Home health rn, does this sound right?

[ZandZmommyRN]

I have been working as a RN for a very small home health agency in a small town. I previously worked 12 years in acute care and now want to work very part-time as I want to be home with my kiddos. I took a home health job for a small agency that advertised part time work. They mainly take patients that need help with med minders and very simple issues. No IV's..or complex wound care. Ok, great! They advertise that they have a 24 hour on call nurse which is basically the RN director. It is just the director, myself, a semi-retired RN, and about 6 CNA's. They gave me a phone to answer and basically said if a patient calls for a simple issue I can just go make a quick visit. My normal days to work are Wednesday and Thursday morings/afternoons. It irritates me that my patients or director can call at anytime and tell me I need to go check 'so in so' for whatever. Not to mention that the director calls me like almost everyday to tell me something about a patient or whatever news she deems necessary that I know. I think that they should have a definitive on call schedule, right? I mean I feel like I can't go anywhere or I can be in the middle of something and have to go see a patient. Is this normal for home health? The director has told me before that she is salaried and they don't like the nurses and aides to get too many hours because they have trouble making budget. When I do get random calls to see a patient I only get paid for the actual time I am with he patient and sometimes that is like 15 mins to check something. I don't think this is fair. I got a call today (Sunday) in the middle of family time and had to go adjust a patients dressing. I hate not having a set schedule or knowing that I am on call so I can make provisions for this. Is this normal home health or are they sort of taking advantage? Thanks for any info!

[TriciaJ, RN]

I've never worked home health but it's not unusual for employers to mistake their employees for indentured servants. Many managers love the idea of having people at their beck and call. This is where boundaries come in.

Let your director know which days you are able to work and which days you are available for call. Calls at any other times go to voice mail and you make no guarantees about checking your inbox. Since you sacrificed the pay and benefits of full time acute care in order to be with your family more, this job is defeating the purpose. I suspect this employer needs you more than you need them.

Be cool, calm and polite, but make your director know in no uncertain terms that the current arrangement is not sustainable for you.

[Libby1987]

This is the challenge working for a little start up, or one that never builds a referral base.

Really, only experienced home health nurses should be part establishing a new agency because the hours are extreme and irregular until a patient census is built to support full staffing. I say experienced HH nurses because they know what they're getting into and would have their reasons to want to participate. Hard to find those nurses though when most want stable hours and wages.

So not normal in the usual sense but expected with a tiny operation. Theoretically the agency has to provide services to existing patients (depending on active patients' needs) 7 days a week and there's no way around pulling on you when you are essentially and solely the nursing team.

How did the director explain this to you?

Also, based on your description of visit type and length, these aren't necessarily billable visits. Is this agency both licensed and Medicare certified (not likely)?

ETA if you have 12 years recent acute care experience, you can do much better than a rinky dink agency. The challenge would be finding one who would hire an RN without home health experience into a part time position. A solid orientation period is costly for only a part time ROI as well as you want to be well prepared to work autonomously and competently in a field new to you. If you can and are willing to make the initial investment in return for years of future flexibility, I'd recommend obtaining a full time position with an accredited agency and reduce to part time after a year or so.

[blockhouseclaudia]

Most agencies do not expect a part time RN who works 2days per week to also be on call at all times.

[Elfriede]

Switch off the phone. If your contract shows 2 days, than that´s it. If they want you on call ... Let them pay for it !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[CPLibra, ADN, BSN, RN]

New Graduate RN, with no prior RN experience, been working in Home Health a little over 1 month now.

The HH agency I work for is a Mom & Pop ran by individuals who use to be an auditing company for charts for Medicare. They have absolutely no experience as an RN and do not understand what it entails to be a nurse.

Like you, I also get calls on my days off about my patients, I get calls when I am not seeing patients on my days off, when I am out with loved ones, and when I am sleeping-in on my days off. What I don't understand is why there isn't an online medical record documentation system that would alert the nurse about new information on patients when they signed in to view their patient care portals/lists.

Maybe I was just spoiled by what I've seen the hospital documentation systems can do in regard to alerting the nurse about new interventions, tasks, to do list, etc., during my clinical's rotation during nursing school.

[Daisy Joyce]

Did you know about this going in?

The agencies I work for (per diem), I contact them with my availability and they schedule me or not.

It tends to be feast or famine.

[KelRN215, BSN, RN]

The simple solution to this is to turn your phone off on Thursday at 5pm and leave it off until Wednesday at 9am. In your voicemail message you say "this is ZandZMommyRN, I work Wednesdays and Thursdays. Any other day of the week, please call [insert 24/7 number here]." The end. Set limits and do not let them take advantage of you.

[recruitern]

I think they have job descriptions confused. I work for a LHCSA and we have a Director of Patient services who would be on call, not the Per Diem Rns. The Rns have a caseload and are responsible for make their visits based on their patients frequency, but if there is anything urgent, the DPS is the one that goes out to make any "as needed" visits. She is salaried for a reason. She will not be paid for additional visits so it should be her responsibility, not yours.