Why do you like home care? What are the advantages?

caliotter3 · Feb 16, 2011

For things clinical, there is a nursing supervisor and the Director of Patient Care Services, an RN. For purely nuts and bolts things, you may have dealings with the business manager, who usually is not an RN, but may be.

BrookeeLou_RN · Feb 16, 2011

So the underlying themes here are autonomy, diversity, and versatility. Right?
Who is your boss/supervisor? An administrator, a RN, a NP...?

For me the key is flexibility... You plan your day ..if you want to have lunch at noon plan it that way..at two..plan it.. If you are good at managing yourself your plan will work out 95% of the time!!

You have a clinical supervisor ot team leader who guides your clinical day problems, many places do have schedulers who tell you about next day/admissions etc. but some places Clin Sups do that also. They can call and change ypur day but n a good agency this is not daily occurance.. yes this messes with your plan but you go with it. Also sometimes pts are not home when you get there, so when you plan I always overlap time frames. For instance set up first patient at 9 am, next one 9:45 -11 next one 10:15-12 etc. or some nurses just say I will be there in morning or afternoon.. my patients hate that, as would I,, even cable co will give you two hr window.

Scheduling your day is hard to learn and frustrating for newbie.. but once you get it..it is so easy.

Above clin sup is usually a DON type and then Executive Director and then Administrator.who may or may not be a nurse.. great when they are as they get it but if not it is business. Sometimes an office mgr for payroll, office issues. This is how good size places are, smaller just have less bosses. In hospital settings you also will have all the levels of hospital admin.

ImThatGuy, BSN, RN · Feb 16, 2011

Seems like it might not be a bad gig to pursue. I've worked largely in law enforcement with some dabbling as a paramedic. I'm used to work by myself. When I'm not I'm not happy. I also like diversity in my day obviously. I thought the ER was the best way to get that since you're not with the same patient all the time, but the more I think about it I'm kind of tired of fighting with crackheads. We'll just have to see where the road leads....never knew it'd go to nursing school or policing for that matter.

Isabelle49 · Feb 23, 2011

I have done Home Health nursing for 8 years now and my salary has decreased over that time. As medicare reduces payment to agencies, agencies make it up by decreasing salary. We are paid per visit. We are on paper and that takes time, and they are forever finding a new piece of paper for us to fill out. Mileage is mediocre, and you are not paid for sitting in traffic and that burns up gas. Am prn and very picky on where I go and when I go there, am not going to waste time, money, or gas. Looking forward to retirement soon.

BrookeeLou_RN · Feb 23, 2011

I have done Home Health nursing for 8 years now and my salary has decreased over that time. As medicare reduces payment to agencies, agencies make it up by decreasing salary. We are paid per visit. We are on paper and that takes time, and they are forever finding a new piece of paper for us to fill out. Mileage is mediocre, and you are not paid for sitting in traffic and that burns up gas. Am prn and very picky on where I go and when I go there, am not going to waste time, money, or gas. Looking forward to retirement soon.

Number one go to work for hospital with an agency attached,, better chance of maintaining census.. number two only work salary or hourly no per visit or you will not make enough....Number 3 Everyone has to be on computer soon per Big Brother,,, and then you will wish for paper with all your heart. I can document 3 patients on paper to one on computer and I am very good with computer!!! Number 4..get a day calender, mark down all mileage every day,, what they do not re-pay you for,, you use as tax deduction for working out of your car..pain to keep record but gets you top$$ available per Uncle sam. Number 5 if hourly or salary you do get paid to sit in traffic and many agencies have a little bonus pay for when you have to drive over one hr or something like that.. they will never offer, you must ask! Number 6 if you are prn or very picky you may as well hang it up,, having been a supervisor the pickiest get called last for cases. Go Fulltime, get the benefits, and if they are paying be their...... go to person! Occassionally if the case has a high reimbursement score and is really far out or nasty,, you can get alittle more....again say no then say well maybe I could do it for you..make them beg!!. No offense but being a guy they will give you the tougher cases or neighborhoods, fact of life.. But if ever uncomfortable, you get out.. or only go in with a police officer. Bad neighborhoods..trick is to go early,,, and make sure they know you are a NURSE and are caring for someone's grandma!! Once, I got a gang escort to a patients home with a gang member sitting watching my car because the patient was the Leader's grandma!!

Do case management or primary nursing if possible.. that way you manage the case (different from hospital case management!), you go see the patients more times than others..A great setup I had once is I had my own LPN and CNA and I scheduled their days around the cases I really needed to lay eyes on!! Truly the best set up but not found too many places. And every agency is different,,, so do not think just cause Place A here does anything like Place B across the street. Some you never want to to work..easiest way to figure that out is ask what percentage of recertifications they do on average.. That is where Medicare has pd the pocket of money for 60 days and you are supposed to be done but you aren't and pt gets recert.. Some cases like a lifetime foley very standard, heavy wound care, same thing...COPD, Diabetic not brittle.. forget it.. they are walking the Medicare fraud line and you want no part of that. You'll know pretty fast even if they lie up front.

If you have more questions you can always PM me and I'll tell you anything I know.

Again try it 6 mos... I bet you love it but just in case..it is not for everyone..No one there to help you out, have to be creative, ahng IV's from drapery hooks sometimes..that kinda thing.. But the rewards!!!! And ER will be great preparation for being creative.

And I have worked prn but I like to know exactly what is happening with my cases and prn is more just going out making visits.. Not a thing wrong with it by any means..but no money in it.. great for moms who want a day or two/week or nurses ready to retire.

ImThatGuy, BSN, RN · Feb 23, 2011

Having been a police officer (wont completely quit actually) I know my way around a bad neighborhood and I can always wear my concealable body armor lol. I also have a concealed handgun everytime I step out of the house. Its concealed (and legal) so no one ever knows. I've already thought this through.

shondaRN · Feb 27, 2011

Simple, I can do more for my one client without anyone (usually, except for the family) breathing down my neck and can see what I have accomplished on a daily basis. I do not have a laundry list of things I did not accomplish by the end of the shift like I did when working with 80 clients in a LTC facility.

You hit it right on the mark! :yeah:

shondaRN · Feb 27, 2011

Imagine this: As on on call hospice nurse i work 5 weekdays, no weekends, eight hour shifts--i get paid, guaranteed, for the full eight hours though sometimes i see no patients, and other times see up to four patients per night. It is not a pay per visit scheme. I never get overtime, nor do i want it. With zero to four patients per evening--the average is only two--i have plenty of time to do my computer charting and sync it. Now, how sweet is that? With a cushy job like this, i'd be completely out of what is left of my mind to go back to back-breaking, mind-numbing hospital work.

You mentioned you do want to do any overtime. I can totally relate. But I was wondering if your employer ever gives you more patients than you can handle in 8 hours. It sounds like you have a great job! :nurse:

enchantmentdis, BSN, RN · Feb 27, 2011

You mentioned you do want to do any overtime. I can totally relate. But I was wondering if your employer ever gives you more patients than you can handle in 8 hours. It sounds like you have a great job! :nurse:

Because i work the 2-10:30 pm shift, there are two other nurses who work 4-midnight for overlap cases--so they generally don't call me after 9:15 pm, which prevents overtime, because one of the 4-midnight nurses can take those cases. Usually i get one or two cases from the office between 2-5 pm and then i let the on-call service know i am available only after i get done with the cases and have documented on those cases that i am already visiting. The most patients i've ever seen in an eight hour shift is 4, so, no overtime is not an issue. The other night, for instance, i received one delivery request from the office before the on-call service takes over, and i also got a continuous care eval visit from the office. The delivery was a 20 min drive with a 5 minute delivery, and 15 minutes of computer charting, but the continuous care drive was a 40 min drive and a 3.5 hr visit just to get the patient under control and deal with disfunctional family members; then with the computer documentation, hospice pharmacia calls, doctor phone calls, etc and waiting for the continuous care LVN to arrive and take over--well there goes another two hours; so before you know it, it was time for lunch, drive back into town, shift nearly over and drive back home. This is a fantastic job; i am constantly telling management how fortunate i feel to have this job. This is the first nursing job i have had where i felt i was appreciated by management.

hawkfdc · Mar 3, 2011

I made the transition to home health nearly a year ago and am so glad I did. Enchantment basically summed it all up. If you are organized, like to drive and can not let things bother you too much then you can do home health. Some have said salary is the way to go, others have said per visit. I do pay per visit, righ now my census is low and I just looked this morning and my paycheck was pathetic ($900 for 2 weeks worth of work) but I was home by noon every day. Last summer when I was doing 40 visits per week those two week paychecks were nice ($2500 once, most all over $2100). Its up and its down and as long as you can adjust your spending accordingly, it will work.

Now I've not seen this said yet, maybe it was said but not very emphatically, so if you tae nothing else from this home health thread, understand this. IF YOU CANNOT TOLERATE ANY OF THE HOUSES FROM THE SHOW HOARDERS THEN YOU WILL HAVE A HARD TIME IN HOME HEALTH. Yes, there are some nasty a$$ people out there and there will be instances where you will have to make the clinical/social decision to contact DCF. I have had my share of cockroaches, piles of trash, and unsafe living conditions but as my supervisor said one day there are people who choose to live like this and there's nothing you can do about it. They're rare, but they do exist outside of TV.

Have to go now, have to see my 5 and get home by 2:00.....:)

hawkfdc · Mar 3, 2011

And another thing....you have to be prepared for those unexpected things like dead batteries....kinda like what just happened to me.

ImThatGuy, BSN, RN · Mar 7, 2011

And another thing....you have to be prepared for those unexpected things like dead batteries....kinda like what just happened to me.

If you work out of your vehicle there are a few necessities. One is a phone book. Another is an inverter that'll let you plug in all your wall chargers and run off your car power. Finally, a car battery charger that can charge off of your car battery is pretty darn handy. Keep a tire gauge nearby! Happy motoring.