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.
Specializes in pill pusher, fanny wiper, poker player.
I'm amazed at how unsupportive your employer seems to be. Most home health agencies have difficulty retaining nurses for the EXACT reasons you have complained about. I almost felt I had written that complaint myself! I have been a home care nurse for 2 years... I still struggle, the OASIS questions themselves do not mention all the things that can be considered when assessing a client's abilities. My office and higher-ups always send back charts for me to "approve" because they have found evidence in my documentation to rate the client at a more acute level for whatever it is. Anyway, I also chart many hours into my home time, late at night. I've been told I do document too much and I've been working on being less wordy. I try to do as much in the home as possible, but, I too, hate to have the client have to "stare" at me because I'm charting on a computer. And, as you know, all that extra charting is not compensated. And...on top of all that... it seems like we are still never fully done.... always needing to do prep for the next day, calling clients to set up appts, f/u for phone calls that were never returned, etc.
But opposite of your experience, my employer/supervisors have always been so supportive!...which is the way it should be! I've never felt I could not go to anyone. and 6-7 points per day is an unrealistic expectation for a nurse that has only been there 8 months...especially if any of those points are a SOC, ROC, or RECERT. I'd be tempted to find a more supportive employer.
So, just because your employer wants OASIS questions answered a certain way, that doesn't mean that your answers were wrong. You are the one who assessed the patient. Likely, your employer is trying to make it seem like the patients' needs are greater than they are because of the way Medicare reimburses for home health services. The reimbursement is determined based on how complex the patient is based on answers to OASIS and the agency gets a flat rate every 60 days regardless of the frequency of the visits. (Unlike other insurers which reimburse based on each visit.)
One of my former colleagues says her boss is constantly changing her answers to OASIS questions- like marking every patient as incontinent because "everyone is incontinent sometimes."
Specializes in pill pusher, fanny wiper, poker player.
Regarding OASIS, the class for that is a day or two. It's extensive and I know that our supervisors etc are sent to it, but the field nurses and therapists are not. It would certainly benefit all to go.
I highly encourage you to take the oasis class. When I use to review Oasis, I took the two day course to better understand. I learned that the questions are not black and white, and if you read it as such you are bound to answer the questions incorrectly. At our agency we reveiw key Oasis questions with our nurses for a better understanding. I also have the Oasis book it cost around 60 bucks. HH requires that documentation be submitted in a timely manner thats's how the agencies receive reimbursement. If I have field visits I spend 30 to 45 mins with a pt, longer if its a SOC, or ROC or if there are multiple issues. Seeing more than 8 pts a day can be tough however we must be flexible and know that days like these can happen as long as it doesnt happen everyday. If its an everyday thing than it will be difficult to submit documentation on time. You're a newbie at all this and luckily
Have you tried to get into clinic nursing, the ones I know that work in the clinics seem the happiest. It might be something to consider. I'm keeping my eyes open too. I'd like to find a pleasant, stress-free nursing job for myself.
Not_A_Hat_Person, RN
2,900 Posts
Does your employer pay for continuing education? Would they reimburse you, even in part, for an OASIS course?