Not cut out for home health?

[KalipsoRed21, BSN, RN]

10 year old nurse with mostly hospital experience. 2.5 yrs ago I was a home infusion intake coordinator and ended up quitting after 2 years because I was working 60hrs a week for 40 hours pay. So I had some familiarity with home health when I started as a home health nurse for a different company 6months ago.

So far I can say that the patient interaction in home health is gold. It is everything I always wanted and never experienced in any nursing role I have had.

The charting, however, is a nasty 4 letter word. I find it difficult and over whelming. I don't understand OASIS, there should be a class on how and why one answers OASIS questions the way they should be answered. But there isn't and the best advice I get is after I turn in my chart a place called McBee sends me an email of recommendations on things I should change. I have improved and am only getting one or two recommendations a chart now.

The other thing I am not doing well is frequency. My coordinator feels that she has gone over it with me to the point I should know what I'm doing. All of this was over the phone. I am still frequently messing it up with resumption's and recerts.

My cooddinator and I are frequently at odds because I am part time and she is frequently telling me to do additional things on my days off when I am already spending 4ish hours charting on most of my days off. And I am kinda getting to the point that I am pushing back. A big reason I took a part time job is because I am trying to be less stressed and home more so I can get pregnant. As I am 37 I really don't feel like I can continue working these nursing jobs that keep asking more and more of my time. I don't have it to give even though it may seem that I am available because I don't have kids.

Things kinda built to the point that I put my foot down hard and said to both my coordinator and my manager in an email that I would not do anymore recerts or resumption's until someone can go with me and watch me chart OR give me in the time to drive to the office and have them do it with me. My office is 45 min or more from the area I cover.

Well that hat is when my manager said I needed to come and talk with her. And after pleasantries we're exchanged she proceeded to tell me she didn't think I was cut out for home health and that she didn't want to waste time on someone who wasn't hungry to learn it. Well that pretty much lit a fire in my stomach. She then proceeded to tell me that since I started in October and it has been 8 months since I started I should be able to see 6-7 points a day and chart with in 8-9hours.

Now I had to correct that I have been working there 6months, not 8. And some other things she thought I had done during my orientation which I hadn't. So that was a bit concerning to me. I then asked if there was anything else I do bad other than charting my frequency and not being able to get my charting done in 8 hours and the answer to that has been no. Consensus is I am a capable nurse, which I already knew.

So so basically I am being accused of spending to much time with my patients instead of charting, and I don't understand how to chart my frequency after 6 months of doing home health and thus I am not cut out to be a home health nurse? This is the oxymoronic, anxiety inducing, severely depressing experience that I have had over and over again in nursing that makes me discourage others from going into nursing. It is emotionally crippling and while I push past the doubt these experiences give me in my abilities, it is seriously how I feel an abusive relationship would feel like.

I am suppose to get 3 weeks of support and then be re-evaluated. I am afraid to as my coordinator questions because it may shed doubt on my ability to be employed with this company, and for the most part it is the best company I have worked for. But I'm not going to stop having questions. I have asked a couple of my coworkers that I like and they have told me that My manager is right about the fact that I shouldn't be having these problems after 6 months. So I guess I will need to be looking for a different nursing gig soon. But I am so tired of trying so hard anymore.

Thanks for the vent.❤️

[caliotter3]

No advice, just want to say that I am sorry to read that this is happening to you. Your post sounds as if you are a conscientious and caring individual.

[Nurse on the Go]

First, I am so sorry you are going through this!

Second, I don't agree at all that you're not cut out for home health! The charting is often what trips up new hires because it is difficult/intense and usually involves a steep learning curve. 6 months isn't a particularly long time to fully integrate into home health, especially working part time. I think it's reasonable that you would still have a lot of questions and need support with OASIS! From my experience, most new hires need between 6 months and 1 year to really get their feet under them and feel comfortable with the job. It seems like you're right on track...

How long is your average visit? Are you able to get any of your charting done during the visit? One of the biggest things that helped my productivity was when I started charting in the home (or at least in my car right after the visit.) I'm not sure what you mean by charting a frequency but if you want to give more detail I'll try to help.

As far as OASIS, there are classes to teach you how and why to answer the questions a particular way. If you're interested, you might check out this organization: Event landing | OASIS ANSWERS

The class is pricey, but you could purchase just the Oasis Answers book if you're looking for additional information. I found it to be really helpful.

[KalipsoRed21, BSN, RN]

Nurse On The Go thank you so much for the suggestion of the Oasis Answer book and class! I kept asking my employer if there wasn't some sort of education about it and no one had any answers, thank you so, so much!

Frequency- like 2 visits a week for 2 weeks. I remember to send the email to scheduling about it, but often for get, or inappropriatly put the order in the computer chart. I realize they have been talking to me on the phone about how to do it, but I really think I just need someone to show me in person a few times. Like watch me do it because I can't figure out what I am doing wrong.

I can usually chart all my vitals in the home, but I feel very rude and awkward trying to chart the whole assessment. If I do that I am not paying attention to what they are saying. For a non complex patient or one I am familiar with, and I have charted the vitals in the home, it takes me about 20 to 25 minutes to chart an assessment. Discharges, recerts, resumption take me about 1.5 hours. An admission takes me about 1 hour visit time and 2 to 3 hours to chart and complete all the paperwork.

Of the 6 people I am to see in a day, I will have 2 to 4 on my schedule I am not case managing and are unfamiliar with. I have been given a case load of 8-10 patients because they want me to be 'flexible' and see other people's patients. It takes me longer todo these people because I am very worried I will miss something. Our computer system doesn't exactly have a go to place to find a summary on the patient. One must look at several documents to try to get a full picture of needs. I am not sure how to continue a plan of care when I don't really know what the patients needs are and what has been going on.

[Daisy4RN]

Sorry you are having a hard time. The OASIS is ridiculous!! I also worked HH part time and quit because of the time factors, just wasn't willing to do that much work on my own time. If you are going to try to get a different job just make sure you don't burn your bridge there. Good luck!!

[Neats, BSN]

Although I have never worked home health I have reviewed on a daily basis home health documentation for the past 6 years. If I was going to work home health and was in training I would ask for a completed OASIS one for initial and one for re-certification, this way I have an example of what to do. I find for documentation you must complete it is nice to have an actual example for review to assist.

[KalipsoRed21, BSN, RN]

Honestly I think that is part of the problem. In 10 years I have never had to 'review my chart' to chart ensure a bunch of questions were answered in a certain fashion. I only re read notes as I added them. I never went back and looked at the chart as a whole. I have always charted by exception, because every hospital I have ever worked at has charted by exception. It does not seem charting by exception is what they want in home health, but they also don't have a cohesive way they want things charted so that it can be taught. For example, when I worked in the emergency room the biggest education I got was how to triage on a 5 level triage system and how to appropriately chart a sedation or code. These were detailed charting needs that were audited. I went to a class that educated me on what the process was to chart these, what the auditors were looking for, and why that information was critical even if it was just critical for billing. I wasn't expected to 'figure out' how to chart these by looking at examples.

[Libby1987]

It's hard to learn oasis on a part time basis but in general nurses struggle with understanding how to use oasis as a tool and view it as an assignment. Nurses aren't trained to document for reimbursement and outcomes, we're brought up to CYA.

For what it's worth, our company does provide extensive oasis training as well as remediation for those that need it. Some staff continue to struggle while others have a strong grasp. If you're down to 2 changes, that's not behind the curve.

I'm surprised that a company that uses a giant like McBee doesn't provide formal oasis training but if I wanted to keep a job I otherwise enjoyed, I'd seek my own training.

Looks like Fazzi might have individual courses available for $199:

A to Z

[KalipsoRed21, BSN, RN]

Thanks! That looks super helpful to look into. I do real well with most of the training I have ever had so a course is greatly appreciated! I am willing to put in the effort, but as I have had a learning disability most of my life, I am very aware of how I learn best, and luckily for me I am usually able to find what I need through Youtube or podcasts or online presentations. So a class is super helpful! Thank you so much for the suggestion!

[Abbys, RN]

It is unbelievable how well you have picked it up with so little support! You should feel proud. I hope you hang in there because you are going to be a star nurse for that organization. I suspect they have a high turnover.

[iluvivt, BSN, RN]

I would not be so inclined to lose a good job because someone else thinks I am not good or fast enough.It sounds like you are doing just fine and just need to fine tune a bit.Often in nursing employers do not provide what you need in order to suceed and you have to find your own resouces.Please try and hang in there and try not to share your struggles with managment....just let them see the finished shining product.You can do this.

[iluvivt, BSN, RN]

I would not be so inclined to lose a good job because someone else thinks I am not good or fast enough.It sounds like you are doing just fine and just need to fine tune a bit.Often in nursing employers do not provide what you need in order to suceed and you have to find your own resouces.Please try and hang in there and try not to share your struggles with managment....just let them see the finished shining product.You can do this. OASIS User Manuals - Centers for Medicare & Medicaid Services