Typical Day For A Home Health Nurse - page 22

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line... Read More

  1. by   MyUserName,RN
    So I thought I'd revive this thread again. I'm thinking of leaving my home health job. I've been doing it for almost 2 years now. Have really loved home health, but the charting, the never being "off" work feeling, I feel like I'm working so much that even though I'm making a lot more money than I did in the hospital, I think if I broke it down hourly, I'd be making a pretty low amount. I was very burnt out on working on the floor at the hospital and thought I'd never want to go back to that again. But it was my first hospital job. I never tried any other floors or any other hospitals. The things I miss about the hospital are working 3 12's and being off 4, when you're off, you're off. I feel like I had more free time for my family......so here's my day yesterday. I wasn't on my "A" game yesterday that's for sure, but here goes...

    Dropped my kids off at the baby sitters house at 745. Went to the coffee shop to connect to the internet and get caught up on some charting from the day before. Charted, ordered supplies, made calls to dr's, adjusted my schedule, called patients, calls to office etc, until 1130. (Working, but not getting paid for this time). Saw my first patient at 12pm....did not want to start this late, but had to get that stuff done. This visit was very involved, lots of wound care, picc line dressing change, calls made to MD. Spent an hour in home and didn't get any of pts charting done. Routine visit. Drove to next visit, was an admit, got to house, realized that I didn't have consent paperwork....great. Had to drive to the office to pick up paperwork before I could made SOC visit, this was 40 min out of my time. Called patients home, let them know I'd be late, they said fine...Drove back to patients home, arrive to do SOC, patient very HOH, very agitated, said he didn't want home health, refused my services.....Okay, so I just wasted at least an hour, maybe more of my day, for a SOC that I don't get paid for.

    On to the next house, this patient never answered the phone today, so I just showed up. She wasn't expecting me, but let me in anyways. Just a routine/sup visit, checked on meds, made sure she was taking the right coumadin dose that had recently changed, instructed on bleeding precautions. Everything was good with her and I was on my way. Still didn't get any of her charting done because I was in such a hurry to get to the next patient, by this time, I'm behind on time. It's about 3pm at this point. So I drive to my next house, routine/supervision visit with wound care. I arrive at home, nock and nock, nobody answers. Soon realize I'm at the wrong house. Lol! Go to the right house. Open my trunk and realize, I don't have my nursing bag!!! What!? I left it at the last house I was at....OMG! I have never done that before. Seriously, what else can go wrong with this day?! Drive back to the last house, pick up bag, go back to patients house and complete the visit....now it is 4pm. I called the next patient who hasn't answered the phone all day. Finally, somebody picks up. They inform me that patient has moved out of state with another family member and they don't know when patient will be back. Okay, so that's a non visit discharge....put that off till later. So I looked at the next days schedule to see if anyone else can be seen today. Move a patient over, go see her, take care of business with her. Day is over....except that I'm on call tonight and have an IV SOC that has to be done no earlier than 945pm. So I go to baby sitters house, see the kids for a little while, eat dinner, and then head out to the SOC that is about an hour away. Do the SOC, admin the IV, teach family how to do. Charting put off until tomorrow. Get home about 11 pm, kids stayed the night at baby sitters house since it was so late and had to drop them off early in am anyways.

    So that's my day yesterday. Oh and I stepped in dog poop. I didn't eat lunch, didn't stop to go pee and was busy all day long. It was a great day. (Sarcasm!) So looking back, I was working from about 830am to 11pm with a 2 hour break in between the night visit. So I worked for about 13 hours, still have tons of charting to do from yesterday, which will take me who knows how many hours to complete, but only got paid for 4 routine visits and a SOC. Now when I break that down.....the money is not very good. I know not every day is like that, but, it seems lately, I'm having more days like that than not. It's like a downward spiral, if one day is bad and you are behind on charting, the whole rest of the week follows suit. Anyways, as much as I love a lot of things about home health. I miss my kids. I hate being home and having to shew them away all the time because I'm trying to get charting done.

    Sorry for such a negative post. I just needed to vent.
  2. by   MyUserName,RN
    Quote from Libby1987
    Entirely depends on the preceptorship, a new grad isn't remotely prepared for the independent nursing judgement and decision making required of a nurse working alone in the field. At some point telephone consults will suffice but not initially.

    They may tell you that they will give you the easy non complicated cath changes and staple removals, but I doubt that'll stick, not when there are visits needed to be made and you're available. (If anyone could get a job just doing the easy visits they would get beat up after school..)

    Home health has a rep for being easy, it's not, not logistically, documentation wise or responsibility wise. Those sick patients that are discharged home barely stable? That's who you will be seeing. The number of patients I've sent back for sepsis with admission to ICU or acute CHF (and the pressure is on for us to prevent that) has increased dramatically in recent years. You want to make sure that isn't because you missed something.

    So my advice is don't let anyone jack with your liability, if you aren't offered a solid orientation, don't accept.
    YES! I have sent so many patients to the ER only of them to be admitted to the ICU. Very sick. I could not have done home health without my med/surg experience. You just have to have that nursing knowledge that only experience can give you.
  3. by   Libby1987
    MyUserNameRN, that was a sucky sucky day and I completely commiserate. I love home health and thrive in it but I know those days and if I couldn't get enough time at home with my kids I'd be exasperated and looking for something more workable too.

    My agency doesn't schedule visits for the on call nurse, in fact we don't agree to evening SOC or visits but it is an option for the individual nurse if they choose. (small semi rural retirement area, branch office) I haven't worked a weekend in years though I have to be available should I be needed. My patients are usually relatively close together and I live in my patient territory. The EMR we launched was horrible and it was a rough few months until they scraped it and started over. Mostly it is and has been a good career.

    If there is any possibilty that you can find an agency that has more family friendly scheduling I'd try that. It takes a number of years to maximize your efficiency so if you love the patient care part it may be worth staying with it in an alternative set up.

    Here's hoping tomorrow or at least next week is a whole lot smoother!
  4. by   Penholder
    I just started reading this thread and I have to say thank you! I have been a CNA for ages, am currently in school for my RN. For 2 years I did non medical home care scheduling/intake/actual care. As I get closer to finishing school I get more of a feeling that home care suits me. I like the connection. The more I look at doing more time in a facility the more I miss home care.

    My question is what is psych home care? I have worked inpatient psych, so I understand the population. Can someone enlighten me on this?
  5. by   ketchasketch
    Been doing home health, pay per visit, 7-9 visits per day, and I have never had a day like that... interesting.
  6. by   ketchasketch
    I have been doing home health for 10 years... in Denver and now in a rural part of Colorado... I have rarely had a day where not everything was finished by 6 PM unless I had multiple SOC that day... but routine visits, no matter how complicated, should and are documented and finished before going to the next home.

    1. That you had so much charting and stuff to do in the morning and did not get to go see patients until 12 PM indicates that you managed previous day poorly. Just an observation, not judging.

    2. I would have finished charting on first patient before going off to next patient... an extra 10 minutes to chart would have saved you guessing when you got home.

    3. It is legal and OK to obtain verbal consents and then perform SOC and have paperwork signed later. That would have saved you time.

    4. Next patient should have been charted on prior to going to next patient... I don't know how long it takes to chart for your company, but I have not worked for a company where a routine visit took more than 10 minutes... if you do your documentation while you are observing, assessing, etc... the myth that patients do not like this is false... rarely have I had a patient complain that RN was not paying attention to me while visiting... he was too busy typing on computer... if you do it correctly, you can make it a fun and acceptable visit.

    5. SOC at 21:45 are rare and we don't usually do them... the office makes sure that the discharge planner is aware that we are 9-5 organization but are on-call for emergencies and PRN visits if needed, and will do the rare after hours visits as long as somebody is teachable in the home so that it is not a routine after hours visit... but I have seen this maybe 3 x in my 10 year career.

    I pray you find your niche, but it seems like this may not be it... home health requires great organizational skills, good computer skills (or paper if your company is still behind), and a knowledge on how to document while talking while making everything make sense in 10 minutes or less.
    Last edit by ketchasketch on Aug 5, '15 : Reason: spelling
  7. by   WhitneyClark
    I noticed this is a rather long going and older post. However, if anyone would care to advise me on a few things of Home Health Care Nursing, it would be appreciated.

    I am going to be going through the nursing program soon. I really enjoy the medical field because I get to deal with people and care for them. This has always been my number one dream.
    My second dream is to leave the nest .. I have been living at home and going full time to school and getting great grades. However, more recently I heard it is getting pretty darn tough to land a RN job. I was looking into Home Health Care as a potential job someday.
    I have been reading some of the posts here and it sounds like something I would be good at.
    Just curious though.... Is this field plentiful with jobs would you say? And is this something I would be able to have a family (I am single and would be adopting)? Also, from time to time, do you get vacation? (I am wanting to volenteer my RN skills over seas every now and then) and would like to know if this is something I can do with thus type of job.

    Thank you
  8. by   Libby1987
    Much depends on who you work for.

    I strongly urge you to consider a company who assigns territories and then live in your territory. It will save time and increase your mileage reimbursement.

    I have standard vacation/PTO and am at 4 weeks/year PTO and 6 days/year sick time (accruable).

    I believe jobs are currently plentiful but require a year's experience.
  9. by   Emeraldturtle
    Thank you for this... I am considering a job offer in Home Health... But our school didn't provide us with much info on it.
  10. by   jennrn52
    I kind of forgot about this thread and found it again tonight. I came across my first post and laughed when I realized it was me!! I'm still doing home health, same company, same supervisor, but things are a lot different now. We get along great, I think she had to get used to me and same for me. My LPNs I work with are still here but only work weekends. I have another RN who just started PRN who used to work for us so hopefully that will help. My "partner" (the other full timer on my team) was off today for a funeral, so I took some of her patients.

    My original schedule was all routine visits with a couple discharges. BUT, two patients went to hospice and a third is doing the hyperbaric chamber for his wound. Took them off the schedule. That left me with a total of eight visits. My scheduler asks if I can do a start in my partners area, about 30 minutes out of my normal area. Sure! Why not! So! On to my day! I got to my first patient about 0900.

    patient 1- has surgical wound to hip, do the wound care. Excited because his dr was okay with me trying silver alginate and I saw today it's really working! He's had the wound for a long time, was in rehab since 2014 and had five surgeries on his hip in that time. They were just cleaning and covering it in rehab. His drainage is waaaaay decreased and the wounds almost closed! Woot!

    drive ten minutes to next one

    Patient 2- very very hard of hearing, was discharged from another agency for multiple missed visits. Because she can't hear for crap when they knocked. We took over, it's my first visit since my start Wednesday. Knock knock.....after five minutes of knocking and ringing the bell I gave up. Called the d-i-l, said I would try again in the afternoon.

    drive 30 minutes to next one

    patient 3- the hard one of my partner. Has an hour long wound care regimen to both legs, skin thickening, legs very large. His O2 sat was 71% on room air, slapped his oxygen on. He took a few deep breaths, denied any sob, asymptomatic. Recheck now 95%. Yay! Moving on.

    drive ten minutes to next one

    patient 4- another of my partners wound cares. Actually takes a lot less time now because they took off the wound vac. She said it wasn't healing and they are going to try the hyperbaric chamber. She will probably be a discaharge soon.

    drive 30 minutes to next one

    patient 5- my own patient, agency discharge. I was going to try and extend her visits, but couldn't get the order. She had heart surgery, extensive cardiac history. Educated again on cardiac complications, weight monitoring, meds and bowel monitoring since she's had some constipation. Gave her my number and told her she could call my cell with questions. I don't normally do that but I've had her before and just love her to pieces, and she doesn't follow up until Wednesday.

    drive 30 minutes to next one

    patient 6- the added on start. Tried calling, no answer, so I do a drive by. He actually is in an alf, but one I've never been to. Spend a few minutes talking to the LPN there, she then realizes he is already with another company. Sweet!! Less paperwork!

    Run in by the office since I'm five minutes away, give report (finally) on a couple starts I did yesterday and Wednesday (we normally call same day or the next morning but the supervisors and myself have been crazy busy).

    drive 30 minutes to next one

    patient 7- lady I had done a nursing dc on last week because her wound had been healed for 2 1/2 weeks. Went to doctor Wednesday and .....it reopened.... So this was my second revisit after her eval (she was still with PT). Wound is healing well, slap a dressing on. Spend a few extra minutes talking about my kids and their shenanigans, thinking I only had two people left and its 3:45.

    Drive ten minutes to next one

    wrong!! Forgot and patient 2 not answering earlier! Ugh! Went back and she was actually there. Reviewed her meds, told her we would be putting the DIL in touch with an agency to provide sitter care. She has dementia and DIL lives an hour away and can only get there on Sunday's. Very agreeable and was so relieved I came back instead of ditching her. Scheduled her next visit and took off.

    drive ten minutes to next one

    patient 8- daily insulin, very unpleasant, bipolar and dementia. Still pretty with the program but is in a locked unit because she would leave the alf and not tell anyone. Today she was in a good mood because Elvis came and performed, yay! My BP cuff sprung a leak as I was doing her vitals, boo!

    drive 20 minutes to next one

    patient 9- nursing discharge for my partner. Educated her on hypoxia and chf symptoms, still with PT and OT. therapy arrived while I was there, which was great because I could use her BP cuff! Finished the visit and took off for home, about 30 minutes away.

    finished the day at 530, but I still have a lot of charting to do. I probably could have rearranged my prescheduled patients to make the drive time less, but I hate doing that so I sucked it up today. How was your day??
  11. by   nickikatie
    HI! I just started doing Hospice Home Health last week. Obviously, I'm still in the honeymoon phase, but I'm appalled at the charting and other time spent that some of you are not getting paid! I record every minute I'm working, charting, checking addresses, driving between patients, etc. I get paid (hourly rate) for all that time. I'm a little nervous about driving in the winter, but so far, I love it! I've been doing midnights at the hospital (ER and ICU) for 23 years, and it was definitely time for a change. Midnights worked well when my kids were little, since we didn't need babysitters, but now that they're 13 and 11, it's time to rejoin the land of the living! Last week for my first week of orientation, I got up around 5:30, got ready, put dinner in the crock pot 2 days, made my kids breakfast and made sure they were ready for their day, left the house around 7, started working at 8, visits/driving/charting until 4, back to my kids' soccer game that starts at 5, and then dinner with the family. So far, the perfect job! AND I get to sleep with my hubby at night instead of working!! I hope I continue to love it!
  12. by   CathyRNMD
    I am considering leaving my hospital position to home hospice. I like the idea of 8:30a-5p, no weekends but it sounds too good to be true.
    As for charting, is it that much more complicated and time-consuming than hospital setting as I have read here? As a hospital nurse, I always find myself spending too much time treating the EMR than patients and I am hoping HH will allow me to spend more time with patients. I would appreciate some feedback and advice.

    By the way, I did a shadow day but I suspect it was one of those exceptionally good days at the best retirement community. I am interested in hearing about the real deal. Thanks.
  13. by   nurse.j.
    I'm a Home Health Case Manager and although it's not hospice, I know it's very similar. There is a lot of charting...but that's the trade off for making your own schedule and not working hospital hours. In the beginning the charting does take a while, you do spend some of your "free time" charting, however, once you find a method that works for you to get your charting done in a timely manner, you won't be spending your evenings after work or weekends catching up (not that you won't ever have that again...I do that when I've been lazy and just wanted to be done early). The way I schedule my patients is, I leave a couple of hours at the end of my day (try to see my last patient by 2), where my kids are still with the sitter, to make calls, catch up on charting and look at the next day. That way, when I'm home and my kids and husband are home, I'm there 100%. Not to say that a coworker won't ever call you after hours or you won't look at a chart...but I do that when my kids are in bed or being taken care of by my husband. I couldn't imagine going back to hospital nursing...I love the flexibility of Home Health and the patient care. You have 1 on 1 time with them and their families...time that you never have in the hospital. Not every day is great, you still have patients and family members that are a**holes or treat you in an unpleasant manner...but there are far more pleasant and very appreciative patients and families out there than their are rude. People that really love their home health clinicians. Another thing to get used to, is nursing in an uncontrolled environment. You have to be able to think on your toes, get creative in people's homes and be a strong advocate for them. Sometimes you are the only eyes on that patient. It can be frustrating at times, you may get a last minute order for a lab draw and not have supplies to complete...you show up to another colleagues patients house to provide care and the supplies you think they have, aren't there. You can spend hours tracking down the correct physician to get an order...but you take the bad days with the good.

    My ex MIL is a hospice RN and has done it for years. The cards and letters she'd get from families of past patients and the way she'd light up about helping them in a way you just don't have time for in the hospital, really turned me on to HH and Hospice. It is it's own beast and a totally different type of nursing... it's not for everyone or an "easy way out" , but it is where I feel like I belong in the world of nursing today.
    Last edit by nurse.j. on Mar 8, '16 : Reason: Forgot to add content