New to HH rant

[IMOKAY, BSN]

I'm 2 months into starting in home visits. It's a lot different from working hospital especially the charting and trying to reach the PCPs. 

I feel like I have to call the PCP for every SOC and ROC to receive or clarify orders, notify of med changes, notify of every little change in vital signs that nobody would blink an eye at in hospital, notify of med interactions of meds this patient has been on for years, missing meds, med non compliance, every insignificant yet pre-existing issue....and I have yet to receive any return call back from any PCP! 

Sometimes I feel like I'm spinning my wheels, not really making any impact on my patients. I do so much planning and phone calls on my own time that I'm not paid for. ( I'm paid points per visit). I'm making around $300/week on average so far and I'm supposed to be full time. 

Is this the reality of HH? I'm still new so the OASIS charting and POC are still daunting. Tips, advice, good/bad/ugly of it all much appreciated. Should I stick with it? 

 

 

 

 

 

 

 

 

[poko, BSN, RN]

I am a Canadian home care nurse and therefore my perspective is likely different as we operate differently here. $300/ week in USD seems on the low end. At my worst paying home care job I was still making around $250 per day (Canadian dollars, so approx $190 USD) plus 41 cents per kilometre. 
 

in terms of workload and feeling like your do a lot of work unpaid- yes me too. Many hours of administrative tasks after hours because I couldn't find time during my day to complete them. Often a lot of difficulty contacting care providers especially through fax correspondence (which is a huge means of communication still in our health system here sadly).

 

is it worth it? Only you can tell for yourself after weighing pros and cons. Perhaps another American can chime in with comments regarding salary. For me, I love the flexibility and autonomy of the job. But there's much to be said about the pay. 

[IMOKAY, BSN]

@poko Thank you for commenting.  The autonomy, one patient at a time, and flexibility were the things that drew me to HH for sure. 

Can I ask you how many routine visits and SOC, ROC you typically do each week?  Right now I only have 1-2 routine visits per day plus 1-2 SOC per week. Many times only 1 visit a day.  

 

[poko, BSN, RN]

I am not familiar with the term SOC/ROC as these aren't used where I am. But generally we will see about 8-12 patients per day depending on staffing.  It's usually on the higher side. I've worked both rural and urban areas and would usually do anywhere from 10km to 100 km of driving total for the shift. Urban areas = less km but more traffic, rural is the opposite.

we also rotate through an on call schedule every few days where one nurse is available after hours for any urgent patient calls. 

In my province, we do home health visits (wounds, IV, meds, ostomy, catheter care, tubes/ lines/ drains of all sorts and many other things) and also we provide  palliative care. My understanding is that many of the US companies tend to offer "home health" on its own or hospice providers. I could be mistaken. Most of our visits are routine ones (scheduled wound care, I.e. q3d dressing change, or daily IV med administration like abx). We also get "admissions" which are the patient's first visit when they come on service with us. In an average week, a full time nurse might  have 50-60 visits, and maybe 5-6 of them would be admissions- these take longer. Unfortunately where I have worked, we still do paper charting as well which adds work.

The visits can take anywhere from 20 minutes to an hour, which is most common, to a few hours at the worst case (end of life unstable palliative with complex needs or unresolved symptoms). 

I have worked both for companies that pay hourly and per visit. Both have pros and cons. Typically, because our health care is provincially funded through tax dollars, the system is very streamlined and the pay and function is similar where ever you go in home care.