Nursing supervisor of Home Health Agency

KateRN1 · Apr 25, 2010

Our agency has close to 400 patients and we are divided into 4 teams, each with a Clinical Supervisor who answers directly to the Director of Nursing. As a clinical supervisor, I am responsible for everything that goes on in my team. I am ultimately responsible for the scheduling, although I have a scheduler who takes care of the nuts-and-bolts of that (it only falls on me when there's a problem, of course). I review all OASIS assessements for completion and accuracy, validate all info, and prepare all the charts for RAP. I seem to spend a great deal of my time on detective work, such as hunting up the details of some transaction, finding the results of labs that didn't get passed on, forwarding those results to everyone involved, etc. I am responsible for annual performance reviews for the full-time members of my team and contribute to the reviews for PRN staff who work for all the teams. I check all 485s for completeness and accuracy and distribute to the field staff as quickly as possible, aiming for a minimum 7-day turnaround from the SOC/recert.

And there are a lot of other little details that get lost in the translation, of course. My big project at the moment is getting all the field staff to communicate with each other. It's like pulling teeth.

Kyasi · Apr 26, 2010

Kate,

I do a lot of what you do. I have 5 nurse case managers who work for me and each of them have a patient load. They open the new cases, do recerts, supervisory visits, and write prior authorizations. I check all the 485's, check and enter the OASIS, do annual reviews of all the employees, handle all patient complaints, take referrals, interview, hire/fire and handle all disciplinary problems. I have 2 schedulers but handle scheduling problems too. I answer to a branch manager who is over 6 of our branch offices, so she is only in our office every week or 2. Gee, my job description is about 3 pages long so there is much more. I have to track the expiration dates of our funding sources and make sure we aren't staffing for cases that we don't have funding for and that we don't go over the authorized number of hours. Also, I schedule all inservices, orientations, competency testing of our HHA's. I have to be sure they aren't doing a skill (like catheter care) if they haven't been competency checked on it. Also, making sure all field employees CPR, Licensing, TB's etc are up to date. I do have 3 office staff that help with data processing, entering payroll, checking HHA documentation to see that it matches the careplan, but I'm ultimately the one who needs to be sure it's all being done correctly. It seems most of my time is spent in checking assessments/OASIS to make sure they match the 485's. It's very time consuming! Detective work is definitely one of my hats too! We have problems with HHA's going to clients late, leaving early and filling out their time cards for the entire shift. We even have clients who work the system and will sign time cards when the HHA never showed so they don't get into trouble.

Gosh, I just wore myself out and the week is only starting!

Luckily, all the nurse case managers get along great. I worked for a hospital based agency for about 25 yrs. and after I got this job and we grew, many of the nurses who I used to work with over the years defected and came to work for me. So they were basically well trained and took very little orientation, which is very nice.

Thanks for filling me in on your job. It's interesting to see how other agencies do things. It's a very challenging job, isn't it?

K.

KateRN1 · Apr 27, 2010

Challenging, yes, for sure. Thankless, most days. Some days I feel more like kindergarten teacher than anything else.

Kyasi · Apr 28, 2010

Kate,

You hit the nail on the head w/feeling like a kindergarten teacher. Someday I swear I'm going to write a book about some of the unbelievable things that have happened since I got this job.

The State Dept. of Health came in for a surprise audit today. It went well but created a bit of tension for the day and obviously upset the normal functioning of the office a great deal. Never a dull moment!

Kyasi

CFitzRN, ADN · Apr 28, 2010

I am a new (5 weeks) Clinical Supervisor for a local HHA (small branch of a national chain, we are being acquired by a new company in June though). I am AMAZED at the craziness of home health!! Like you say, I could write a book about the insanity that we witness on a daily basis! If it isn't the patients, it's the family, the neighbors, and even our own nurses and/or CNAs! Just CRAZY! But I'm learning to take it day by day and laugh. We LAUGH a lot in our office. We have a smallish internal staff of ED, DOPS, me, the staffer for our skilled nursing cases and the staffer for our CNA cases. We are a super-tight group. Almost like sisters, because we love each other but occasionally have to b-slap each other, haha. Never with malice though.

Because I'm so new to this, I'm too inexperienced to even know what I don't know (if you know what I mean) but everything I have learned has mostly endeared me to HHC. There are those things which I don't even have to tell you about that make you pull your hair out, but mostly I really love it all. I think I have found my niche. At times I feel that I didn't "earn" this job. I've only been an RN for two years and I got very lucky (if you read my post in the "roll call" you'll see what I mean) but every day I'm there I feel more and more strongly that I was made for this job.

2 months after graduation I was offered a HUGE case management job at our local hospice. I felt totally and completely under qualified for the job (and I think I was). I knew I wouldn't take the position because it was a 50-hour a week job (far more than I was looking for) so I asked the director of nursing there why he would offer this job to such a green nurse as myself. He told me that case management requires a unique type of nurse and that my clinical experience and skills were far less important than my personality, intelligence, communication and people skills. He thought I would be perfect for the job. Talk about a huge ego boost. He had been doing that job for many years and I do trust his judgment. That, coupled with this situation I am in, has led me to believe that case management/clinical supervising is what I was meant to do. I really love it.

Kyasi · Apr 28, 2010

CF,

What is Roll call? I'm new to this site so I'm not sure where to find it.

I turned this job down 3 times before I finally did accept it. I'm not sure I felt so lucky for the first 3 or 4 months... more like I should have my head examined. When I started, it was a sink or swim venture. The previous Supervisor was fired and I had a big mess to clean up along with learning the job. I do enjoy the job now and I'm glad I took the position but there are days when I'd love to be able to say, 'let me transfer you to the Supervisor' when I have an angry client on the phone.

As I said before, never a dull moment. Just when I think I've seen it all, something happens that proves I haven't.

Kyasi

CFitzRN, ADN · Apr 28, 2010

I'm sorry, I didn't make it clear... I meant the "roll call" thread on the Home Health Nursing board. I had seen your post there, then I saw your post here too.

One thing I've noticed in the office... toward the end of a really hectic, stressful day (like today), we turn into huge goofballs. This afternoon our Director started shooting us with this little toy she had brought in (she brings in little toys for the kids of patients or employees) - it was a foam "ice cream cone" thing and we chased each other around with it, laughing our heads off. I tell ya, if we weren't able to decompress that way, I think we'd all just explode. This is one of the most stressful, most wonderful jobs I've ever had. The office staff makes all the difference.

How does your staff get along? Do you find that all the craziness makes the bonds stronger? That's what I have seen.

Kyasi · Apr 28, 2010

Our office staff gets along very well. We are one big happy family. But I was lucky to be able to hand pick them all. All of my nurse case managers worked with me at another agency. So as we grew, and they heard I was the Supervisor, they started contacting me to say if I was ever hiring, to give them a call. So I did! So every one of my office nurses are friends who have known each other and worked together for years. I was with the other agency for many years and recently the supervisor from there saw me at a restaurant and asked me to stop stealing their nurses. My office staff support staff are great too. (schedulers, data entry, etc) One of them had tons of experience and worked with my husband at a public utility. When the city let her go to cut costs, I snatched her up as a scheduler and she is wonderful. We have our days when everyone unwinds in the office too. Like after the audit we were all pretty giddy. We also have a nonskilled division and DD program under our roof, so there are lots of people in the office.

Well, off to start the day! Have a good one. Thanks for the friend request. I hope I accepted it correctly. Will check out your other post later.

Kyasi

CFitzRN, ADN · May 22, 2010

Hi Kyasi,

Just wanted to check in and say hello. We had a particularly trying, horrific week and I just need to vent a bit. I'm going on 3 months now and I still love the job, but we are in the midst of transitioning from one company to another and along with everything THAT entails, our cases have seemed to just EXPLODE with "issues" the past few weeks. I don't know what it is. In the hospital we would liken it to "full moon syndrome" when everything just seems to get nutty for a day or two, but this has been going on for a couple of weeks now and our ED is about to lose her mind. She's great - she keeps it together pretty well - but I will go to her office, close the door, and she will just look at me like a deer in headlights and shake her head. She tells me that, in all of her years in HH, she has never seen it so unbelievably nuts as it has been lately.

I know this is a cyclical thing, and I know it will probably calm down at SOME point (oh pleeeaaase), so I'm hanging in there, but some days I just can't believe these things actually happen out there.

One thing I've had to really get on top of is Medicaid fraud that I am seeing in the field. I really care about most of my CNAs - I really do - but there are a few who I KNOW are getting to the home late, leaving early, and still having our clients sign their timeslips. When I open a case now - or when I go on Sup visits - I vehemently encourage clients to scrutinize the slips before signing, and to refuse to sign if they see a discrepancy. The problem is, there are CNAs who I know are bullying these clients - or at the very least, "brainwashing" them by telling them they will lose their services if they cause problems. It's really tough to get on top of. I'm still so new that I'm not completely sure how to deal with it. But I'm learning and I will get there.

Anyway, I hope things are going well for you! Thanks for being my sounding board here. :)

CFitz

KateRN1 · May 23, 2010

The DON at my agency has recently been talking to me about taking over as ADON. I've never worked at an agency that had an ADON and my requests for clarification of the role have been met with a lot of analogies and little substance. I've been looking online for job descriptions of ADONs in home health care, but have only found one so far.

If you have an ADON at your agency (or would like to have one!) would you please tell what the specific roles and tasks are of that position? A job description would be ideal, if you have one written.

Kyasi · May 23, 2010

CFitz

I can sure relate to what you are saying about the Medicaid fraud. I find that the patients cover for our HHA's. We now do unannounced Supervisory visits... showing up about 15 min before the HHA is supposed to leave or before he/she arrives to see what time they actually do come or go. Often, we won't even let the client know we were there but do a 'stake-out' (like a detective) and then we see to see what times are on the timesheet. If we show up and the client tells us the HHA "just left" we will often get a call from the HHA a very short time later reporting that client asked them to leave early or whatever, making it obvious that client called the HHA to let them know that we know she left. HHA's and clients aren't supposed to call each other, but they do. I do disciplinary write-ups for it and still it continues.

We actually had this happen: Client called us on a Wed. to say she was leaving town on Sun. to get a second opinion from a specialist in another town and would need coverage through Sun. but then not the week following. One of our HHA's let us listen to a voicemail the client left her saying she was actually leaving town on Thur morning but she would sign everyone's timesheet for the rest of the week. The HHA who let us listen to the v.m. did not want to get involved and refused to let us quote her or say she let us hear the v.m. so our hands were tied. So we went each day to do S.V. and found nobody home. I called the HHA's in who were involved and one was fairly new and admitted she wasn't there and I fired her. The client and one HHA were slick though and had worked out a story that I couldn't prove wasn't true. Long story short, because I couldn't use the evidence, I couldn't close the case or fire the HHA I know was lying. We had to write her PA and cut her down from care 7 days a week to 3 days a week because we don't think she even needs care but can't prove it. She is going to have surgery soon and we will have to close her because she will be on hold at the end of her certification period. She doesn't know it yet but we won't accept her as a client when she tries to come back to our agency. It's a lot harder to close someone than to choose not to accept the referral or to open the case.

Another case: Supervisory nurse shows up at a home a half hour early and client isn't home. HHA is sitting on the porch waiting for the client's sister and patient to arrive from "a doctor appt". They arrive and sister hurried the patient in and the nurse notices a name band for a local Psychiatric hospital which the sister cuts off and throws away when she asked about it and said it was from an appt. last week. But later, we faxed the admission agreement to the hospital which gave us permission to discuss/coordinate care with all other caregivers and they told us that he had been hospitalized for a week and a half!! The HHA had turned in time sheets for the entire time he was hospitalized and the sister signed them. We of course didn't pay the HHA or bill Medicaid and closed the case. It's unbelievable though. I feel like a babysitter for HHA's and wonder what happened to integrity, work ethics etc. Patients seem to have this 'entitlement' thing going on and think that they deserve all they can milk from the system whether it is fraudulent or not.

This past few weeks have been relatively calm on my end but I'm waiting for the 'other shoe to drop.' We have those days where like you, all you can do is shake your head in disbelief.

Should we get together and write a book?? The stories I could tell could fill one and it sounds like you could too!

Hang in there... hopefully the good days outweigh the bad and the patients who truly deserve the services and who are grateful for the help will prevail. I'm glad to hear it's not only me who is experiencing this!!

Kyasi