New to home health, next to nothing for orientation...vent


Hi all. I am brand spanking new to HH and feel totally overwhelmed. I was to be the 2nd nurse in this office but the week before I started started the only other full time RN in the office notice. So, I have only been able to ride with an RN a couple of days. With OASIS and our totally sucky computer system two days is nowhere near enough time to pick everything up.

I enjoy seeing the patients in their homes and helping them stay there, but I have never had a real orientation to what my role is to be. The LPNs who work out of this office are great but they can't help me with my admission charting and OASIS. It seems like 90% of our patients are OASIS.

My orientation was been next to nothing. I tried to ride with an LPN for a day my first week there but after an hour I got paged to go back to the office. I was then sent out by myself to do an OASIS admission. I felt they only cared that I had RN behind my name and it didn't matter that I didn't know what to do. Yes, I can go out and ask the questions and assess the patient, but then how do I chart it and how do I get the supplies needed out to the patient.

The computer charting we have to do is way too complicated. I wish I know how to do programming. I would write a simple, logical program that doesn't take 3 minutes to chart the patient's clear lungs.

Plus to top it off I am not allowed one minute of overtime to catch up my charting before being sent on more admissions. They are expecting me to see 6 patients a day. Almost all of my schedule consists of admits and recerts. I could probably do it if they would mix it up a little and give me some routine visits.

I apologize for the long rant. I am just so frustrated.

Thanks for listening.


38,333 Posts

Hopefully things will straighten out as time goes on. The best advice I can give you is kind of easy. I would look for another agency. It appears as if nobody is willing or able to help you. The giveaway is the refusal to pay you OT for extra time spent trying to figure things out. If they don't want to pay this time for you to figure it out on your own, they should provide help during your regular hours. You can probably find an agency nearby that is established and able to provide you with work without having to go through this. The only way I would recommend putting up with this situation is if you have no alternatives or if you were an internal employee with a stake in getting things going. Good luck.

Has 12 years experience.

This is an outlying branch of a very well established home health agency. I think that the supervisor either should give me a lighter load for a few weeks or I should have been given at least a couple of weeks to ride with an RN from another branch. This is my first home health job and there are a lot of "little things" about home care I still need to learn. However, the supervisor never declines an admission and just tries to run me like crazy.

I really get the feeling that she expects me to catch up my charting at home off the clock. Of course she hasn't said this but it is almost like the unspoken alternative for me to stay caught up on my charting. The rebel in me won't chart "off the clock" because I know if I did it would only lead to even heavier workloads. And I feel like doing so would condone this sort of behavior towards future nurses at this agency.

I am considering sending out my resume. About the only stopping me right now is the fact that I work Monday through Friday and I am so busy I don't know how I would schedule interviews. I guess I either call in sick or lie and say I have a doctor's appointment or something. I can't afford to just quit and look for another position full time. I think I am understanding why the other nurse quit so abruptly. I understand she had a similar "orientation."

When I took this job I was really hoping I would be posting questions on this forum looking for tips and advice. I am really disappointed that my first home health post was a vent. I really do have lots of questions....I just don't have time to ask them these days.:bugeyes:


38,333 Posts

It's too bad that you apparently will go the way the first nurse went. I don't think anyone there has a clue. They will most likely have to go through several people before it becomes obvious to them. I kind of agree with you about the paperwork. However, you will find it the norm in home health for nurses to be completing paperwork at home. This practice decreases as the nurse picks up speed. I do think that you have the right attitude. If you are not wasting time, then you should do your paperwork on company time. When nurses spend hours instead of minutes on documenting at home they are doing themselves a disservice. Hope that you find a better situation soon,

annaedRN, RN

519 Posts

Specializes in LTC/hospital, home health (VNA). Has 10 years experience.

I am so sorry to hear about your orientation..or lack thereof. 6-7 patients is considered a full day for me, but an admission counts as 2 visits. So 3 admissions would be a very full day! Recerts or ROC are technically 1 visit, but our case manager takes them into consideration as a longer visit. Just remember it is your hard-earned license, not theirs. I would say that 1. You need a more thorough orientation to the OASIS...b/c there is ALOT to learn about performing them correctly ( refer to the OASIS links on this forum) and 2. If there continues to be that many OASIS visits in a day than you may need to look elsewhere. I would tell them what you said....why you like/enjoy HH but in order to do the job, you need to be prepared!!! Hope it works out for you!

Cora Zone

4 Posts

I also am new to HH. And fairly new to nursing, as well. I do feel very at home in my neighborhoods, some of the poorest in the area. But I am absolutely freaked out and exhausted by all the extra time I put in. I calculated that it makes my pay less than $10 an hour, counting travel time. We have to pay for any cell phone minutes over the allotted, which often are eaten away on hold to doctors. My patients don't get their supplies, and I buy them myself, etc. I know I am doing everything wrong here. I feel I have no time to study what I need to to understand what I am seeing each day. Why does it seem like nurses everywhere are expected to ride a steep learning curve like we are superhuman. I have contemplated going per-diem and forking over the money for health insurance out of my own pocket, just to be able to work less hours. Meanwhile, my ankles are blowing up from sitting in my car most of the day, or in patients' houses, or at my desk, instead of NEVER having time to sit, like my last job.

Gotta make a living...Time to get back to that last OASIS....By the way, I already posted this elsewhere, I am in need of some really simple educational handouts, big print, pictures, easy to read. Any ideas?:redbeathe


78 Posts

That is very unreasonable orientation time. Time for you to look for another job. HH is stressful enough without having proper orientation, especially with an OASIS. As an LPN, I was so thankful I was not able to fill these out.


272 Posts

Make sure if you work for a salary that you put a "cap" on the amount of visits you are expected to do per week. If you go over the cap then you should be paid for those additional visits or hours worked. Some agencies will run you in the ground with too many visits yet still pay you for a 40 hour week. Home health is one of the ONLY industries that I know of that expect their employees to work additional hours at no additional costs to them, and we seem to be letting them get away with it.

Most use the "point scale" as a measurement. One point for regular visits, 1.5 points for recerts and 2 points for admits. Total points for week vary from agency to agency but I believe 30 points is average. Also some agencies vary in the amount of points given to each visit, some give 2 points for recerts, etc. Discharge visits are usually one point each, but that varies too.

When I am asked to do additional work for "free" I always respond with something like "would you let me come up here tomorrow and sit around doing nothing but still get paid for it?". Of course the answer is always a NO with a laugh, but there's no mistaking that their NO means NO. Let your NO be just as clear. Also note that they don't bother giving you an explanation as to why they CAN'T pay you for doing nothing. Don't lower yourself by giving them one either. You work, you get paid. You don't work, you don't get paid. Simple concept.

Also, don't get bamboozled by their empty promises such as "there will be days when we aren't busy and you won't have many patients". Understand that this won't ever happen enough times to mention unless the agency you are working for has no growth or referral base, in which case you would need to find other employment.

Zachs Mom

4 Posts

You can refuse to go out into the feild unless they give you more orientation. Its your license on the line. I have been working in Home health for 10 years and I notice the agency always takes advantage of the nurses who are new to home health such as work load and pay. If you can work as per diem. the pay is much more and the tax deductions are greater too. You might gothrough more than one agency before you find the right one but if you show you are too flexible they will always take advantage of you.


275 Posts

Specializes in LTC, Home Health. Has 7 years experience.

I worked for an agency that was running off the RNs by riding them too hard to get so much done in such a short amount of time. I couldn't figure out, at first, why they looked so frazzled all of the time until I went to assist with an admission one day and saw what was going on. I knew then I assure you. I was then called and asked if I wanted to earn some extra money and do an admission for them. I thought I would help out but then realized that I was given the paperwork but then told not to sign it and that the RN would sign off on it when I dropped it in the office. I got paid peanuts for it and I never agreed to do it again.


280 Posts

I was then called and asked if I wanted to earn some extra money and do an admission for them. I thought I would help out but then realized that I was given the paperwork but then told not to sign it and that the RN would sign off on it when I dropped it in the office. I got paid peanuts for it and I never agreed to do it again.

Holy cow!! That is wrong on so many levels!:eek:


41 Posts

Specializes in Long Term Care. Has 4 years experience.

I will be new to HH to as an LPN...I currently work in long term care..which is always crazy in itself...I have always wanted to do HH but it seems as though it is just as or even worse than Long Term Care! I love the residents that I take care of dearly..I do not like the politics of the facility...I am hoping that HH will be less of drama and you could focus on the patient so much more.. I will be having to do 6 visits per day can anyone give advice on about how long of a day I can look forward to?? I currently work my 8 hours and come home...Is that going to change...will i be working many more hours for less since i will be getting paid per visit?? Any advice would be so appreciated!!


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