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I used to love home health..

by decadespast decadespast (New) New

Hey all! This is a vent/what would you do thread!

I've been working in home health for over five years. I get paid per visit. I loved it until up about a year ago. Way back when, I saw approximately six or seven patients a day (for instance, 5 regular visits, 1 soc, 1 recert). This, to me, was doable and perfect. I was also backup on call every 4 weeks (doing pm admits, Ivs, or weekend socs and rocs). There was always a lpn on call for our regular patients calling in. During the week, I would see only psych patients (mine only, since I'm the only psych nurse). The on call was medical.

Fast forward to a year ago. Someone gets the bright idea to start admitting--regular and psych patients even though I said I was "full." I started seeing around nine patients a day (a mix of socs, recerts, regular visits--sometimes as many as three recerts and one soc in the mix PLUS 5 regulars). This was too much work.--they kept saying they were trying to get another psych nurse and even hired two, but neither stayed for over a week. It came to the point where I had no room to do any evaluations on our regular patients who also needed some psych. I voiced my complaints, and the answer was always the same, "we are trying to get another psych nurse."

Fast forward to a couple of weeks ago. Patient load has gone up AGAIN, and this week I have 54.5 "points." Full time is 30 points!!! I am almost working 2 full time jobs!

The straw that broke the camels back was this week when my office has the audacity to remove lpns from the call rotation, and have RNs as primary. On average there are 2 prn on call visits to do on the nights when lpns had previously taken call.

Its not just me. The other RNS are up to nine patients (many of these oasis visits) a day. We are all freaking out because we don't have time as it is to finish all of our visits in a timely manner, much less the ones we will now have to see on call. We are still admitting patients even though we are completely overloaded because they say we have to.

I'm thhhiiissss close to quitting. We have demanded a meeting (the other RNS and me).

In my opinion, this is not safe. At this time our census is over 270 with only 5-6 nurses working in the field (office lpns previously took call too). Doesn't take a genius to do the math and see the outrageous pt load.

What would you do?

Edited by decadespast

I would voice my concerns in writing to the medical director and nursing director.

I would refuse to accept visits which put me in a dangerous situation referencing my letter of concern.

I would dust off my resume and start looking for another home health provider in the area.

I would expect to lose my job in the coming months as the employer shifts blame for unmet patient needs to me.

I would advise my malpractice insurer of the unsafe staffing expectations.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

That sounds horrid and I have been doing HH a long time! Nothing will change if you all keep rescuing them so I am glad you are having the meeting! What do you suspect the cause is for the change? It is greed...a change in management....a change in payments you are receiving? Isn't' the OT killing the budget..not to mention the morale and staff? So they just keep taking referrals whether or not they have the staff to cover the visits? Now even after really long days you now have to take the on call visits..that is horrendous! They don't care about safety,the morale or your ability to handle the patient load.....something else is going on here and hopefully you can get the the bottom of it at the meeting. Are they trying to grow the business without adding anymore more benefited employees? I suspect that they will have none if they do not listen to you...you must however stand united in your grievances or they will just pick off the complainers and let the rescuers continue to work their butts off! :mad:

As long as everyone complies, they will keep it up. Nothing stops any of you from doing what the new nurses did after less than a week.

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

Sounds an awful lot like where I work, which is why I'm getting the heck up out of there.


Specializes in ER, Forensic Nurse, SANE.

I recently heard, HH agencies are going to get reimbursed for their improved pt outcomes, instead of per episode/cert period with Herg scores. how is that going to work? where is HH going in the future?