in crisis mode...

  1. i have been a home health nurse for about 16 years. i have always loved the job (still do). i have only worked at this particular agency, tho i have had different supervisors and different owners (my agency is independent and now part of a larger multistate company). my job is so difficult at times. i am wondering if perhaps it is just me, my particular office/company or is my frustration typical of the nurses/industry.

    1. how many patients are you required to see a week for full productivity?30-35 visits
    2. how much mileage do you average, and at what point does mileage get factored in with respect to the visits you are required to make?between 75-150. varies. get paid for milage.
    3. how much time is spent on an "average" visit?minimum 30 minutes but depends on the patients needs/education,ect.
    4. are you frequently "hassled" about productivity?somethimes
    5. do you spend time on paperwork off the clock? dailyif so, how much?minimum 2-3 hours
    6. do you accrue overtime hours?nothing i get paid for. i'm per visit so tho i work more like 50+hours week it isn't considered ot if so, how much on average?
    7. are you required to do chart audits in addition to your visits? yesis time alloted for this or are you just expected to "fit it in?"fit it in. usually fits in after the patients and before the paperwork
    8. what is a typical case load for you?i manage approx 42 patients at last count..for visits/oversight/paperwork/ect.
    9. is your paperwork all written or do you have a palm pilot or laptop to make it easier?handwritten
    10. have you ever been denied overtime your earned because you were not "productive" enough according to administrationyes
    in addition i am considered preceptor. plus case conferences. plus obqi committee (i didn't volunteer) i could go on and on and on about the paperwork. it is nothing for me to see 8-9 people in an day which typically includes an admission, 1-2 recertifications maybe a resumption. i wouldn't necessairly consider myself "burned out", but i just don't know if i can do this another 20 years. any thoughts...
    thank you all for letting me vent.
    Last edit by tennesseeRN on Aug 27, '06
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    About tennesseeRN

    Joined: Aug '06; Posts: 15; Likes: 2
    Case Manager/Care Coordinator; from US
    Specialty: 22 year(s) of experience

    5 Comments

  3. by   indigo girl
    Wow, serious burn out issues. Have you looked into other agencies in your area? What can you cut out? Maybe you need a break from home health.
    I don't see how you can keep this up.

    I used to work 7 days a week in home health, no overtime but it was worth it financially. There were no committees, no chart audits. We were paid by the visit so the more visits, the higher your paycheck. Our paperwork was done by hand, but many of us hired someone to type out our dictated notes onto our forms. It was worth the cost. Of course, being in a city, our cases were close together in location usually, and that saved time and gas so we could see many people in one day as we did not have to spend time commuting.

    I can understand that you probably love this work in this setting. I know I did. But, you have to take care of yourself. You are responsible for you.
    Do you really need to work full time?

    Please let us know how it works out for you and what you decide to do because it sounds like you are ready to make a change.
  4. by   mommazac
    At our agency our productivity for RN's is 5 patients per day, LPN's is 6. Caseloads vary from 25 to 50, some of our part time nurses pair up and co case manage a larger case load. Unfortunately, our agency productivity is at 4.9, with some of the nurses pulling more than others. We use a PDA for OASIS entry, but rest is on paper. Our nurses travel anywhere from 25-100 miles a day, depending on the area they cover. There is alot of paper work and PDA entry done after hours on your own time, the nurses are salaried, so overtime is not an option.

    This being said, our nurses are burned out, no doubt you are. Also, our nurses are required to work every 3rd weekend and take call 2 evenings every 3rd or 4th week.

    We are in the process of going to a completley computerized system, start training in 2 weeks. I am hoping this will save some of the time that is wasted looking for missing papers and charts.
  5. by   tennesseeRN
    Quote from mommazac

    This being said, our nurses are burned out, no doubt you are. Also, our nurses are required to work every 3rd weekend and take call 2 evenings every 3rd or 4th week.

    We are in the process of going to a completley computerized system, start training in 2 weeks. I am hoping this will save some of the time that is wasted looking for missing papers and charts.
    Our Call is every 4th week for the entire 7 days. And you bring to mind all the time I spend looking for papers/charts ect.
    I talked to a friend earlier today (nursing administration), and she pointed out one could look on this as a marriage, for good or bad, and I may be hanging on "hoping things will get better", because I do like homehealth. I think I would have a more positive outlook if I didn't feel as if I give 120 %, yet my manager can still point out "well if you had planned better", or "a prudent nurse would..." Morale is low at our office, yet the manager isn't leaving, our "numbers" look good so it's up to me to fix me. 16 years at one office is a long time. :stone
  6. by   indigo girl
    Quote from tennesseeRN
    Our Call is every 4th week for the entire 7 days. And you bring to mind all the time I spend looking for papers/charts ect.
    I talked to a friend earlier today (nursing administration), and she pointed out one could look on this as a marriage, for good or bad, and I may be hanging on "hoping things will get better", because I do like homehealth. I think I would have a more positive outlook if I didn't feel as if I give 120 %, yet my manager can still point out "well if you had planned better", or "a prudent nurse would..." Morale is low at our office, yet the manager isn't leaving, our "numbers" look good so it's up to me to fix me. 16 years at one office is a long time. :stone

    Too long. Look around.
  7. by   cherricka
    Answers to your questions.
    1. I work part time, 20 hours (yeah right!) a week. I am expected to see twelve patients
    2. I would say I average about 200 miles for three days work. We get something like a .25 point if you go over so many miles a day. I have not received a clear cut answer to that one.
    3. I spend about one hour on each visit.
    4.We are offered a 75 cent increase a hour if we meet our productivity expectation quarterly.
    5.I spend about one hour at the end of the day on paperwork and phone calls, up to 3 hours if I had an admission/recert/roc. Yes I charge them for it.
    6. We get time and a half on the weekends, no matter what. We get overtime only after working over 40 hours in a week.
    7. We have specific people doing chart audits, which I like. I have learned a lot from my mistakes!
    8. Typical case load for regular full time people- 25-30 visits a week. Admit and ROC are counted as two, recert as 1 1/2
    9. We are all on computer now. Some nurses hate it , I love it. It reduces mistakes and med errors, I think.
    10. No one is denied O.T. in our agency. If you are willing to work, they have it for you.
    Our company continues to work on what is considered fair productive expectations--as you said, we have a lot of meetings we are expected to go to, etc. I am also the go to nurse that they ask new nurses to go with, or students from the local colleges to go with. I don't get paid extra for this, but I think they are going to change my productivity expectations when I do this, since it takes so much time.

    Home care---you either love it, or hate it! Thank God I love it!

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