I have a job interview next week for a SOC nurse in home health. I am totally new to home health and need all the info I can get before this interview!
The company is very large-reputable. They are the preferred HH agency for two of the major hospitals in my area so i am not worried about any sketchy issues that I have heard about other HH agencies. They said on the phone interview that I would typically see 3 patient's per day for SOC-this is specifically for a SOC nurse only-not case management. The pay is 105 per visit and this is if you complete your documentation within 24 hours. Otherwise, it is 90/visit with 48 hours to complete. Training is full time for 6 weeks.
My question is, the hours are listed as 8-5. I have never done HH before but have plenty of experience with admissions. I know the OASIS documentation is totally different but once I get familiar with it, does anyone know what a typical day would look like for me? I mean, would i really be out there from 8-5 everyday?? The territory is very close to my house so I am not anticipating driving very far.
How long does a typical admission take-the part where you are actually in the home. I don't think I would want to do my charting completely in the home as I would be more comfortable doing this at my own house where I can concentrate and really do it right. How long can I expect to actually be with the patient for a "typical" admission? If I scheduled my 3 patients at say 8, 10, 12 and then took the rest of the day to chart, is that acceptable or do companies typically add on to your schedule if they see it is done at 12. I'm just wondering if those 8-5 hours are with documentation included-wherever you want to do it-or if those are the hours you are expected to see patients. She did say no more than 3 a day. Just wondering if this would be the right choice for my family. It's sounds great but I am wondering if it would really be that way.
I am the soc nurse for my agency. I love my job, but can't imagine trying to do it with no home health experience. I work a 10 hour day and my expectation is to do 2 soc and a routine visit. Each admit takes me 2-4 hours depending on what's going on. I'm in the home between 1.5-2 hrs.
There is no way to compare an admission in the hospital to a home health admission. They are completely different.
Like others have mentioned, I would be hesitant to take job with an organization that is hiring a doc nurse with no prior HH experience.
Good luck to you, though! Home health has been, by far, the most rewarding and challenging job I have ever had.
Okay, just to clarify-I didn't compare an admission in a hospital to an admission in HH. I am well aware that they are completely different. However, as I said above, I do not work in an acute care hospital. I work in a rehabilitation hospital. Our admissions take no less than an hour and that's when you can do it fast. Our admissions screens and evaluations, documentation, etc, are very lengthy. What I was saying was that I am no stranger to long specific admissions. And yes, regardless of what is said, I do believe that being familiar with long admissions and being able to figure out how to perform an assessment based on the questions who will need to answer later will be beneficial to HH admissions. I have reviewed some OASIS documentation online and although it is different, it does not look like something foreign to me or something I won't be able to learn.
Furthermore, as far as I know, all HH nurses do SOC at some point, right? So is this thread to say that a nurse without specific HH experience should never get a chance in HH because he or she doesn't have direct experience? Can't we say that about any nursing job?
Lastly, the company is not sketchy. They require two years plus of med surg or acute care experience and provide 6 weeks full time training-which is more training than I got as a brand new nurse when I didn't even know how to do an injection. Thats 8-5 M-F for 6 weeks.
I also wasn't asking for opinions on whether or not I was capable of doing this based on my experience because reallly, no one knows what my experience is, the kind of learner I am, and what I personally feel I am capable of doing. I was asking about what to expect out of my day. I am more than confident that with the right training and guidance I can learn how to do this properly and effectively. I am a good nurse and passionate about the field. EVERY nursing job has a learning curve. Honestly, I have a hard time believing that HH is THAT much different than other nursing jobs. They are ALL hard jobs and they all require training and committment. I have friends in the field working for hospital HH agencies and they have caught on just fine-including doing SOC visits.
Thank you all for your input but I feel it is mostly negative. I really wasn't asking if any of you thought *I* was capable as that is not an opinion you can form. I am going to go on the interview, observe a nurse in the field and decide if this is right for me. I don't believe any nursing job is limited by lack of experience. I am an experienced RN and have no doubt that I will be able to pick this up and do it well with time like I have my other jobs.
I'm sorry if I made you feel attacked or that I was questioning your nursing ability. This was not my intent!
I should have just answered your original question. No, I don't think your agency would add more visits to your day if you were done seeing patients by 12. I do think that it would be incredibly difficult to finish the in home time and all the documentation that goes along with it by 5. As others have stated, most people will not let you come at 8.
I have seen a lot of very competent and wonderful nurses get very discouraged with the amount of documentation that goes along with an admission. Besides the OASIS assessment, there are a multitude of other things to do on that first visit. Yes, all of our nurses can do a soc, but I'm the only one that does 2 in a day. 3 would leave me utterly exhausted and overwhelmed, but I'm not you. You may be able to do this with ease. I was just trying to give you some feedback from experience in this field.
Like I said before, I really do wish the best for you. I absolutely love home health. Each day is an adventure, but when you are responsible for someone making even one small change to better their health, it is an amazing feeling.
I thought the gist of the thread was whether you could complete and sustain 3 SOC's in a 8-5 workday but you're getting pretty defensive about a position that may turn out to be unrealistic.
Yes, charting is considered part of your assignment, they will not add more patients just because you completed the visits.
We have some nurses who came from LTC who likened their admissions to our HH admission process, apparently they're both lengthy.
I'm considered a high producer at my company and I couldn't do it. There isn't a nurse in our office who can do it including our long term per diems who don't case manage.
I hope it turns out to be what you want it to be and works out to be doable. If they don't have a high turn over for that position then that would be a positive indication that it is. The best way to find out is to shadow one of their actual admissions nurses for a full day.
Here's my experience and realistic take on SOC. It takes 3 hours to do a SOC from arrival at home #1 to home #2. If you schedule this way, you start at 8 and end at 5. These would be basic, uncomplicated visits including one a phone call to the doc, simple wound care. I spend an hour to an hour and a half in the home, at which time I do at least the entire physical assessment documentation and teaching and documention of at least one or two interventions. The physical includes what you won't remember unless you write it down. I don't want to write it down and enter it. It wastes time. That's also why I chart as much as I can right after the visit. It's easy to remember. 3 hours includes travel up to about 15 minutes. Lunch is while you travel. The night before or morning of, I review the charts and call to arrange visits. Add 30 minutes to an hour. I put in an hour because I take notes so I don't have to fuss going through the chart at the visit. The closest I can schedule is 2 hours apart and chart later.
These are things that extend your day and happen frequently except for the first two:
. Staff meeting monthly.
. Case conference weekly.
. Call.
. Wound vac changes.
. IV infusions, hyperal.
. Foley cath insertions, changes.
. PICC dressing changes.
. Blood draws.
. Travel to the lab.
. Travel to the office for supplies.
. Travel to the office if paperwork didn't
make it to your device.
. Substancial wound care.
. Your patients don't want a visit before
10am.
. Arranging for DME.
. You have lengthy travel between visits.
My typical day is 10-11 hours. If I take a break (5-7), I chart after dinner until 9 or 10.
My place doesn't have this position but I would try it if they did. I will not do case management homecare. It's grueling and requires days to visit and evenings to chart. Every day. Some nurses have to cut corners to get it done.
The pros: autonomy, flexibility, usually soc nurses don't do case management, some don't do call, weekends or holidays. Little workplace drama to contend with. Opportunity for advancement. There are days when things go smoothly and you can finish by 5. I don't go home until 5. It keeps me focused. Like someone else here said, It will "kick your butt." The job itself is great though. I love the travel, the autonomy, the patients.
It's very misleading to say this is an 8-5 job. I am glad you can go into it with your eyes open.
I think you definitely can learn. Everything that is mentioned here about obstacles is realistic and will help you not to be caught off gaurd. As I said in my post, representing this as 8-5 is misleading. At my agency, A full day is 3 SOC. If you look at my time, it reflects 2 1/2 hours visiting/documenting but doesn't reflect everything else. It's the white elephant in the room. Good luck!
Here's my take. I have been working as a home health nurse not quite a year, did outpatient, acute care, and acute rehab over the last 15 years. Homecare is nothing like any other nursing job I have done.
At at this point a soc takes me 3 or so hours. About 1 1/4-2 hours in the home, the rest charting. At first it was 5-7 hours for and admit. Again, I am an experienced nurse, and still took a ton of time! We have nurses who do just admits. When I shadowed one of our best experienced admit nurses she was doing 3 admits a day, and said it was impossible. They were in the process of transitioning admit nurses to 2 soc visits a day, with a revisit added if they have time. So, no, in my opinion 3 admits is not easy for anyone, and likely not even possible in a day if you are new.
Also, 6 weeks of full time visits barely scratches the surface of what you need to know in home care. No one is questioning your abilities, just trying to get across to you just how different home care is from acute or sub acute care. Oasis is not anything like any admit you will ever do in an inpatient facility.
So, here's what I would do if I was you and wanted this job. I would counter their offer. Ask for 3 months as a home care nurse (not admit nurse) to learn the ins and outs of home care, then transition to the admit position. During that three months have them start you with 2-3 admits a week, working up to one admit (along with a couple revisits) a day. If they are not willing to understand that you need to acclimate to home care before taking on full time soc position then they don't understand what they are asking you to take on with no home care experience.
Again, you seem to be feeling a little defensive about the advice you have gotten. No one is questioning your ability, just trying to make you understand how different home care is. I'm a good nurse, a really good nurse (I think lol). I was a pretty great acute care nurse. When starting in home care it was like starting over. I wouldn't even say it was harder, just so very very different. Turnover is high in home care (in my experience). Many people don't make it beyond a few months. The job you are describing is, IMO, setting you up for failure.
I just started in HH and as a SOC nurse with no HH experience. I've been doing this for a little less than 2 months. This IS NOT a 8 to 5 job, many times I'm charting until 9pm and that is on ONE SOC because I'm new and this is a very LONG learning curve. The fastest I've gotten out of a home was in 3 hours. The OASIS form is ridiculously long and not cut and dry at all, sometimes the questions conflict each other but the way you answered them are right for the patient. It can be absolutely ridiculous.
Like others have said, things can really slow you down like wound care during your visit. The company I work for wants 3 SOC's per day, but as I'm at the end of my "orientation" I'm quickly seeing that this is not doable while having a life and I will not kill myself doing 3 per day to make them happy. Our management either hasn't been a SOC nurse or hasn't been in the field in many years. Most SOC nurses at my company either leave or transition over to case management because you can see patients, way less charting and be done by 5 and have a life most days. Unless you find a way to get fast and accurate at doing SOC's prepare to spend most your waking hours working.
I'm looking for ways to speed my process up while doing a good job, but I can tell you I'll likely be case managing once I'm able.
I understand. Unfortunately, lack of experienced management isn't the problem.
Wherever I have worked before, it's expected that an RN does 6 "points" a day. SOC was 2.5 points until corporate cut it down to 2. They said productivity reports show it is only taking 2 hours to visit and document a SOC. Now, you know that can't be the truth. The first place I worked expected 33 points a week. That means 3 days a week I would have to do 7. I didn't stay long. This is the dirty little lie in homecare: It's an 8-5 job. At that agency, my so called mentor did a SOC at an ALF. She copied the woman's chart, took vitals and took off. She did not speak to the woman, assess ambulation, etc. I guess she had to guess when the LBM was because she did not talk to anyone or look at any logs on her unit. The woman was in the lobby in her wheelchair. Another nurse there had patients in a nursing home. She finished her first visit short of the minimum time, let her visit continue to run while she moved onto the next patient. The first nurse was considered a top performer.
Go for case manager now if that's what you want. Nurses usually start there. Talk to your coworkers to get a realistic picture of a CM day before you do.
I prefer 3 SOC to 6 visits. Only three homes to travel to, 3 patients to care for. Practice makes perfect. I like to coordinate and I like thoroughly knowing the patient.
Either way, this job can make you feel like an incompetent time manager. Rest assured, your experienced coworkers are charting at night and struggling to get it all done during the day. I find it hard to believe someone who is going home at the end of the day without charting is doing a good job. I would say that's rare. We're getting a beating right now because productivity is not where corporate wants it to be.
If you don't mind ruffling feathers, ask your supervisor to take you out and help you time manage to increase your productivity. Let him/her show you how it's done. I admit, I look back at my day sometimes and ask myself, "What did I do all day?" It's easy for anyone to wonder if they haven't done it themselves.
Welcome to homecare. Don't forget to take care of yourself. Full disclosure: I need a full-time job but I am not "productive" enough. I work nearly fulltime when I can as a per diem because I didn't need benefits. Still looking for a better situation.
I began an angry post last night and deleted it. After reading Gibsongirl's experience I'm tempted again.
There is no way we would assign nor encourage 3 SOC in one day let alone PER day.
Quality is vital to us. And my admin doesn't want everyone charting at night, home life is also vital to keeping healthy employees. That doesn't mean some don't chart at night but that is more by choice (I don't usually leave my house until 9 but if I hit the ground at 8 and work consistently end efficiently I am done in a reasonable amount of time for the amount of work).
If I make 33 points/week, I'm making 112K/year because I'm PPV, while 25 points is the expectation with potentially 1 SOC/day, which never happens consistently.
Now some of us are just more organized and efficient. Some of us will struggle with charting and need to pause before every click while others whip through it, we all have inherently different wiring and different years and type of nursing experience which affects our speed and thoroughness. I see nurses stick with it because they prefer the patient care and acute care/specialty units are not options and LTC is not a desire.
Depending on where you work, where 4-5 visits take all day due to travel time or you're expected to knock out 6+ visits/days should determine preferred pay structure.
I personally am able to organize and stock my car that I don't need to go to the office more than once/week and I stay in my patient area and reduce my commute time. I also work in a semi rural area where we have specific territories. My coworkers have the same option but some do not or are not capable of doing the same for a variety of reasons.
My career goals are to leave my comfortable little corner and move into staff development with intent of training nurses how to thrive in home health, clearly there are some agencies where that wouldn't be realistic. Home health is a specialty but isn't always seen or treated as such, it's often a plan b.
The only reason homecare is not my first choice is that there is no work/life balance and I am not able to meet the expectations. Also, in my case, that is were the jobs are, and there are many.
HHRN81
19 Posts
I am the soc nurse for my agency. I love my job, but can't imagine trying to do it with no home health experience. I work a 10 hour day and my expectation is to do 2 soc and a routine visit. Each admit takes me 2-4 hours depending on what's going on. I'm in the home between 1.5-2 hrs.
There is no way to compare an admission in the hospital to a home health admission. They are completely different.
Like others have mentioned, I would be hesitant to take job with an organization that is hiring a doc nurse with no prior HH experience.
Good luck to you, though! Home health has been, by far, the most rewarding and challenging job I have ever had.