was anxious to even try to give him a heads up notice, so she left a note on a Friday afternoon before she left for the weekend. So for once, im not going to feel bad about giving a short (possibly VERY short) notice. I don’t feel comfortable dealing with him. Especially since it’s usually only me and him in the office, there’d be no one to diffuse or distract from the situation if he were to get angry or upset.

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On 9/7/2019 at 4:54 AM, anrn1995 said:

Get out. It's not your responsibility that he has no other RN too see pts. That is a sinking ship and I think a violation of labor board to pay both salary and PPV. It is where I live.

Also, I didn't even think about how that might be illegal- how he's paying me. I'm trying to find the regulations of that online - I haven't yet. (Being paid salary and PPV on top, I mean)

Also, if I'm getting paid "Salary", I should be paid a flat rate no matter what, right? Whether I worked 50 hours or 35 hours that week, because that's how salary works. Well, APPARENTLY, if I don't work one day, or call in sick, I don't get paid for that day. That doesn't sound like salary to me. So you're not gonna give me PTO, or benefits, (also tells me I can NEVER take a Friday off) and you're not gonna pay me if I take a day off or call in sick? The guy pulls his own rules and regulations out of his you know what and tries to enforce them as if I'm going to be okay with it.

Nope. Can't wait to quit this gig.

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Does anyone know of a number or hotline you can call to report suspicious things? Or a hotline or appropriate person to call (state BON maybe?) for this situation:

one of my PTA’s saw a patient and went to chart on her but there was no scheduled visit for that day to chart on. Bewildered, I look on her chart to find her recertification COMPLETELY WIPED OUT AND DELETED, meaning my charting gone, as well as that PTA’s visits wiped out (pt was recerted for PT only after her wound healed) so idk if she’ll even get paid. Worse than that though, is that we have this retired LPN come in 2x week who used to work here and she helps out (really she does more damage than help) and she went in, DELETED my recert and past PTA visits, and instead put in a discharge assessment in its place, on the date I actually recerted her, and put it under MY NAME.

i don’t even know what to do in this situation. Not only is she no longer an employee, but shes also an LPN and can’t do recerts or discharges anyway. Are she and the admin just going to “pretend” the patient wasn’t seen for the past 2 weeks?? Can I go back and recreate a recert? Demand she delete the discharge? I don’t even know. I don’t even know if she legally can see or work with patient charts seeing how she’s no longer employed here. I doubt she’s signed any HIPPA forms.

Also just found out a PT didn’t see a patient when he was supposed to, and he charted that he did. This isn’t the first time. The PTA and I are angry. I want to report all of this.

I know all of this is grounds for walking out TODAY because I jusr can’t stand for this, but I am in a financial place right now where I NEED a paycheck and can’t quit until I secure another job.

Wondering if if there’s anything I can do in the immediate future to report or cover myself.

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@oceanmermaid05 I would use that state hotline in the SOC packet.

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