New job-SOC nurse-NEED INFO

Libby1987 · Jul 18, 2015

I have nearly 20 yrs of HH experience and 3 SOC's 5 days/week (the way I do them) would kick my butt.

It concerns me that they would put someone without HH experience into the SOC role and makes me question why they need to do that, apparently their existing staff aren't interested in the position?

Admissions are actually my favorite, they feel the most purposeful and it takes me 3 hrs to complete all aspects of a SOC, sometimes that includes driving, most of my patients are also close together. Unless it's a knee I'm there for 1 1/2- 2 hrs, but my patients and families are prepared to make it through to the next visit, all meds have been reconciled, all referrals made (that's a major part of the SOC, assessing for patient's needs that weren't on the intake orders), treatments performed and taught, a relevant POC developed (I've got templates in my head but that comes with experience) and all communications made. On top of the documentation. I had one of our new nurses tell me she finally got a SOC down to 4 hrs.

On the other hand, you would hopefully not be peppered with calls throughout the day since you will not be part of the ongoing care, I think.

I'm not saying don't take it but be prepared to either do minimum care and planning (in which case you lose the best aspect of HH care) or working beyond 8 hrs. And you can use this experience to better position yourself.

rdl2881 · Jul 18, 2015

Thank you for the input. I appreciate it as I really have no idea what to expect. I have a close friend that works in HH and she told me her admission generally take an hour so I was trying to guess how long I would actually be out in the field. I definitely do not want to be out there from 8-5. That's way more than I am working now in the hospital.

Not sure how it works but it seems, according to their website and job openings, that they keep the SOC nurse and case manager separate for all positions.

Libby1987 · Jul 18, 2015

I can tell you that trying to knock out 3 SOC visits 8-12 then going back to chart all 3 will much more difficult than you think and predictably leads to errors and omissions, even by experienced HH nurses.

It's not realistic to think you won't be out in the field most of the day with 3 SOC's, not with quality thorough care. The acuity is high these, and there has always been complex socio issues with a significant amount of patients, throw those two things together with an IV or wound vac SOC (or an IV/Wound vac) and you'll be out there for up to 3 hours for one patient.

They aren't all like that but they range from a healthy knee to the complex and dysfunctional.

How long has your friend been in HH?

For reference, we consider 2 SOC and 1 revisit a full day for an experienced nurse.

rdl2881 · Jul 18, 2015

Yeah, I have no problem *working* 8-5 but being out from 8-5 and THEN documenting seems like it would be way too many hours of work for me. Actually, one of the reasons I was looking into HH was for flexibility although with other things but definitely not to work MORE hours.

My friend has only been in HH for a year and she loves it. She mainly does case management visits but she said her admits are 1 hour on average 2 at the most. In our area with these particular hospitals, she is seeing a lot of ortho patients.

I don't want to sacrifice good care and am not looking to do a little amount of sub par work by any means but I don't want to work more hours than I already am.

Libby1987 · Jul 18, 2015

No, I didn't mean that you would be in the home 8-5 but that getting all 3 visits done before documenting is hard.

But it to keep all of the detail straight and be able to document for reimbursement (big in HH, we're responsible for providing a thorough clinical and functional picture to support the need for services, the amount of payment is literally based in large part on our assessment) as well as meeting patients' needs.

When you're learning especially, you will want to complete charting as you go. Which means make one visit then go chart whether at the coffee shop, side of the road or whatever. You will not be able to go home and do charting on 3 SOC's at one sitting. I mean you can do it but it will take longer and accuracy will likely be affected. Unless you're different than everyone else :-)

Can you get it all done 8-5 without charting in the evenings? Hard to say but will depend on your time mgmt, ability to multi task, consise documentation and ability to roll with chaos without getting rattled.

I've seen so many new nurses get overwhelmed with the learning curve and scheduling expectations and then quit. I want to see everyone be successful even if that means a rough first year. No schools provide even a sliver of HH education, it all has to be learned on the job, while meeting productivity expectations.

rdl2881 · Jul 18, 2015

Would you suggest asking to shadow a SOC nurse after the interview? Granted everything else is still what I was looking for.

Libby1987 · Jul 18, 2015

One more thing and then I'll shut up.

Doing one SOC a day is entirely different than 2 or 3. Difficulty keeping all of the details straight increases exponentially with the number of SOC's in a day, even in a week. That's why completing one before going onto the other is essential to not frying your brain in frustration.

melaniekrn97 · Jul 18, 2015

I also hold this position in the company I work for. However, I have been a home health nurse since 1998. That being said, I think it has the potential to be very overwhelming for a nurse with no home health experience. Most nurses that come to home health with no experience, leave because the documentation is so different than a hospital or clinic, much more detail is required. Do you know what software they use? I have experience with kinnser and home care home base. Kinnser is very user friendly and will make your SOC much easier. Will you always be finished between the hours of 8-5? not likely.

Most patients do not like visits at 8:00am! I usually plan to see my first around 10, second at noon and third around 1:30-2:00 and plan to be headed home by 3:00-3:30. I often spend a couple hours in the morning documenting. I can get through an oasis very quickly now, I know the questions by memory. However, like the previous person replied, keeping all the details straight is vital. Do not think you will remember if this patient has MPOA or has had a pneumonia vaccine, write it down. I carry a notebook with me and I write down all the details of my visit such as pain, do they wear glasses/hearing aids/recent falls, who manages meds, appts, etc. The only thing I document electronically in the home is vital signs and the patient's signature is also electronic. I document everything else later from my notes. But you must remember what to ask. Make a list and ask because the oasis is very detailed and you will need to know about vision, pain, hearing, assistance from family, medical history, meds, etc. An oasis must be completed for each medicare SOC, ROC, recert or SCIC.

I do on occasion admit patients that have private insurance and no oasis is needed so those are much quicker. Patients are all different though, you will have some that are so talkative and make it difficult for you to get through your assessment and ask questions and others that you have to pry information from. What information is provided to you on paper from the office is not always the picture in the home. I have spent 4 hours in a home before because things were a mess, meds had to be clarified before I left, dressings change, IV's inserted, etc. I have been in and out in an hour before. Also keep in mind that you may have to go to the office to pick up supplies if you will need to do wound care (it is appropriate to obtain enough supplies for the nurse that will see the patient next so they are able to do proper wound care), you may have to draw blood and drop it off at the lab.

I would say that two hours between SOC is reasonable as long as you don't expect to complete your documentation in that time as well. See your patient, keep a notebook with all notes from the visit and plan to spend a couple hours at home documenting. You will likely have to give a report to the nurse that will follow you as well. You will need to call your patients for the following day. After I confirm my visits, I prepare my SOC paperwork, fill out as much as I can. Most documentation is electronic but there is still a paper consent and med profile and depending on your agency, there may be a few other documents to turn in as well.

Organize, organize, organize and be time efficient is the key to being successful in home health but it does allow for great flexibility. I am able to attend all my son's school functions and pick him up if needed. Run errands during the day, etc.

Ask to shadow someone like you mentioned. Make sure you know what software they use, it will be vital!

Good luck on your interview and don't let fear of a change scare you away, give yourself a good 6 months to adjust!

rdl2881 · Jul 18, 2015

Thank you! I appreciate the input. She did mention the system they use but I can't remember the name of it.

Also, just to add, and I know it isn't the same thing, but I was an admissions nurse for years and I currently work PM shift which is where all of the admissions happen. I am used to doing tons of charting. I understand this isn't the same as the OASIS but it's not like I am a stranger to long charting.

melaniekrn97 · Jul 18, 2015

Charting is definitely different, there is more emphasis of the patient's current/prior level of functioning. Can they dress themselves or do they need assistance? Can the prepare a meal or answer the phone? Stuff like that. A lot of this you will be able to observe while you visit the patient.

Hospitals are concerned with patient's current condition, they don't care if they can dress or feed themselves. It isn't hard to pick up, just MORE to document, that's all. Each note must be able to stand alone and your supervisor should be able to read your SOC and tell what you did, why the patient needs home health and what the plan of care is.

I still love home health. I like being with patients one on one and not having one ring the call bell for pain meds, this one needs to go to the bathroom and this one needs IV abx. I can focus on one person and it's nice to see them in their environment, meet their families and pets (hope you aren't afraid of dogs). Most patients are just grateful to have someone looking after them. There is lots of teaching involved, hospital nurses don't always have time to tell CHF patient to weight daily or Coumadin patients to take their Coumadin at night.

You can probably find a sample oasis online I bet.

Best of luck with whatever you decide.

rdl2881 · Jul 18, 2015

Thanks! I work for a rehabilitation hospital so our charting focuses on current levels of functioning such as how they can dress themselves, how much assistance is needed, transfer level, etc. Along with all of the other nursing stuff. Hopefully it will help a little. I am going to go on the interview and decide from there.:)