I love home health but I miss my life

CFLA.RN · May 20, 2016

Work/life balance is a struggle for the majority of home health nurses that I know. The best days I have are the days where I charted completely in the patient home during the visit, at least everything except the narrative note. Over time you'll learn to get faster with charting and it really makes a difference. My first company used HomeCare HomeBase (HCHB) and in the beginning it took 30 minutes for me to chart a regular visit and about 1 1/2 hours to chart an admit. After a year I was able to chart a regular visit in 6 minutes and an admit in 30-45 minutes. The key that helped me was copy/pasting common teaching guides for the narratives. I had a desktop folder with every medication I ever taught on so that I readily had access to teach the patient and had Medicare approved documentation for charting.

I also learned to go into a home and tell my patient that the first thing we were going to do is run down the assessment list so that I could put that in the computer and then we could address everything else. Some patients don't like that but the majority of patients would rather let you spend 5-10 minutes doing your assessment and charting so that you can spend the rest of your 20-30 minutes completely focused on them with your device turned off.

As far as points - 27 points shouldn't be too many visits a week. Most home health nurses don't know how to say no and end up picking up more than the requirement. Learn to say no if that's the case. It's important to create healthy boundaries with your employer because they will always work the "yes" people to death.

It takes a good year to get into a routine with home health, there will be days that even your best intentions with charting fail and you spend all weekend catching up. But then there will be days when everything works beautifully and you find yourself at at 3 with nothing to do but relax.

Haddoa · May 20, 2016

Have you looked at a different agency. I also left the hospital about 8 months ago now for HH. We are payed per visit. I see 5-7 a day and can almost always see my pts 8-230. Pick up my kids and come home and finish up what I didn't in the home, which is very little. I work 34-38 hours a week except the weeks I have weekend call, like this weekend. :***: We are on a pretty old computer system but go to homecare homebase next month on iPads. I also freely say nope. Can you do a soc? Me: no I already have 6 and my daughter has a softball game tonight. My boss: ok sounds good. Someone else will always take it and I do when I can. I would really consider looking around. I wouldn't trade this job for any other job out there, I promise it can be amazing! Also it helps all my pts are normally pretty close to each other so drive time between is usually like 6-10 min.Good luck and I super hope it works out for you!

Libby1987 · May 20, 2016

Home health is a field where you have to develop before you can really take advantage of the life friendly hours. And that development is primarily dependent on each individual. School doesn't prepare you for the skill sets needed to be happy and successful in HH and having precepted many new HH nurses from a variety of backgrounds, I can tell them how to do it, I can demonstrate it and I can share every tip I've accumulated over decades in HH but ultimately it becomes something they have to work out.

Another important aspect, you will have best long term experience if you gain working knowledge of the job and then relocate and negotiate with an agency that has the best logistics for you.

OldDude · May 20, 2016

It's not possible...EMRs and technology has gotten so "advanced" that patient care has become a nuisance. Now that licensed staff are relegated to the level of what used to be the responsibility of data entry clerks to complete the yearly additional documentation requirements and provide patient care and drive between patients, deal with traffic snarls, it's not possible to be completed in a 8 hour day. So the day stretches to 10, 12, 14 hour days while the nurse, PT, OT, is being paid a "salary" - defined to mean, "If we paid you an hourly rate you'd be making $300,000.00/year+ and those salaries have to be paid to upper level management who don't actually generate a dollar. Similar to the remora attached to a shark. Add weekend coverage and the deal is even sweeter for the company.

Oh yea, you can listen to those who "used" to do patient care tell you how it can be done in an 8 hour day. Of course they won't actually "show" you it can be done because it's not possible.

My wife is a HH PT and 15 years ago she had a life (yes we were married then and she worked HH then) and year after year technology has taken bite after bite out of her day to where she is today, 60 to 70 hours weeks plus the shared weekend requirements.

Like I say, you can drink any flavor party line company koolaid but at then end of the day, reality is reality.

Libby1987 · May 21, 2016

I left the field only 9 mos ago, I've documented on paper and EMR, and I could finish in an 8 hr day. But I lived in my patient territory which was semi rural and only commuted to the office 1 x week. I was PPV and made a nice income working M-F flex hours and never missed anything important with my kids.

You can't do this with every agency and every territory but if you are willing to establish a home health career before committing to a residence, you can set yourself up well.

A good home health career doesn't necessarily fall into your lap and you can't always make it work with the agencies in your area. So many go into home health as a plan B after losing the ability to move for their career and that is very self limiting.

OldDude · May 21, 2016

I left the field only 9 mos ago, I've documented on paper and EMR, and I could finish in an 8 hr day. But I lived in my patient territory which was semi rural and only commuted to the office 1 x week. I was PPV and made a nice income working M-F flex hours and never missed anything important with my kids.
You can't do this with every agency and every territory but if you are willing to establish a home health career before committing to a residence, you can set yourself up well.
A good home health career doesn't necessarily fall into your lap and you can't always make it work with the agencies in your area. So many go into home health as a plan B after losing the ability to move for their career and that is very self limiting.

I hear ya, but PPV/Flex versus full time/salary is comparing apples to oranges.

bfit262 · May 22, 2016

Thank you so much for your feedback! Yesterday I tried a new tactic where I planned out my day the night before and said no to last minute scheduling requests. However I found new decubitus ulcers on 4 of the 7 pts I saw. Some of these people had just been seen 2-7 days previously. It's possible that they just occurred but I think that the need for speed is preventing the time needed to accurately assess. I then got an email the next day saying that the pt I had put a hydrocolloid dressing on had breakdown with no dressing. This probably means that one of the multiple caregivers removed it.

So I am going to use your suggestion to use a desktop folder for teaching templates. The copy/paste feature will definitely help me free up time. I will also begin saying no more often. I tend to take too much on.

I am looking forwarded to streamlining my processes in the next 6 months and getting through this first year so I can enjoy those days when 3 pm comes and I can relax!!!

Thank you again!

bfit262 · May 22, 2016

Thanks so much for your positive feedback! I think changing to a pay per visit system is a good idea. I was just worried I would not get enough work. I don't need benefits but I was told I had to take a full time position because I had not had previous home health experience. I would much rather do per diem as long as I could make enough money. It seems that they try to overload the full timers and give the per diem people the scraps left on the weekends and after hours. It sounds like it may be time to have a discussion with my manager and see if there are PPV options for me.

Thanks again!

Farawyn · May 23, 2016

Thanks so much for your positive feedback! I think changing to a pay per visit system is a good idea. I was just worried I would not get enough work. I don't need benefits but I was told I had to take a full time position because I had not had previous home health experience. I would much rather do per diem as long as I could make enough money. It seems that they try to overload the full timers and give the per diem people the scraps left on the weekends and after hours. It sounds like it may be time to have a discussion with my manager and see if there are PPV options for me.
Thanks again!

I'm PPV and I can work every day if I want. Depends on the area and the need. I can do up to 5 wounds a day if I want.

But I don't want. :)

Good luck.

Libby1987 · May 24, 2016

Wait, you see 7 patients a day and you're only 6 mos in? Is that every day or a fluke?

Our new nurses aren't seeing that many at the 6 month mark. With us, that's a senior nurse average and if PPV, can be very lucrative.

Jensmom7, BSN, RN · May 24, 2016

Thanks so much for your positive feedback! I think changing to a pay per visit system is a good idea. I was just worried I would not get enough work. I don't need benefits but I was told I had to take a full time position because I had not had previous home health experience. I would much rather do per diem as long as I could make enough money. It seems that they try to overload the full timers and give the per diem people the scraps left on the weekends and after hours. It sounds like it may be time to have a discussion with my manager and see if there are PPV options for me.
Thanks again!

When I did Home Care, the only way to get health insurance at the agency I was at was to be full time. I was the only full time nurse they had. I was also salaried, and the other nurses were FFV.

Can we guess where this went? The FFV nurses could refuse any admission or visit they wanted to, no questions or consequences. As a full timer, I was not allowed to say the word no; I had to take anything they threw at me. The intake person actually said that to me: "You have to do this, you're full time."

This meant that in addition to 5 or 6 scheduled visits, I could have 1-2 admissions. I was routinely putting in 10-12 hours in the field, over 100 miles/day on my car, going to the sketchiest neighborhoods in our service area (which included Chicago, home of the sketchy neighborhood) and then several hours at home playing paperwork catch up.

Because I was salaried, there was no overtime. After factoring in all the added hours, I was making about $10/hour. The FFV nurses were making money hand over fist, were done by 1pm, even after seeing 6 patients, because they would only choose patients within a certain distance. Some of them were literally able to park their car and walk to most if not all of their visits!

Thinking about that job still gives me stomach cramps, even after several years. If I hadn't needed health insurance, I wouldn't have allowed myself to be treated like that.

Home Care can be rewarding, but the potential for being taken advantage of is just as bad as in a hospital or facility. Maybe worse, because you really never see your coworkers and you have no idea if their load is comparable to yours or if you're being worked like a Hebrew slave.