HH Administrator Seeking Feedback About Productivity

Specialties Home Health

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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?

You could easily find replacements for your spoiled workforce from members of this site. We would be grateful to work for such a good employer. I know I would. :mad:

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

My agency is in Oklahoma. We reimburse for mileage. I can't imagine not reimbursing for mileage. We have some nurses who cover the Oklahoma City area and we reimburse mileage. However, for our high mileage drivers, we have company cars which have a fuel card and maintenance card so they don't have any out of pocket expenses.

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

Out of the nurses who left our agency, we had some who were new to home health but coming from the hospital and some were seasoned home health nurses. The hospital nurses went back to the hospital. The other nurses went to another agency for less pay, more frequent call, and no company car. No feedback on whether they have regrets.

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i agree, sounds great to me!!!! where are you located!!!???? i travel, on average 100 miles/day and see 8-10 pts. , we do our own soc's etc, can only give to PRN nurse the easy visits, no oasis pts.,,,so your nurses do have it good.!!!!

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

Ladies~ come on out to Oklahoma....where the wind comes sweepin' down the plain. And the wavin' wheat can sure smell sweet. When the wind comes right behind the rain. :wink2: If anyone is seriously interested..send me a PM..I'll give you the sweet details.

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Specializes in COS-C, Risk Management.

Have you conducted exit interviews with the nurses who've left? I can understand why hospital nurses might go back to the hospital. HH can get lonely for those who are used to the cameraderie of the hospital and the adrenaline rush from an emergency. But I'm at a loss why a seasoned HH nurse would cut bait from such a sweet (to us, anyway) deal. Personality conflicts? A bad office manager or scheduler? Another long-term nurse with issues? For seasoned HH nurses to go to other agencies for lower pay and fewer benefits, that's a huge red flag and sounds like you might want to investigate with those nurses. Let them know that you're trying to make things better and improve staff retention, that their answers are absolutely confidential and they won't be penalized at all. Or even hire an outside firm to conduct the interviews for the sake of confidentiality. I think there's more to it than what we're reading here.

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

All of the nurses had exit interviews and all have said that they just worked too long. They stated that they did not have any issues with their clinical supervisor or me, the Administrator. We had one who felt underappreciated. Our scheduler is the best I've had the pleasure of working with. A couple of the nurses who left recently were ones who were quick to judge and tell others that they could do it better. However, when I consulted with them to allow them to make their suggestions for the good of the whole, they had zero suggestions to contribute. I believe that they did partially taint the newer nurses which is a shame. I was very impressed with the hospital nurses. They actually made fantastic case managers. They really seemed to resent my questions about discharges and seemed to think that I mistrusted them. My company is working diligently to grow our census. However, we do not color outside the lines or ask/do anything that is fraudulent. I have a high standard of ethics and will not work for an organization that does not. There are lessons to be learned from any conflict. I'm committed to gathering as much information and learning from this experience.

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Specializes in COS-C, Risk Management.
All of the nurses had exit interviews and all have said that they just worked too long. They stated that they did not have any issues with their clinical supervisor or me, the Administrator. We had one who felt underappreciated. Our scheduler is the best I've had the pleasure of working with. A couple of the nurses who left recently were ones who were quick to judge and tell others that they could do it better. However, when I consulted with them to allow them to make their suggestions for the good of the whole, they had zero suggestions to contribute. I believe that they did partially taint the newer nurses which is a shame. I was very impressed with the hospital nurses. They actually made fantastic case managers. They really seemed to resent my questions about discharges and seemed to think that I mistrusted them. My company is working diligently to grow our census. However, we do not color outside the lines or ask/do anything that is fraudulent. I have a high standard of ethics and will not work for an organization that does not. There are lessons to be learned from any conflict. I'm committed to gathering as much information and learning from this experience.

Based on the bolded statement only, I would suggest that you look into your own communcation style. You may be coming across in a way that you don't intend. Also because of this, I would suggest an independent firm conduct your exit interviews, maintaining the confidentiality of the former employees. Nurses may have a hard time telling you that *you* are the issue. Are you friendly and approachable or do the nurses sit across the desk from you when they come to your office to speak with you? Do you take time to chat with the nurses or do they only come to you when there's an issue? As I said before, if you have seasoned HH nurses leaving your agency for what appear to be poorer working conditions, there's probably a good reason.

Another possible move for you, just off the top of my head. Consult with the nurses that you still have. Any of them long-timers? Ask *them* what's working, what's not, and what could be tweaked. The more invested your nurses are with the daily operations, the more satisfaction they'll have. Are they micromanaged? Do they have freedom and flexibility within their assignments? Are they able to take a mental-health day if they need one? Is there good communication between the nurses and the higher-ups (including you)? Is there good communication between the nurses themselves?

I would look at the "working too long" statement. Sometimes four visits is a lot, considering the driving time and the type of visit. If I have to drive 75 miles between each patient, have an hour-and-a-half long visit for each one, that's a twelve hour day. Too much. (And I've done that, sadly.) Add in that one of them may be a SOC, and it's too much.

Consider the loneliness factor, also. You say they're only required to come into the office two days a week. That may put an unreasonable amount of distance between field and office staff. Technically, I only have to go to my office to turn in OASIS admits within 48 hours, and have my regular notes turned in by 3pm on the pay-period cut off. Theoretically, I could only show up once a week if I wanted to. But I want to get face-time with the staff in my office, my Nursing Director, the clinic nurse (we do infusion therapy), the pharmacist, the office manager, the receptionist (especially!), other nurses, etc. There's always something going on with the office staff--they frequently order out for lunch, get cakes for birthdays, have pot-lucks, etc. The loneliness factor cannot be underestimated for field staff, especially when you're working in rural areas (I did HH in rural MO many years ago). Anyway, that distance may be contributing to a wider gap between office and field staff than there needs to be and can lead to a feeling of underappreciation for some nurses.

Those are some ideas off the top of my head. Off to take DH out for Father's Day brunch.

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

Once again, I genuinely appreciate the feedback. It's great to hear someone else's perspective. Yes, I agree that communication styles can really morph the intended meaning of a statement so your point is well taken. You had some interesting comments about the loneliness factor. Perhaps that is why they have felt unappreciated. I never considered that. With regards to the staffing model, as previously mentioned-our RNs never drive more than 1 to 2 hr per day- unless they are on call. And a typical day would be 2 -3 visits/day for 4 days of the week and a built in office day once per week. If the nurses need to pick up their children or attend a school function, we have no problem working with them on those things. I'm also a single mother so I understand the need for flexible scheduling. Thanks again!

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Specializes in COS-C, Risk Management.
Once again, I genuinely appreciate the feedback. It's great to hear someone else's perspective. Yes, I agree that communication styles can really morph the intended meaning of a statement so your point is well taken. You had some interesting comments about the loneliness factor. Perhaps that is why they have felt unappreciated. I never considered that. With regards to the staffing model, as previously mentioned-our RNs never drive more than 1 to 2 hr per day- unless they are on call. And a typical day would be 2 -3 visits/day for 4 days of the week and a built in office day once per week. If the nurses need to pick up their children or attend a school function, we have no problem working with them on those things. I'm also a single mother so I understand the need for flexible scheduling. Thanks again!

This may seem like a silly question, but do they know that? My gut feeling is that it's a communication mis-match somewhere. The workload doesn't seem bad, the driving doesn't seem bad, I dunno about the pay, but if nurses are leaving to take lower-paying positions that's probably not the issue, so that leaves communication as the major contender in my book with loneliness a close second. Perhaps you could work on your communication style and institute some sort of socialization for the field staff that would make them feel more connected to the office as a whole. Good luck. It sucks to be the boss.

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I work in an agency that has the same "amenities" yours does (computerized charting, etc). Our productivity is expected to be 6-7/day, though mine is 5-6 because I cover an entire large county instead of the 1-2 towns that most of my colleagues do.

I would think I died and went to heaven if my productivity was 2-3!

And we don't have even half of the backup assistance/support from the office staff that you describe! I would be SO grateful for that, as I know my co-workers would be also.

Keep doing what you are doing. If any of your staff leaves, they will soon find out just how good they have it. :wink2:

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

KatyRN~ the staff definitely know that we offer a flexible scheduling. That part of the office culture has been present prior to my arrival and it's a huge perk. You may be on to something with my communication style. In this forum, I could see where it might come across as being cold, rigid, and formal. That's not my personality at all. Live and in person, I'm warm, fun, and open-minded but always fair and consistent. That's how I perceive myself. (Hopefully, I'm not looking in the funhouse mirror..haha) The nurses actually seem to be comfortable talking to me and their direct supervisor. A couple of the nurses who left actually were the ones who told me that they felt like I was questioning their nursing judgment when I offered to help them look for a reason to recert by doing a chart review. That's how I learned that bit of info. I respect them for telling me. It's not easy to give your boss that kind of feedback. They weren't being mean or catty when they said it. I believe they were being honest. We have a neutral party from another department conduct all of our exit interviews. We also do anonymous exit surveys to try to ascertain even more information.

More on that discharge issue.. Our exec admin really scrutizes our number of discharges so I do reviews to make sure they're goals are met and well documented, that they are truly homebound, etc. And I can totally understand how some nurses could view this as being micro- managed. So I go into great detail to explain that sometimes, a fresh set of eyes can pick out something that they might have overlooked. I had suggested letting them do peer reviews but that idea went over like a lead balloon. lol.

I am directly involved with the QI department so we are always conducting chart reviews on wound care patients, patients who were hospitalized, etc. Our approach is to provide QI feedback to the group as a whole without divulging the patient name or the nurses involved. Occasionally, we will have to meet with a nurse individually and coach her on what was missed, etc. I'll be honest, we've had a bit of a learning curve with some of our nurses both the new ones and the seasoned ones. As we have really revamped our QI department, our nurses are getting more feedback than ever. It's never derogatory or demeaning. I don't believe in that style of leadership. However, some nurses are receptive to feedback and some aren't.

My position as the Administrator is unique in that I'm actually middle management. I have an exec admin team above me and one clinical supervisor below me. I have to tell you~ middle management is tough. But I accepted the position so I accept all that goes along with it. I always make the exec team aware of the staff concerns. Both the clinical supervisor and I are solid advocates for our staff. But we also have to carry out the instructions of the exec admin team and try to meet the goals they establish for us. Sometimes, the goals are negotiable but often they are not. So we work diligently to come up with solutions that are win- win for both.

Perhaps it's the nature of a for-profit organization that is causing unhappiness. Our patients receive the services that they need. The staff members, clinical supervisor, and I are unwavering in that aspect. However, with all of these Medicare changes, we really have to plan ahead and really be smart how we spend their healthcare dollars. I'm not sure of any agency that can send a home health aide out 3 days a week anymore. One of the nurses told me that she didn't really think she should have to worry about any of the financial aspects of patient care. This made me really question if I had failed her in some way by not properly defining the role of a case manager when she was in her orientation phase.

I love the idea of improving the socialization aspect. I'm already thinking of things to do.

I'm not in any way trying to say that my company runs a perfect organization. We wouldn't have had the staff turnover of late. I definitely get that. But so far, I'm hearing the workload isn't completely unreasonable.. and that we seem to fair in what we expect of the nurses in the coordination of care aspect. A communication mishap? Perhaps. I'm doing some soul searching on that one. I've worked for employers who were cold, demeaning, and even derogatory. I sure hope I don't come across that way. It's definitely not my intention. I'm thinking my frustration with the situation is pretty evident. I'm working through that..... it's another reason I'm here....seeking info, suggestions, and tips.

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