Published Aug 2, 2009
I'm new to home health and been with a home health company for about 6 months, Amedisys, and initially really enjoyed it. Lately though we've had a lot of staff turn over and I'm one of the only RN's left. My office is so referral happy and I do around 4 admissions a week, not to mention all the recerts and ROC's and I am drowning in paper work. I'm so busy doing all these OASIS visits that the LVN's have to do practically all my revisits and I feel as though I never see my patients! I feel as though I'm only seeing my patients on admit, maybe 1-2 times during the cert and at discharge! I never get to intensively work & educate my patients and follow their progress. I'm pay per visit and these OASIS visits pay a bit more than regular visits, but take so much more time and have a ton of paperwork attached. So basically I feel pressured to do work 10-11 hr days to make enough money, then head home for more hours of paperwork. Plus our territories are HUGE and I'll routinely drive 60-75 miles a day! I've never had home health experience and am ready to quit. Is this typical of home health nursing?
The company I work for (first in Indiana, Arizona now California. altho in Cali at this time we don't have any LVN's doing visits) but anyway, we were told that company policy (this is a nation wide company also and I have been told the same thing in 3 different states) is the RN has to see the patient at least one of the visits a week. I am not sure if it is a state law in those states or not, but that is what company policy is (company policy is usually a littel stricter than federal guidelines). If you are not seeing your patients much, I hope you trust all the LVN's taking care of your patients, because ultimately it is your license they are taking care of your patients under (I know they also have a license, but you are ultimately responsible for their care as case manager, so if something goes wrong, and you aren't aware of it, it's your butt). I am told LVN/LPN's are not suppose to "teach" patients either, they are only suppose to reinforce/teach what you, the RN has already taught (again I am not sure if that is a state law, federal law, I know that in my agency that is what we are told tho). If it was me, I would insist on seeing the patient at least one visit a week, and knowing exactly what is going on with those patients, what they are being taught so on. Like I said, it's your butt, and your responsibility to know what is going on as Case Manager. I would also find out what your company policy is, in writing to make sure you are being compliant with your company. At times when RN's are short staffed, the powers that be are a little more willing to be flexible with the "rules". but if it is your company policy for an RN to see the patients at least one visit a week, and you are not following that policy, state can ding you good, and you could possibly loose your license. JMO though.
When I worked for this same company in the Phoenix area, our areas were huge also. I drove 250-350 miles a week and hated it. I was 32 hours in Phoenix, and still had to work 5 days a week, I was told no matter if I met my par, I was theirs from 8 am until 5 pm monday through friday. I live in San Diego now and although we cover the whole San Diego County, and there are less nurses, because of the freeways out here, I drive much less, and it's a prettier drive :) I work 4 days a week, and am much happier now, I ran as fast as I could from there to San Diego, same company, but totally different. I was so stressed in Arizona, but I love working in Cali.
Thanks for your reply! The license thing is definitely forefront in my mind! It IS totally MY responsibility if something goes wrong with these LVN's seeing my patients! That's another big reason I'm thinking on leaving. Too much of a liability risk. I'll have to check my state laws about this. Thanks.
I had this same issue with the company in Phoenix, even tho they said we had to see the patient one visit a week, they expected us to keep picking up SOC's and turf out our revisits and still see them one time a week. In other words they expected us to do more visits but still see our regular patients lol. One or the other has to give, I learned to say no with that position. You have to if you plan on staying sane and keeping your license.
I don't have to do paperwork at home or drive all over creation because I don't do intermittent visits, only shift work. What you describe is most of the reason why I do it this way. I don't have do be worrying about my job all night long (or all day long, when I work nights) and doing all this extra work for free. It makes for job satisfaction.
I worked in home health as an LPN for 3 years, now I am an RN working in home health. You as an RN are not responsible for what the LPN does in the home, they have their own license, and they are to follow the POC you have setup, if they fail to do so, it is on them, not you. For example, if an LPN fails to report a change in condition to the physician, that is on them, not you. I would say that if you are discharging these patients without assessments or reevaluating the POC and basing it on what the LPN says then it is your license to be concerned about. I would make sure you are getting reports from the LPN after each visit or sitting down for a report weekly on the patients they have seen. I know it can be very frustrating to have patients assigned to you that you rarely see.
That company you work for, well let's just say I have very strong opinions on how wrong a "pay per visit" agency is run. The focus is taken away from the patients and directed towards their pocketbook! I hope you can work things out, I hate to hear about companies taking advantage of nurses.
I've been working for an agency for about 6 mos that has gradually increased my driving time to almost 4hrs per 8hr day - I went over 100 miles a few wks ago. This does not include time from home, and from last visit to home. I also have had to complete documentation at home, on days off. I'm considering leaving the field, but I wondered why the new state laws governing mandatory overtime/unpaid time are not being applied to the home health field?
When you work for an agency that does not pay overtime, file a request for your pay with the labor board, if the company is violating labor laws in your state. If they are not violating labor laws, then find a company that pays for overtime. They are out there if you look for them.
caliotter3, by shift work, do you mean you have patients who need nursing 24/7 and you stay with them for however long your shift is?
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