New Home Health Nurse with Questions

paradiseboundRN · Dec 7, 2012

Your hourly was is fair for a new nurse. But, here are a few problems that I see. Their productivity EXPECTATION points are high. Most agencies require 26-30. But your daily productivity points are higher too. For example, these are the points that I've worked with SOC-2.0, RECERT/RESUMP-1.5, REG Visit-1.0 AND D/C OASIS 1.0. So you may not be that far off. Secondly, before you leave to do a SOC, you should always call the patient and ask a lot of questions to determine homebound status. Sometimes they fool you but most of the time you can find out on the phone if they drive daily etc. If the agency makes a rule that you have to go out there anyway then you need some sort of reimbursement for it. It should be worth some points. Thirdly, the government standard for mileage reimbursement in my area is about .50 cents per mile. So you can tell if they are paying you enough by doing the math. Remember, mileage to your first patients home (of the day) and from your last patients home (of the day) to your home does not count. If you really like the job, and you think you are doing a good job, then try to negotiate with them. If they are not willing, then stay until you get more experience and then leave for an agency that pays better. Good Luck!

Cyoung07 · Jan 11, 2013

Hello I am new to home health..In South FLorida..i am also a new nruse..and hospitals are very picky about hiring and they dont want new nurses..anyways..i am getting started and dont have much training by any of the Home HEalth agencies..does any one have some sample forms i can see for like SOC's and any other ..my email is [email protected] greatly appreciate it any help or process flow you can provide..

Ana

paradiseboundRN · Jan 12, 2013

Your agency should have all the forms you need for a SOC. If you are looking for a narrative for the clinical findings, its goes like this...

PATIENT IS 78 Y/O FEMALE POST HOSPITALIZATION FOR EXAC OF COPD. INDEPENDENT PRIOR TO HOSPITAL PMH: COPD, CAD, HTN, ANEMIA, NIDDM. CURRENTLY, A&OX3, VITALS WNL. USES 2L/NC OXYGEN CONTINUOUSLY. DYSPNEA WITH MINIMAL EXERTION. LUNGS SOUNDS DIMINISHED BILAT. NEW NEBULIZER AND RX FOR ALBUTEROL. ADMITS TO STRESS BLADDER INCONTINENCE. POSITIVE BS X4. SHE HAS A 0.5 X 0.5 X 0.2 CM WOUND (SKIN TEAR) ON HER RIGHT ANTERIOR FOREARM. POSSIBLE TAPE BURN. WOUND BED IS BRIGHT PINK WITH NO DRAINAGE. BANDAID APPLIED. FBS 110 TODAY AND COMPLIANT WITH GLUCOMETER AND 1800 ADA DIET .EDEMA: 2+ PEDAL BILATERAL, LEFT INSTEP 28CM, RIGHT INSTEP 26CM. RATES PAIN 2/10 IN BACK DUE TO ARTHRITIS. UNSTEADY GAIT, USES WALKER. INDEPENDENT WITH ADL'S EXCEPT BATHING. LIVES WITH BROTHER WHO IS MAIN CAREGIVER. PLAN TO TEACH COPD DISEASE PROCESS AND MANAGEMENT; TEACH MEDICATIONS, SAFETY, NEBULIZER, HOW TO DECREASE EDEMA. MONITOR WOUND.

Basically you need to write the story. What were they in the hospital for? Medical HX? and then go through this list. I usually chart by exception, meaning that if I didn't mention it, it does not pertain or is normal. I added normals to this example so you could see how its done. All of this assessment data is in the OASIS anyway but most agencies want you to write a narrative. I might have missed something but this is the basics. Hope it helps.

orientation

vitals

lungs

oxygen

exertion level

bladder/bowel

wounds

pain

edema

FBS if diabetic

diet

ambulation

assistive devices

ADLS

support system/CG

new meds (coumadin, insulin)

any new or changed DME

aflack41 · Jul 31, 2013

What state are you in? I've been an LPN for one year at a LTC I am now doing home health and get paid 30/visit but I do not have guaranteed hours, it can be slow in the beginning but everyone tells me (other nurses) that it'll pick up. I think that pay is low for an RN, I'm in Illinois and at my company they pay the Rns forty a visit.

KelRN215, BSN, RN · Jul 31, 2013

What state are you in? I've been an LPN for one year at a LTC I am now doing home health and get paid 30/visit but I do not have guaranteed hours, it can be slow in the beginning but everyone tells me (other nurses) that it'll pick up. I think that pay is low for an RN, I'm in Illinois and at my company they pay the Rns forty a visit.

Per visit pay is different than hourly pay. OP is being paid hourly.

aflack41 · Jul 31, 2013

I know :) that's why I put that I get paid 30/visit. My company pays the RN's 45 a visit not forty like I said earlier.

mullen831 · Oct 8, 2013

Here in Ohio, I am paid per visit : 60 for skilled open, 35 for non skilled, 25 HHA check, 30 for reg skilled visit, 45 for oasis and 50 for resumptions...42 cents per mile. I avg approximately 25-30 visits per week, I make my own schedule. For those who are paid per visit, what are your pay scales like... To the OP: That is a confusing pay scale! I would have a hard time following that!!

pfaza2 · Oct 14, 2013

Your agency should have all the forms you need for a SOC. If you are looking for a narrative for the clinical findings, its goes like this...
PATIENT IS 78 Y/O FEMALE POST HOSPITALIZATION FOR EXAC OF COPD. INDEPENDENT PRIOR TO HOSPITAL PMH: COPD, CAD, HTN, ANEMIA, NIDDM. CURRENTLY, A&OX3, VITALS WNL. USES 2L/NC OXYGEN CONTINUOUSLY. DYSPNEA WITH MINIMAL EXERTION. LUNGS SOUNDS DIMINISHED BILAT. NEW NEBULIZER AND RX FOR ALBUTEROL. ADMITS TO STRESS BLADDER INCONTINENCE. POSITIVE BS X4. SHE HAS A 0.5 X 0.5 X 0.2 CM WOUND (SKIN TEAR) ON HER RIGHT ANTERIOR FOREARM. POSSIBLE TAPE BURN. WOUND BED IS BRIGHT PINK WITH NO DRAINAGE. BANDAID APPLIED. FBS 110 TODAY AND COMPLIANT WITH GLUCOMETER AND 1800 ADA DIET .EDEMA: 2+ PEDAL BILATERAL, LEFT INSTEP 28CM, RIGHT INSTEP 26CM. RATES PAIN 2/10 IN BACK DUE TO ARTHRITIS. UNSTEADY GAIT, USES WALKER. INDEPENDENT WITH ADL'S EXCEPT BATHING. LIVES WITH BROTHER WHO IS MAIN CAREGIVER. PLAN TO TEACH COPD DISEASE PROCESS AND MANAGEMENT; TEACH MEDICATIONS, SAFETY, NEBULIZER, HOW TO DECREASE EDEMA. MONITOR WOUND.
Basically you need to write the story. What were they in the hospital for? Medical HX? and then go through this list. I usually chart by exception, meaning that if I didn't mention it, it does not pertain or is normal. I added normals to this example so you could see how its done. All of this assessment data is in the OASIS anyway but most agencies want you to write a narrative. I might have missed something but this is the basics. Hope it helps.
orientation
vitals
lungs
oxygen
exertion level
bladder/bowel
wounds
pain
edema
FBS if diabetic
diet
ambulation
assistive devices
ADLS
support system/CG
new meds (coumadin, insulin)
any new or changed DME

This is a perfect example of a narrative or nurse's note