New to HH/ Rant/ Advice

[aksti1018]

Hi guys,

I just started in home health about 4 months ago. I absolutely LOVED it the first couple of months and couldn't imagine doing anything different, felt I hit the jackpot with an amazing company. The patients are amazing and actually appreciate every little thing you do for them which is the complete opposite of how you are treated in the hospital setting. So, our weekly productivity goal is 25 points. (Regular/wound care 1.25pt and SOC/ROC 2.25pts) Last week I saw 32.25 points and this week I already have 34.25 points assigned to me, which will change as I get more admissions. The constant emails/phone calls questioning every little thing are making my anxiety almost debilitating as I am trying my best to give the best care, which lets face it the patients are not getting at this load. If I send back a patient, for whatever reason, I get a phone call asking why I wasn't able to see the patient and I am getting to the point where I want to say "HELLOOOO look at my load, how on Earth can I see this many patients?" One day I saw 2 SOC, 2 Recerts, 2 discharges and 2 wound cares. I am kind of on my own out here and don't really have coworkers to ask if this is normal. I did my research before trying out home health so I knew the charting would be awful, but I was okay with it since I would be able to do it in the comfort of my home. I know a stress-free nursing job doesn't exist, but my God I wasn't expecting it to be this bad! We are required to be on call about 8 days a month and have to call patients on Sundays to schedule for Monday so I really only have 1 day where I don't have to think about work. I am really missing those 4 days off every week.

Thanks for reading if you got through all that. Advice/words of encouragement appreciated!

[Hoosier_RN, MSN]

Welcome to home health. I left because of this and driving the tires off of my car

[Kaisu]

Way too many points. You are a valuable employee. Say NO.

[caliotter3]

Ehh, I enjoy the slow pace of extended care. My car thanks me too.

[KalipsoRed21, BSN, RN]

Yeah, saying no is the big thing. People throw around a lot of crap about what you are responsible and how long you have to get it done, but guess what...you will get it done when you get it done.

1) on your voicemail make sure it says you will deal with messages by the end of the next business day. If they need immediate assistance they need to call your company’s main phone number.

2) You will not see more than 30 points a week. Be consistent and be adamant. No, No, No. It is okay to say no. Home health is hurting for staff just like hospitals, they aren’t going to push you unless you let them.

3) If you have one fall off do not let anyone know about your missed visit until 2-3pm when it is to late to pick up another patient. Use that time to catch up. It went against my ethics to do this at first, but I would not have a life otherwise and I am F****** tired of nursing being my whole life.

4) Direct your patients, don’t let them direct you. Chart as much of your assessment in the home as possible. Be like, “Hey Mr.Sonso I’m going to cut you off for a second. I have these questions I need to go over with you and I’d love to get them out of the way so I can hear your story.” Unfortunately, just like in the hospital, you have a job to do and awesomely with home care you can get through it and have time to visit if you get through the work part first.

5) Regular visits go like this 1) Assessment, education, and charting, 2) check supplies and order, 3)Provide/teach wound care or procedure and a little visiting 4) Call MD for concerns/orders and/or coordinate with other services like MSW, CNA, PT/OT etc. and say good bye. If you don’t get an answer from the MD let them know you will call them when you do. 5) Go to your car ensure that anything unusual about the assessment is charted and any communication preformed is charted. 6) Listen to any voicemails you got while in the visit and respond appropriately. 7) Drive to next visit. 8 ) At the end of your day or get up early next morning before your first visit and chart.

It does get better, but yeah I didn’t have a life for like a year. It sucked balls but I couldn’t bring myself to go back to the hospital. Like I had an interview and went to it, but when we started discussing the work, which I had done before, I just cringed on the inside.

Good luck!

[eliza30]

Do you get paid for documentation at night in home health. I am trying to get organized but up to 10pm charting sometimes . Thanks

[caliotter3]

9 hours ago, eliza30 said:

Do you get paid for documentation at night in home health. I am trying to get organized but up to 10pm charting sometimes . Thanks

I’ve never heard of anyone getting paid for the time they have spent documenting at home. I thought I read once about somebody getting an hour’s pay for documentation but don’t remember the details and I also think I read about being required to go to the office to complete documentation. For the latter, I pretty much am certain they are paid for that.

[Matikins RN, BSN]

Keep your head up -

Watch these employers, employers will try to push nurses around to maximize the bottom dollar and profits . In this home health care climate - there is a massive shortage that will be ongoing due to a variety of factors. Put your foot down and do not accept beyond 30 points. It is the agencies responsibility to ensure sufficient staffing and quality of care.

[Kaisu]

I got paid by the hour, so documentation time was paid for. I was given the option of going to PPV, and would have made a lot more money, but I transitioned into hospice where pay by the hour is standard. Most of the nurses are salaried, but I prefer hourly because that way I don't feel guilty saying no when I am full and I don't feel bad when I have heavy weeks because I know my bank account will fatten.

[TAKOO01, BSN]

On 7/25/2019 at 11:32 PM, KalipsoRed21 said:

If you have one fall off do not let anyone know about your missed visit until 2-3pm when it is to late to pick up another patient. Use that time to catch up. It went against my ethics to do this at first, but I would not have a life otherwise

This ^ is very important.

Also, can you call your Monday patients on Friday night? That way you have Sunday free, too.

For me, 5 to 6 patients per day was enough. I wouldnt do more than 2 to 3 long visits per day, meaning i would do, for instance, 2 SOCs, 1 ROC , then three wounds. I wouldn't do, for instance, 2 SOCs then 2 ROCs and two wounds in one day. Too much.

I have heard of people doing 10 to 12 visits per day, but im not sure thats even possible.

[Matikins RN, BSN]

21 hours ago, TAKOO01 said:

I have heard of people doing 10 to 12 visits per day, but im not sure thats even possible.

I have witnessed this and have seen such a thing . I worked for an agency once where LVNs would see 10-15 patients a day. I at one point would get 2 SOCs, 2 Non billable D/Cs, 3 Oasis Transfers, 2 Aide Supervisory Visits, and a Oasis D/C. RNs would see an excessive amount of patients, the mom and pops can really scam nurses. The agency had about 1000 patients in a region, I was there briefly.

[Kaisu]

2 hours ago, Matikins RN said:

I was there briefly.

Sounds like the appropriate response to an abusive employer....