New HH RN Case Manager

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I accepted a position as a HH RN Case Manager that starts in January. I’m a LPN now and I work agency in geriatrics so I’m very familiar with wound care, CPAPs, joint replacements, CVA patients, diabetic patients, etc. I’ve watched some videos of other case managers and of course I’ve gotten the rundown of what to expect from the branch and clinical manager.  So my questions are

1) Is the rumor about charting true? (We are paid per visit and I’m told that charting can be done in a reasonable amount of time but other nurse case managers say that’s a lie most of the time.)

2) Does anybody utilize a planner to stay organized with appointments? (I’m in a couple of HH nurse groups on facebook and some people sell them)

3) My schedule is 8-5 Monday-Friday but I’m told that once I get the hang of things I can see people earlier or basically schedule people at convenient times depending on location as long as I’m hitting 60 units every 2 weeks. 
 

4) What brand of vitals equipment did you buy? I have some pretty nice stethoscopes but nothing else because I’ve been working in facilities.

5) Overall, it sounds pretty good and I am forever done working the floor. What are your pros and cons of working in this field? 

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I'll address your question about equipment. I'm a home health nurse and I remember a couple of years ago when a nurse case manager came to access the patient unprepared! She neglected to bring a thermometer, BP cuff, or a pulse ox device. And her stethoscope was a cheap-o piece if junk. She had to borrrow my stuff to obtain vitals. So, do yourself a favor: get decent equipment and take care of them. Buy a good no-touch thermometer. Never hang your stethoscope on the rear-view mirror of your car. Don't buy one of those "light weight" Littman's. The SE II is much better. But there are other brands that are equally excellent for less money. I'm familiar with electronic stethoscopes. If the environment is noisy (TV in the background, kids making noise etc.) they will amplify all the unwanted noise. However, if the environment is silent, then an electronic stethoscope is absolutely superior when auscultating abdominal & lung sounds. Never assume that someone else will lend you their stuff, some nurses don't even bother to bring their own equipment to work. Never assume that the "other nurse" is honest with BP readings of exactly120/60 again and again! Obtain your own vitals. 

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(more)

About electronic stethoscopes; I'm not advocating the idea of purchasing an electronic stethoscope for two reasons: 1) you'll probably need to carry around a regular stethoscope anyway because of the background noise issue and 2) it's not worth paying $300 for one, unless money is not a concern for you.

I happen to have a specially-made amplified stethoscope, (made for me) made from Littman parts and transistors etc. by a person who studied electronics in college. I have tested it on more than 100 patients. In a silent room, I can clearly hear heart valve sounds, bowel sounds, lung & airway sounds, and anything abdominal. I am not pleased with obtaining blood pressures because a portion of the systolic is super loud, while the actual start and stop sounds (diastolic/systolic) is difficult to catch. So in conclusion, I still carry around my regular stethoscope regardless of whether or not I have the electronic one.

Thanks for reading. 

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Specializes in retired LTC.

In many HC facilities, it is PROHIBITED for employees to use their own equip. The reason being that there is no assurance that their personal equip is properly maintained or calibrated. Hence no quality control re accuracy.

IMHO, and this is just my opinion, I think your agency should provide you with the equip you need to monitor a case (and I'm including a portable weight scale).

Also, there is a possibility that you could lose or misplace your equip --- your loss.

Re today's HH charting - every thing I've ever heard is that it is very EXTENSIVE (and becoming more & more so). Now if you're SUPER  focused and directed, you may be able to keep ahead of it. I VERY briefly did HH years ago, and the documentation was CRAZY then.

Just FYI - currently, I'm dealing several HC providers who make home visits to me. I note that they all use some kind of planner. It's like their bibles!

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Specializes in Home Health/Med-Surg.

1. Yes, the paperwork sucks, and someone still needs to define reasonable for me in that sentence because I've been told the same. So about a year into this job, I no longer need to read the Oasis questions and think about the answers. That makes it faster. I get paid 2.5 points (hours) for each start of care I do. My hourly rate is nice. They're paying me a lot more than I made in the hospital, and I supposedly don't work full time. (I don't work Wednesdays. However, I get enough work that I'm usually at 30 points per week anyway.)

2. I have HIPAA issues with the idea of keeping a planner.

3. I can't help you with scheduling. Scheduling patients for home health is like herding cats. Just when you think you have your schedule set, someone will cancel or the office will try to add another visit or 2 to your day. On top of that, half of my patients don't answer phones/texts.

4. My company supplied all of my equipment. The only thing I use of my own is my stethoscope.

5. Work-life balance is a joke. Sorry. Like all jobs, this one has its good parts and bad parts. Supposedly, 6 points is a full day. Yesterday, I had 12.85 points assigned to my tablet. No, I didn't see all that. My resumption of care was back in the hospital. My start of care was moved to tomorrow because he had a wound care clinic appointment that day. My discharge flaked out on me and I ended up doing a non-visit discharge because she won't let us come back to do it in person. The rest were all regular visits, and I saw those. *shrug* It all works out in the end, I guess.

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2 hours ago, wheatfree said:

1. Yes, the paperwork sucks, and someone still needs to define reasonable for me in that sentence because I've been told the same. So about a year into this job, I no longer need to read the Oasis questions and think about the answers. That makes it faster. I get paid 2.5 points (hours) for each start of care I do. My hourly rate is nice. They're paying me a lot more than I made in the hospital, and I supposedly don't work full time. (I don't work Wednesdays. However, I get enough work that I'm usually at 30 points per week anyway.)

2. I have HIPAA issues with the idea of keeping a planner.

3. I can't help you with scheduling. Scheduling patients for home health is like herding cats. Just when you think you have your schedule set, someone will cancel or the office will try to add another visit or 2 to your day. On top of that, half of my patients don't answer phones/texts.

4. My company supplied all of my equipment. The only thing I use of my own is my stethoscope.

5. Work-life balance is a joke. Sorry. Like all jobs, this one has its good parts and bad parts. Supposedly, 6 points is a full day. Yesterday, I had 12.85 points assigned to my tablet. No, I didn't see all that. My resumption of care was back in the hospital. My start of care was moved to tomorrow because he had a wound care clinic appointment that day. My discharge flaked out on me and I ended up doing a non-visit discharge because she won't let us come back to do it in person. The rest were all regular visits, and I saw those. *shrug* It all works out in the end, I guess.

Wow this is the best answer so far. The whole idea of not being paid if charting takes me longer than it’s supposed to has turned me off of the job. I ended up rescinding my acceptance of the offer and taking something else, somewhere else in nurse management. Pay is the same and again I am exempt from overtime but with this one there no direct patient care so no charting that I may have to take home while not getting paid. 

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