Home Health Nurses, how many opens and visits do you have a week?

Chemistry Sux · Jul 28, 2011

Not sure how much has changed in the last couple of years, but I use to work for a medical solutions company and lots of nursing visits per episode were a bad thing. I assume nurses get paid per visit like therapy does, and more visits equals more money, but from a profitability standpoint for the agency, the more visits the less profit. If you are being efficent with your time and the pts are getting what they need then that's whats most important.

My wife use to work HH as a PTA and she would see an avg of 5-6 pts a day. She would leave at 7 and was home by 3. Her pts were pretty spread out and she had to spend at least 30-45 min with each pt. Some required 1hr of therapy so that made her day longer. How much time are you spending with each pt, how many miles are you traveling each day, are you required to report to the agency before and or after you start your visits, how long are you working each day? If you are working the same ammount of time as other nurses and you are 20 visits behind them then either you are slacking or they are cutting corners. Either way giving quality nursing care is whats most important.

owleyes · Jul 28, 2011

Most of my visits are about 20-30 minutes, but a new open is about an hour. It's the paperwork that occurs that is the real time-consuming part. I figure hourly, I work about 12-14 hr days when you factor in visits and paperwork. I work from home mostly and on a laptop. I get paid salary- and think per visit would probably be better- I am considering asking to be per visit instead, because then the company may be less incline to keep piling on visits. Thanks for the feedback.

Chemistry Sux · Jul 28, 2011

What agency do you work for if you don't mind me asking.

If you are working 12-14 hr days and being efficient with your time then the other nurses may be taking short cuts and not taking great care with thier work or charting. Are they on a per visit pay rate? If your agency stays busy and are able to get as many visits as you want each week then I would go to a per visit rate. The good thing about a salery is if the census is low you still get paid, but if you are rinning ragged all the time it may be worth the risk.

KateRN1 · Jul 28, 2011

Are these Medicare intermittent skilled visits? If so, I'm a little worried. If not, then disregard all that follows.

Medicare requires all visits to be skillable and billable, so a 20 minute visit isn't likely to cut it. And an hour to do a start of care seems awfully quick. A visit should ideally be 45 minutes to an hour and a SOC should be well over an hour, I'm usually in the home about 2 hours to do a full OASIS assessment, complete all agency-required forms, and do patient/caregiver teaching.

There are some nurses in my agency who do 50 visits a week and I question their visits, I don't think they do the teaching required to document per the 485 and you may have some of the same nurses in your agency.

jammycakesRN · Jul 29, 2011

I'm salary and I'm required to have 20 visits per week, but an intake (new pt visit) counts as 2 visits. I do fairly well as long as I don't have more than 2 new pts per week. When I have 3, I tend to get behind.

twokidsmom,rn · Jul 29, 2011

I have been averaging 40-45 a week but I have also been seeing a few pts on the weekends too. Not oncall but doing visits. Working 7 days a week for the past 3 weeks. I get paid per visit. Not doing it for the money but my census is 20 was up to 22.

owleyes · Jul 29, 2011

Wow, how in the world do you see that many without going insane? Are you doing opens and recerts in the mix too? I can barely handle 32 visits per week. If I didn't want to have a life outside of work, I would probably be OK with taking more pts- but my life does not revolve around my job. Unfortunately, it seems like Nursing expects it to and it's not a respected attribute when you say "NO" . If you set boundaries for yourself, often times it's met with resistance rather than support. This is why nurses burn out- and why companies have difficult times with retention. In general, there seems to be a lot of turn-over and burn-out in HH. I think it's because nurses don't set limits on themselves and get worked to death.

twokidsmom,rn · Jul 30, 2011

I am burnt out. Today I called my Mom crying. Summer is almost over, have not seen my kids much. Leaving the house at 0730 coming home around 5pm doing another 1-2 hours of homework 5-6 days a week. Now my husband is taking the kids down the shore on Monday, I have too many pts and not enough nurses to see my pts so I will go wednesday hopefully in the afternoon but probably not till night time. Making great money but to what end? I like home health but this is just too much. I love days when I have 6 pts a day. They are once in about 2 weeks I have had that kind of day. THanks for listening.

OkieeRN · Jul 30, 2011

My agency considers 25 visits per week full time. OASIS visits count as two regular visits.

owleyes · Jul 30, 2011

I'm sorry to hear, but if it makes you feel any better (and I'm sure it doesn't), but I feel the same way you do. Which is the primary reason for starting this thread. I am burned out as well. All I do is work- and when I have a lighter day, someone at the office sees that and throws me more work to do. I'm sure not all home health is like this. I think the draw for me is the money and not being in an office all day. I like my patients but feel so rushed to see them so that I have time to do the paper work. Are you also having to be on-call? And doesn't it feel hard to take a day off- because you have to find someone to take your patients. This job requires lots of planning ahead, connecting the dots, and being very detailed oriented. I am detail oriented, but getting lazy with things because I can't hack the amt of work. Thank you for listening...

abbie0 · Jul 30, 2011

I have been a Home Health Nurse for 18 years, and to do a good job for the patient the typical day for an RN is 1 intake and 3-4 other visits. Some nurses want to work long hours to make more money, but I left the hospital to have more connection with my patients, to manage their care plan and to have better job satisfaction. In spite of the paperwork, I have enjoyed Home Health very much. I work now as a director of an agency in San Diego, and I miss being in the field with my patients, but I really enjoy the great comradere in the office with the nurses. I don't want to lose site of what is good about Home Health by turning it into a patient mill. I know some of our nurses want a lot of visits, to make more money. I think that is fine if they are doing good case management, but I would have burned out long ago if I hadn't stuck to these more reasonable visit ratios. I judge how many patients a nurse can manage by the quality of care given and the documentation. Some can do 3 a day, some can do 6, but I have never seen good care from a nurse who consistently does 7-8 visits a day. I would rather see a nurse know her limits and practice good self care, for the sake of the nurse, the agency and the patient.