Is there a cap on maximum amount of patients per day

  1. Is there a regulation or law for the maximum amount of patients a home health nurse can see in one day? I posted a reply to another post describing my typical day and week.

    The RN's may do 7-8 visits per day, including recerts, admits, etc. I'm part time and am committed to 4-8 hour days, but if I already have 7 people to see, and a medicare referral comes in at 4pm, I have to do the admission. I often do not see the patients I'm responsible for case managing, and they do not follow my schedule. I usually do the equivalent of a 12 hour day, and I'm trying to get out of this mess by getting a new job before I leave this one, but I have no time or energy left!

    We also have no computers, no technology, and we're all swimming in paperwork.

    The LPN's are paid hourly, and see from 7-9 patients per day. They case manage their patients, also.

    Is any of this even legal? I would like to find the information online to find out if there is a cap on the amount of patients home health nurses can see in one day, and case manage, also.

    If anyone has any info, please reply. Thank you.

    Roxxy
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    About Roxxyruns

    Joined: Jun '09; Posts: 3
    Home Health Care/Visiting Nurse; from US
    Specialty: Home health, med surg, ltc

    15 Comments

  3. by   paradiseboundRN
    There is no cap in homecare. You have to be assertive with your manager in home care and learn to say "no" alot. If that doesn't work, try to find another agency to work for. Good Luck!
  4. by   caliotter3
    If someone is energetic enough and has clients that are willing to accept very early and/or evening visits, I see no reason why one can't do as many visits as feasible as long as the agency has the caseload to provide that amount of work.
  5. by   Nurse4life09
    wow, we are required to see 4 patients a day. Admits count as 2 visits. What kind of agency do you work for?
  6. by   AnnemRN
    seeing that many patient day after day will lead to major burnout. most agencies keep the daily patient load to - 5 to 6 patients for rn's and 6 to 7 for lvn's.
  7. by   DKS3132
    No, there is no law limiting the amount of patients per day.
    I agree with the first respondent that sometimes, you have to learn to, politely and professionally, say "no" to more visits.
    I have been on both sides of the fence, the scheduler trying to cover every patient's need and the RN running around trying to juggle a busy and ever changing schedule.
    I have learned to not say no right away but to work with the scheduler to see if maybe another patient could be moved to a different day to accomodate the new patient, I try to be creative.
    I have also learned that if you are the one who never says, no, they will always call you first when there is an extra visit to be covered!
  8. by   Roxxyruns
    I am looking for a new job. From my experience, 5-6 visits per day is a normal day for RN's and admissions usually count as 2 visits. I am getting quite burned out. All I do is work, and I really need part time for now.

    Yesterday, I was sick and had to call off. The LPN's picked up my revisits, so that they had 9-10 between 2 of them.

    I think that it's irresponsible for an agency to take on more patients than they can safely staff, and if the patients complain that the nurses don't spend enough time with them, the docs will stop referring.

    I appreciate everyone's answers, Thank you so much.

    Maybe there should be a cap on the amount of patients seen daily or weekly, or the amount of patients on a casemanager's caseload?
  9. by   DKS3132
    That day may come, they have been talking about this in the hospital setting for quite a while. But for now, I think, the only way this might get addressed is through union contract negotiations.
  10. by   AnnemRN
    Quote from Roxxyruns
    I am looking for a new job. From my experience, 5-6 visits per day is a normal day for RN's and admissions usually count as 2 visits. I am getting quite burned out. All I do is work, and I really need part time for now.

    Yesterday, I was sick and had to call off. The LPN's picked up my revisits, so that they had 9-10 between 2 of them.

    I think that it's irresponsible for an agency to take on more patients than they can safely staff, and if the patients complain that the nurses don't spend enough time with them, the docs will stop referring.

    I appreciate everyone's answers, Thank you so much.

    Maybe there should be a cap on the amount of patients seen daily or weekly, or the amount of patients on a casemanager's caseload?
    Yes, to the last question. I also think that physically it is too tiring to see so many patients and leads to injury. I also agree with your statement regarding agencies taking on more patients than they can staff. It does seem like most agencies are trying that route to beef up income. It does not allow nurses to provide quality of care, though which is the patients right and what's been drilled into our heads since nursing school.
  11. by   KateRN1
    I think that a lot of it depends on what type of visits you're doing and how much you're driving. For example, today was a particularly long day for me. I drove 100 miles, none of my patients were close together, for 4 visits, and two of them were discharges. If I have several patients in one place, like a senior high-rise, then I can see many more patients than if I have to drive all over creation. My max most days is 4, or 3 if one is an admit. If I had half of them in the same physical area I could probably do 7 or 8 in a day, but not with driving on top of that and running bloods to the lab to boot, or if there are any that require infusion therapy. There are just too many wild cards in HHC to dictate a max, IMHO.
  12. by   AnnemRN
    to some degree the driving area does play a part. although, i will tell you that lately i have been seeing 7 patients a day within a 30 to 50 miles radius and it is still very difficult. it is certainly not an 8 hour day. the case managers who initially were seeing 4 patients/day have now been seeing up to 6 patients/day and several of them are starting to look for other jobs.
    i've also noticed that patient care really suffers as case management becomes very sloppy with everyone being pushed too far.
  13. by   berube
    for all the years i have worked HH, (22), i think i can count on one hand how many days were 8 hr days,,,i believe it is just the way it goes in HH. there is always a patient that needs to be seen , an admission that "just came in"..so when i have "only 6 visits" i feel like i haven't worked!!!! i just try to go with the flow.
  14. by   AnnemRN
    i have worked over 13 years in home health and it is my experience that the agencies don't want you to work overtime. i have always had excellent annual evaluations that mentioned my time efficiency. i rarely had overtime and my patients were well cared for.
    on the other hand, lately with the daily patient load creeping up to 7, i do not get done in 8 hours. of course, management is not happy as they still want you to finish in 8 hours.

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