New nurse / new to HH / tons of questions

[tinyRN72]

Hi all, I just graduated and got my license. My first job is home health. My first week is over and I have found that I have a ton of questions if anyone doesn't mind taking the time to give me some input.

1) Where do you normally get lab supplies? I have been told to get them from the hospital lab, but the lab tech doesn't seem to want to supply me. She did for the patient I have right now, but I am not sure that she will in the future. I don't want to take the cost out of own pocket, and the office isn't giving me any either.

2) A doctor told my patient that I can take his staples out. I know how to use the staple remover, but, again, don't want to pay for one, especially since they are one-time use. I told him that I can't. Does this sort of thing happen a lot?

3) How do most agencies pay? I get a flat rate for each visit and that is ALL - no car allowance, not even benefits. Is this normal in home health?

I really like the work, and could't get a better job right out of school, but what do you guys think of this stuff?

I will stop with just these for now. Thanks to anyone who is willing to help. Any other suggestions?

Thank you!

Melissa

[stephanie.]

Also- if they aren't paying your mileage, get a log ad write your miles down so you can deduct them.

[Sun0408, ASN, RN]

I would leave like YESTERDAY.. You are a new grad with no experience. You need training and the lack of it will not protect you if/when something goes wrong because A.. you did not receive the proper training and B.. you are not given the proper supplies needed for the job at hand ie: the PICC dressing. A central line dressing is a sterile dressing change and CVS does not have the needed supplies. You are responsible for your own actions regardless. That agency is putting you at risk.

I wish you the best and hope you find something with better supplies, training and support.

[LaRN]

If we do not have the supplies that are needed to provide care to a patient in the office, we will ask the nurse who has accepted the case if they can obtain those supplies and we reimburse them once they send the receipt in.

that seems so unprofessional to me. whether it is a small agency or a big agency, they should be able to obtain the supplies a patient needs without making the nurse "shop" on her own time. I would resent being asked to do this.

[mother1strn2nd]

that seems so unprofessional to me. whether it is a small agency or a big agency, they should be able to obtain the supplies a patient needs without making the nurse "shop" on her own time. I would resent being asked to do this.

Many of our nurses live on average an hour away from the office. Many times they do not want to drive to the office to pick up supplies and may be inconvenient for them, especially if they have accepted a

Case and Soc is the next day.

[mcsurley]

Does anyone have viewpoints on whether home health nursing is better than possibly seeking employment in the hospital?? Thanks...

[Jesse74]

I absolutely love HH nursing. The flexibility, being able to work with a team to take care of ALL of the patients needs (not just what I can get done in my 12 hr shift), being able to make my own schedule. I also enjoy the independence I have to make my own decisions. HH nurses have so much independence. Often times the docs send a patient our way asking for our opinions. I like being able to admit a patient, see them recover (mostly) and then discharging them and actually seeing the fruits of our labor.

[gabrield, BSN, RN]

I also worked Homecare based but here in Middles East, the family took supplies from the hospital, everything is given monthly. about the pay, we are getting a minimum of $1,370 per month free transpo and allowance, 48 hours per week schedule.

[LaRN]

Many of our nurses live on average an hour away from the office. Many times they do not want to drive to the office to pick up supplies and may be inconvenient for them, especially if they have accepted a

Case and Soc is the next day.

I keep a few supplies on hand, every nurse should. Not a stock pile, but one of everything you will likely need. catheter kit, cath irrigation kit, sterile gloves....central line or picc line dsg. I wouldn't mind going to a medical supply store and picking up items that are charged to the home health's account.

[joy&caring]

Medicare pays the agency about $48 per patient for the cost of supplies. While a patient is under service, your agency is obligated to pay for all of their supplies. That includes any dressings, ostomy wafer and bags, catheters, suture and staple removers etc. The agency should also have basic supplies to be used by the nurses such as alcohol, band-aids, tape, thermometers, non-sterile dressings, cotton tip applicators, etc. Many agencies stock the basic stuff and drop ship supplies that are specific to a patient. If the patient doesn't have Medicare, they still need to pay for a staple remover and have a DME supply the other stuff. Lab supplies are usually supplied by the lab that you drop off your specimens on a regular basis. They are ordered in bulk. I'm not sure if there is a charge for them. Do not pay for any of these things out of your pocket!

A flat rate per patient is pretty common but they should be paying you mileage. This should be close to .0.50 per mile. If they don't want to pay mileage than you should be getting a higher per visit rate. In Michigan, the average per visit is $50 for a revisit and $85 for a SOC.

I recommend that all new home care nurses read this book cover to cover. It explains home care documentation, Medicare regulations, the OASIS and much more! I know I suggest this book a lot but I learned so much about home care after reading it. You can find it on Amazon or the authors web site.

The Handbook of Home Health Standards: Quality, Documentation and Reimbursement, author: Tina Marelli

Welcome to Home care!

Thank you for posting this resource!

Do you have any suggestions for other resources for new home health nurses?

[KarenJordan]

I am a DON of a small mom and pop agency and we are not much of hand-holding when it comes to orientation because we lack the time and resources most of the time. But sheesh! I would never put a new grad in the position you are in!! But I also confess that I do not hire new grads in home care. You need to be in a hospital to learn get your skills down pat before you start in home care. I would go to your DON or administrator and tell them that you need some orientation. If they aren't willing, go somewhere else.

Also, our agency doesn't pay milage either. We have a higher per visit rate to compensate.

[tinyRN72, BSN]

I actually found everything -- choraprep, sterile gloves, tegaderm -- at CVS. Just not the biopatch, which no everyone uses. Her stat-lock was outside of the dressing anyway. Maybe I made a mistake, but I cleaned it the best that I could and I know that everything under the tegaderm was sterile.

I have 2 other PICC patients, and they have had supplies... I am hoping that this was just an isolated mess-up.

[tinyRN72, BSN]

Yes, thank you VERY much!

I started this post on my first week there... I was VERY over-whelmed by everything. Since then, I have sort of "learned the ropes." I know, now, to call as soon as I get a case and find out if I need to order supplies. The lab has realized that I will bring the specimens back to them, and they are more helpful.

Things have definitely gotten better. It is a small company. I like reporting directly to the owner. There is no chain of command. I like working directly with the actual person in charge. Believe it or not, tomorrow is the first day of my 6th week... and I am the main RN. There are 3 others, but they only work part-time.

I feel much better now. I don't know what the deal was with the lady with no PICC supplies. I think another agency dropped them, and we took them. I sort of panicked, but it turned out OK.