Home Health RN should Unionize and Strike

4evernrs · Jun 19, 2010

Not sure I understand what you are saying.... something about Oasis being responsible for lack of care???? Please clarify.

allnurses Guide · Jun 19, 2010

What kind of events are you asking about? I thought the RN always did the OASIS.

Willow Moonsidhe · Jun 19, 2010

When the federal government makes a rule it is usually to protect someone. In the case of HH it protect those on Medicare. Is it really functioning this way. I know I am good at doing Assessments, but I am also a good Skilled nurse. In four weeks of working for the new company. I have done one wound care and one lab work blood draw. That is the extent that my skills have been used. I sit night after night pouring over paperwork and then the company pays another person to check that paperwork. They call me and give me the third degree on my answers even though they were not in the home doing the assessment. Talk about money spent. I am not sure this is exactly what Medicare had in mind when they set up a RN doing Oasis. I think they basically were trying to make sure people on Medicare got good care. As with all things now though; companies have found they can use the RN for paperwork then have a LPN do the skills. It is cost effective; but is it good for our patients. I would hate to know the number of patients already I have gone to Discharge who had to be recerted with health problems not reported to the office. It is not the LPN's fault they have there own stress because if anything goes wrong they have been the only nurse to see that pt in 60 days. Just like HHA's I feel a RN if responsible for that pt and supervising the pt should make no less than a weekly or biweekly visit to see if they are ok. RN's are seeing a major role change and just sitting back and doing nothing about it.

Home Nursing Agency

Not sure this answers the question. I just feel initially Medicare did not set up Oasis so companies could just use RN's to fill those out and nothing more.

~Willow

allnurses Guide · Jun 19, 2010

The world of the Home Health Agency is striking for it's variety in how things are implemented beyond the unchangeables of Medicare regulations that if not done, will cause the agency to not be funded for those cases and eventually fold.

As far as I know, the OASIS and recert visits have always been an RN only responsibility. The RN who does this is supposed to be supervising the team, whether LVN, other RNs or HHAs. The degree of communication you have with the others isn't limited to every 60 days, and as far as I know, phone calls and written communication notes between you and everyone else to provide you with an accurate snapshot of the patient's status at all times has no restrictions. If there is such a change, the field staff is not doing their job if they don't notify you.

The field staff, whether RN or LVN, should be notifying you of any significant changes in the patient's status that will change your OASIS, and also of hospitalizations. You'd think that would be obvious, but I've seen it more than once-- the RN supervisor has no clue for weeks at a time that their patient was admitted and discharged! :eek:

Some agencies hire RNs to do the episodic visits, some LVNs, some a mix of the two. Some agencies hire RNs to do in-home private duty if the patient needs it, most hire LVNs for that-- but that doesn't mean you should be living in an information void!

I've always felt, as an LVN taking care of the patient day after day, that I'm an under-utilized resource that can make the RN supervisor's job a lot less stressful than it is, but for whatever reason they rarely ask me for my input, even when offerred. Why this is, I don't know, but the best RN supervisor I've worked with in 6 years would actually call me a few days before her scheduled visit and get a run-down of the patient's current status, with special concerns I may have and potential problems in the making. It made everything go smoother, gave her an idea of priorities, and avoid asking routine redundant questions at the last minute that eat up her time.

Sorry you feel so dissatisfied with the situation that you would want to go on strike, but there really are good agencies out there, and maybe you would be happier working for one that sends you out on visits, and not be responsible for all the paperwork? Best wishes to you, anyway!! :nurse:

annaedRN, RN · Jun 20, 2010

I understand what you are saying and I realize that it happens frequently....depending on your agency. You cannot blame Medicare or OASIS for how your agency chooses to utilize the RNs/clinicians performing assessments ( there are plenty of other things to drag Medicare into....) At my agency, we have a few weekend RNs that do mainly OASIS...but primarily the RNs are case mgrs. I perform OASIS, as well as plenty of follow up visits. On the more chronic, stable patient that the LPNs follow - I still see them atleast every 2 weeks (usually more). There is plenty of continuity of care. There is also alot of communication between all the disciplines involved with the patient so they do get the best care possible - we change the plan of care accordingly. I get to do lots of wound care as well as IVs, labs, catheters, ostomies, teaching, etc. For me, OASIS is a big part of the job...but definitely not the only part. While I understand your frustration - it seems that it is more a problem with your agency...not HH ( or Medicare)in general.

Willow Moonsidhe · Jun 20, 2010

Maybe so I am the only Full Time RN besides the CM and DOO. So I get all Admits. The paperwork after hours is insane. I can remember years back working home health before Oasis and my day was done when I went home.

anticoagulationurse · Jun 22, 2010

Willow - I feel your frustration, but agree it may be misdirected. Striking because of OASIS is not going to change Medicare. OASIS is here to stay and as annoying as it is I have grown to see that it serves a purpose and a standard of assessment which I can appreciate. I also agree perhaps your agency doesn't utilize the RN's properly. Or, perhaps since you are the newbie, you are getting stuck with all the admissions nobody else wants!?

Either way, I spent MANY many, horribly long 14 hour days seeing patients and charting until midnight when I started. I would cry and cry in frustration. This lasted about 6 months until I hit a wall where I suddenly seemed to be able to groove through all the minutia and get it over with and my days became much more reasonable. Now, it is a (pretty much) breeze. I will admit I have MUCH less charting on days where I am scheduled to see only repeat visits and no OASIS. Give it time to get in a groove. It is a nice place to be in and much less stressful. Hang in there!

Also, I don't think Medicare instituted OASIS for the purpose of protecting people. Pshaw! The motive is always money, always (Medicare doesn't deliver care, they pay for it). OASIS is a way of measuring outcomes and thereby affects reimbursement, not patient care. It should never have an effect on the care YOU personally deliver to a patient. That part always rests on the nurse, not Medicare, not the agency, not anyone but those touching the patient. Us! Take heart, you're a great nurse!

tewdles, RN · Jun 22, 2010

I think I understand the concern.

Basically RNs become OASIS machines. I know that when I worked in HH I primarily did OASIS, post hosps, recerts, and discharges. I "case managed" 48 people. I had never actually visited 36 of them...couldn't even look at their electronic chart on my laptop because the software we used wouldn't allow it unless I had visited sometime in the past 14 days. This did not bother the employer at all...NOT AT ALL...afterall, they were seen by the team LPN (who was excellent).

There were literally people on my case load for 2 months without an RN visit except for the admission and recert visits. I was held responsible for hospitalizations of patients...as case nurse I was eligible for a bonus if a low percentage of my patients were hospitalized during their HH. What craziness is that??? I wasn't the one seeing them...I couldn't even review their chart for pete's sake. I had nothing to do with their hospitalizations or health declines.

It wasn't like I could just determine to go visit them...the central office scheduled my day/week and I never had fewer than 8 visits (except of course on those days that I had 3 admissions). Wouldn't have known these patients if I ran into them in McDonalds yet the company called me a "case manager". LOL

Of course, that was my experience in for profit HH with one company. Personally, I am glad to have that foray into HH behind me.

caliotter3 · Jun 22, 2010

I worked for an agency that was union and for another agency where an attempt to bring in the union was attempted. In both instances no one would have been interested in striking for any reason. Paid employment is a very valued commodity in that area.

Willow Moonsidhe · Jun 23, 2010

I think I understand the concern.

Basically RNs become OASIS machines. I know that when I worked in HH I primarily did OASIS, post hosps, recerts, and discharges. I "case managed" 48 people. I had never actually visited 36 of them...couldn't even look at their electronic chart on my laptop because the software we used wouldn't allow it unless I had visited sometime in the past 14 days. This did not bother the employer at all...NOT AT ALL...afterall, they were seen by the team LPN (who was excellent).

There were literally people on my case load for 2 months without an RN visit except for the admission and recert visits. I was held responsible for hospitalizations of patients...as case nurse I was eligible for a bonus if a low percentage of my patients were hospitalized during their HH. What craziness is that??? I wasn't the one seeing them...I couldn't even review their chart for pete's sake. I had nothing to do with their hospitalizations or health declines.

It wasn't like I could just determine to go visit them...the central office scheduled my day/week and I never had fewer than 8 visits (except of course on those days that I had 3 admissions). Wouldn't have known these patients if I ran into them in McDonalds yet the company called me a "case manager". LOL

Of course, that was my experience in for profit HH with one company. Personally, I am glad to have that foray into HH behind me.

This is exactly what I have found myself in. I have yet another job interview on Thursday with Advance Home Care for a SNV position where I do wound cares and such. No Admits. To be honest even if it is less pay I would rather take a cut in pay and give patients real care than fake care. Just my opinion.

They called in the Regional manager today to ask if things were going ok and he asked the wrong person because I am too honest. I told him he had a job to make money and mine was to be a patient advocate. I explained how it felt to be placed in a position to be these peoples nurse but in reality just a paper secretary. I told him that was not what I went to school for. I think he had not seen such honesty and direct talk. My boss could not look me in the eye. I told her I have to be able to trust what she says or I will not work for her. Also told her the job is not what was described to me during the interview and brought her own words back to her. Seems they just tell you what you want to hear to get you.

I am hoping since the other company does nonprofit for a big hospital here it will be different. Say some prayers for me it is. I love home care so much and the patients just not the political bull.

Thanks for all the replies!

~Willow

allnurses Guide · Jun 23, 2010

Best wishes to you in your new endeavor, Willow. I applaud your courage in using such plain and direct language during your meeting with the Regional Manager and your boss.

It just may change their approach to the next nurse in line behind you. :redpinkhe