HH Administrator Seeking Feedback About Productivity

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Specializes in HH, ER, Primary Care, QI, Risk Mgmt,.

I'm an home health administrator in need of some feedback. My company has had a bit of turnover of late. Of course, my goal is to minmize the turnover, improve job satisfaction, improve patient care, etc. All of the nurses who've left had said they are just working too much. I've been a case manager so I know the work can be tiresome. But I've been committed to making things better at my agency. I'm looking for feedback from other case managers and administrators. I live in rural america. Our nurses do have to travel which does extend their day. I've been able to drop the expected case load down to 30 to 35 patients. We have computerized records and give all RNs laptops and wifi cards. I try to hire them to cover the region they live in in order to maximize their efficiency. On average they have 2 to 3 visits per day unless they have lots of sup visits. We don't staff more than 4 visits per day ever. The most travel they would have in a day might be 2 hrs but it's averaging to be 1hr for the group. We also build in 1 office day each week to allow them time to get caught up. I have streamlined processes so they can email their calendars, their HH care plans, and labs requests and don't have to come to the office. I can even scan/email their start of care information to them. They really only have to come to the office 2 times per week. We have a triage nurse who actually manages getting all labs faxed to the docs, updates the orders, and projected visits. She then scans and emails the lab to the RN so she has it. When fully staffed, they only do call 1 week out of 10 weeks and are paid quite well for this time. If they are on call, then they are off the following Monday. I really think we are working diligiently to try to be the employer of choice and to allow RNs to have a healthy work-life balance. I've read some of the other threads on productivity and think that 5 or 6 visits a day are for metro areas. I'd love some feedback on what you think. Are we truly asking too much of our RNs? Any suggestions or tips?

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Frankly, I don't see how they are working too much. Especially if they are salary. If they are pay per visit, they should be complaining about not earning enough to support their families. Everything in your post sounds pretty good to me. Short of raising the pay rate, which I doubt you could do or you would have done so already, I don't see what else is possible. Maybe I am missing something here.

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Specializes in HH, ER, Primary Care, QI, Risk Mgmt,.

They are salary. We gave them a raise in 2008. We are very competive. I keep thinking im missing something too.

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These people are spoiled. If they had to go through what other hh nurses have to deal with, they wouldn't be so unhappy with what you have provided for them.

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Specializes in HH, ER, Primary Care, QI, Risk Mgmt,.

More on the feedback of working too much... I'm also wondering if they are referring to the coordination of care piece of home health- coordinating PT/OT/ST referrals; following up with concerns from LPNs, and HHA; making sure the patient has the supplies they need ie glucometer, nebulizer, BSC, walker, meds, etc. I have them send me a daily email of admits, discharges, and non-admits. I also really scrutize discharges because I want to make sure they patient is ready. In my mind, if the patient is ready for discharge, then the outcomes should be stellar. I know there are exceptions to this. They do not like when I question discharges. However, that is my role.

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Specializes in LTC/hospital, home health (VNA).

I do what your staff/field nurses do and I routinely see 5-6 patients a day. I am salary. 5 patients is a very doable day...even with 1+ hr of travel. I work with other disciplines, order/deliver supplies, manage/draw/deliver labs, make referrals to other disciplines, update/communicate with MD, etc...and still have time to see patients. The days where there are SOC, ROC, etc...things are a little busier. Each day is different though...some days 5 is alot and others I still get through in less than 8 hrs. Just depends. We too use computerized charting and signing. Personally, if 4 visits per day was my max I would be thrilled!

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You have presented nothing that is out of the ordinary for the job. If they don't want to do this or think they are being asked to do too much, then perhaps they should be encouraged to seek another work specialty. Frankly, from what you have said, I would love to work in an office where I was provided so much support and my administrator showed even a fraction of the interest you seem to devote to the job. I still believe the problem lies with the unrealistic expectations of the nurses that work for your agency.

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Specializes in HH, ER, Primary Care, QI, Risk Mgmt,.

Thank you for the feedback. I'm really proud to work for an agency that is committed to working with our RNs to find that happy balance. We realize that in today's market, RNs have options. We are a for-profit agency but we're not only focused on the profit margin. However, with the changes in Medicare, we've had to put on our thinking caps and really learned to be smarter with the reimbursement that we receive. We have all sorts of tools for our nurses and the orificenal is getting larger. We have telehealth devices, clinical pathways, wound care algorithms. I've been in another agency where I took care of patients armed with a bag full of basic supplies, equipment, and an ink pen. Anything beyond that came out of my own pocket. It's exciting to know the agency I'm affiliated with is so much more than that. We are committing to improving patient outcomes and their quality of life.

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Specializes in LTC, assisted living, med-surg, psych.

Hey, can I come work for you??

You sound like an excellent employer. If I could find a home care agency like yours where I live, I'd already be working for them!

Good on you for considering your nurses and their workloads, travel time, paperwork etc. Too many employers treat us like we're nothing more than an inconvenient expense, and they couldn't care less about us as human beings. I wish you all the best!

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The hh agencies in my area and the ones that I work for are decreasing their rates of pay. Just out of curiosity, is this happening in your area too? Oh, and if I can find out where you are located, I'll be in on Monday morning looking for work. You say you are in a rural area so I guess that means your agency isn't located around the block from me. Too bad.

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Specializes in HH, ER, Primary Care, QI, Risk Mgmt,.

I haven't heard of anyone in my area decreasing rates of pay yet. There have been layoffs and hiring freezes at the hospitals though.

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Specializes in COS-C, Risk Management.

Have these nurses ever worked for another home health agency before? Are they new grads? 'Cause frankly, I agree with Caliotter--they're spoiled.

Where are you? Can *I* come work for you? I'm putting an average of 75 miles on my car per day, no reimbursement for mileage because it's all "in town" (in the largest metro area in the country), and everything except gloves and lab supplies comes out of my own pocket. I even had to buy a pill planner box for one patient! Send your nurses to this forum, let them see how good they've got it.

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