Need advice on new job offer

[Curious1alwys]

If you can offer insight, I'd appreciate it.

I am an RN that graduated in 2007 and only worked a few months on a hospital floor before staying at home to raise my children. I am now currently enrolled in a refresher course and have taken a few classes towards my BSN. On a wing and a prayer, I applied for a home care weekend PRN position, interviewed, and was hired on the spot. This surprised me since I have not had any recent RN experience.

The lady I interviewed with was super nice and told me a lot about what the job would entail: Mostly admits on weekend, mostly older adults..medicare..many of which can be pretty acute since they will have been d/c'd from hospital day before. I'd do admits and regular visits, there could be a lot of driving involved since this is a semi-rural area and there could be as much as 45 min drive between pts. Typical is 3 admits per day. $65/admit, $45/visit, and 0.45 cents per mile reimbursement. I reiterated to her that I had nearly no experience and she repeatedly ensured me extensive training would be provided, including IV classes, wound vac training and cert, and then some. Oasis training as well and training on the tablet system they use.

I actually called her back to decline the position as my gut was telling me to be fearful. But, again she was super nice and reassuring, telling me that orientation would be sufficient, they have hired others like me in the past, and that they wouldn't just "leave me hanging". I told her i needed to mull it over and that I would call her back in a few days.

This is a rural area so I am thinking that is part of why there is such a need-smaller applicant pool. This area is also exploding in terms of needing home health. She also said she is wanting to hire people that are looking to advance, that there is promotion opportunity here. I would be commuting 1.5 hrs for this job and staying overnight in this town to get this experience since jobs are scarce here for new grads and I don't want to pass up an opportunity that also lets me continue to stay home during the week and care for my young children.

What do you think? Am I crazy to take this job? I don't know what else to do other than try it and see. I told her I did not want to accept and then quit because I did not have the skills she needed and therefore possibly be dangerous or risk my license. Any info all you veterans have about this would be appreciated (also in terms of the pay, reimbursement, etc).

Thank you so much!

[RN1263]

she didn't ask me much at all about me. Is this the huge red flag? She said she would not have hired me if she did not think I could do it but how could she determine that without even asking me questions?

Don't forget what you said above which is a tell tale sign that they just need a warm body, RN license and a car...In my opinion. They were probably going to let you sink or swim... My company does that to nurses all the time, unfortunately.

[lily1289]

I guess I'm the odd man here but i would probably take the job if i were in your place. We're kinda in the same situation, not having worked in awhile to raise the family. I started looking for a job recently and got offered to be a nurse manager in a LTC facility. I turned it down because i've never worked in a nursing home and do not feel i would be effective in this role plus it's not really what i wanted to do.

With home care, i would looove to do it even though i haven't done it before so i will overlook all the negatives so i can get some experience. I know home care nursing is very difficult but it seems like that facility is willing to give you an extensive orientation. Now if you don't really want to do home care then i can see why you don't want to accept this job, just like i declined the nurse manager position in the LTC because my heart wasn't in it.

[Curious1alwys, BSN, RN]

Well, I did decline the position....for now....until I am done with my refresher course. I really feel I need that. While the lady that hired me sounded dissapointed, she did say that if anything changes for me just give her a call and I am in. Another red flag? LOL!!!!

It was so hard to do because she is just so nice! Who knows, maybe after the refresher I'll take her up on her offer.

I had other personal reasons to decline...for example the 1.5 hr commute with nowhere to stay overnight. Paying for a hotel would not make sense, especially if I am already averaging 10 bucks an hour as the above poster pointed out! I applied for the same company locally in my city and never heard a word...

Thank you all again for helping me with this decision! :)

[KateRN1]

I would suggest trying to work out an agreement that the weekend on-call nurse does the admit visit with skill (including getting all consents and admission paperwork completed) during that weekend visit. However, on the following Monday--the regularly scheduled RN for that particular area can complete the OASIS assessment for submission. I don't understand why agencies beat up on the weekend on-call nurses and make us hate on-call so much by demanding that all SOC OASIS assessments be completed that first visit. Medicare guidelines state that an agency has five days to complete the admission OASIS.

Not to hijack the thread, but this is against OASIS data collection rules. The OASIS assessment must be completed by one clinician and it is that clinician who has up to five days to collect the data required, not the agency.

And bear in mind that getting that OASIS locked and submitted is how the agency gets paid. They may have a thirty-day "grace period" as you call it, but how long do you like to wait to get paid for your work? I don't think many of us as individuals would like to wait 30 days to get paid. The sooner the paperwork is in, the sooner the OASIS can be completed and locked, the plan of care can be completed and sent to the physician and the agency can send out the RAP. Without money coming in, no business can stay open, even the non-profits have to have an income.

[sweetsugar]

KateRN is absolutely correct with regard to the OASIS collection rules by Medicare. However, 1) the weekend RN should have the option of completing a skilled nurse visit along with the consents and admission paperwork. Then, the RN picking up the case the following Monday can start and finish the OASIS (one clinician rule is met). 2) Otherwise, the weekend RN should have the option of starting the OASIS on the weekend and then following up Monday or Tuesday (depending on what kind of weekend he or she had on call) [one clinician rule is met].

As far as the 30-day turn around time, having to wait an extra day or two for admission paperwork is not going to put any home health agency out of business. What will, however, is what is going on with the Gentiva class action lawsuit regarding unpaid overtime (specifically dealing with unpaid travel time and unpaid pay for documentation in the home). I have it good grounds that the same lawfirm that filed the class action suit is now looking at Amedisys for the same practices. Just my humble opinion.

As of the week of January 9, 2012, there are approximately 1100 Gentiva employees who have joined in the above-referenced class action. The Georgia state judge overseeing this matter, granted permission to the D.C. lawfirm to contact all employees (not just nurses) to inquire about their willingness to join the class action suit. These notices were limited to only those employees who worked for Gentiva from 2008 to 2011; seems like a lot of unhappy clinicians out there about unpaid overtime. Seems like a whole lot of clinicians out there that just can't seem to get all that paperwork done in the patients' homes.