New Clinical Director for a Home Health Agency- Very frustrated!

[HealthyNurse]

I just finished my first week as a new clinical director for a medium-sized home health agency. I'm feeling completely overwhelmed and ready to quit already- especially since I found out today that I'm getting a job offer from another employer. The agency is family-owned and has been around for many, many years. During the interview, I was very impressed with the administrator/owner and it seemed like the agency really had everything together. I was really excited about starting this position.

A little about my background...this is my first experience in management. I've worked in home health care for four years in a variety of roles- field nurse, nurse educator, and quality improvement. I have a master's degree in health care administration. My dream job is to have a consulting practice for home health and hospice agencies offering consultation on quality improvement, education, etc. I thought that this position would be a great stepping stone to get me where I want to go.

The week got off to a rocky start because a surveyor showed up on my first day. Of course, my anticipated schedule got changed for a few days, which I completely understand. I got some bad vibes on my first day when I met the exiting DON, who was supposed to provide my orientation. I was told during the interview that she was retiring and that was the reason she was leaving. I discovered after starting that she has only been there a few months and is basically burnt out. She doesn't have a job lined up, but isn't truly retiring- she just feels like she needs a break for awhile and is fed up with working with this agency. During the few days I got to spend with her, she made it clear that this agency operates differently than any other that she's seen in her 25 years in home care. Coming from a large agency, I have to agree that there are many things I see that don't seem to follow home care best practices. One of the most frustrating things for me is that they are on paper only and I am used to electronic documentation. The paper is already driving me crazy!!!

I spent about 3 half days out in the field seeing patients. I got to observe one admission and then the other visits I was plugged into the schedule and seen patients on my own because of short staffing. On Friday, after I spent the morning seeing patients, I was told that it was the exiting DON's last day and I would formally be taking over the position on Monday. I clearly indicated to my boss that I was not prepared and there is a TON that I still need to learn about how this agency operates. I was very frustrated because I had spent a great deal of the precious time seeing patients, but this is not an area that I need orientation to. I know how to make a patient visit! This feel on deaf ears and I was just told to ask lots of questions and everything would be fine. I have a wide range of responsibilities in this position- I am responsible for the management of several nurses, home health aides, and a few social workers. I participate in intake and coordination of referrals, the scheduling of staff, physician/patient complaints and problem-solving, coding, review 485s, other QA responsibilities, performance improvement, staff education and competency, infection control, etc. And I am expected to spend about 20% of my time in the field. In my interview, I took this to mean that I would be doing supervisory visits with the field staff, etc., but this apparently means that I will be out seeing patients 20% of the time. My week ended when I was told that I would have to see a patient on Saturday and Sunday too, because there are no nurses available to see this patient. Next weekend, I have to take on-call and I will be the only nurse working!

The other odd part of this job- I'm beginning to realize that the owners have little faith in their staff. I found out that there are several video cameras in the office and staff are watched at all times. The staff is also convinced that they have audio. My working hours are expected to be 8AM-until the work is completed, but I only have a timed 30 minute lunch break. I am not permitted to leave the office on my lunch break. The computers do not have the internet on them. I told my boss that I'm not sure if I can do this job without internet access for resourcing, but was told I can use her computer in her office for this purpose. I was also told that I should not carry my Blackberry around- personal cell phone use is strictly prohibited. I'm not used to such a restrictive work environment and I feel very uncomfortable with all of this. My boss is very nice on a personal level, but everyone in the office keeps telling me that she is extremely difficult to work with. She is very scattered- she gave me a few assignments to work on after the survey and came back an hour later to ask if I completed them. These aren't projects that can be completed in an hour, a day, or even a week if done properly.

I actually took a pay cut with this position. I thought the experience would be worth it and I knew that they were a smaller agency than my last employer. I actually wanted to quit on Friday, but I desperately need the money and can't leave without something else lined up. I just found out today that I'm going to get a job offer for a state surveyor job that I interviewed for some months ago. I'm excited, but nervous about the travel that's required. I also feel bad about leaving a position so soon after starting. I don't know if I should try to stick it out for awhile longer or see if I can talk to my boss about the things that are bothering me. Any insight into my situation would be appreciated!

[caliotter3]

Your paragraph about the workplace surveillance did it for me. Accept the job offer or find another job. I don't see anything changing for the better any time soon. You should be doing supervisory, not regular patient, visits as you said. And everything you talked about sounds like work enough for two people to share equally. I would definitely look for a friendlier place to work. JMHO

[HealthyNurse]

Thanks for your input! I know this situation is not normal by any means. I hope that the other job offer works out or I can find something else very soon.