Overworked Home health RN

[jeepluv818]

I've been working in HH for 5 years now. I worked the baylor position for the 1st year. I've worked M-F for 3.5 years. Now I work Tue-Sat to try to alleviate the weekends for the new people. The turnover in my office is horrible. We are supposed to have 6 RNs and only have 2. We rotate call. It was me and another RN that had been there for many years for about 6months being promised new hires were coming as we are dragging by our fingernails to finish the day. The other RN put in her notice and that left me alone. My office has about 350 patients. 350 patients... let that sink in. She stayed long enough for them to hire two new RNs that had absolutely no home health experience. I had to train BOTH of them at the same time. They were damn near thrown to the wolves. Fast forward 4 months. One has already been fired for fraud..(awesome). The other threatens to quit everytime she goes on call. I'm about to be the only RN again. Now, again, they are promising help is coming, we(managment RNs) will help you in the field, we'll slow down the admits..blah blah. Nothing. We have a morning meeting every Wednesday that lasts till 10am. They have me scheduled to see 1admit, 2rocs, 1sn eval, 4regular visits with sups. Its like this every.single.day. 10-12 hour work days in the field. 2-6more hours of charting every single night. I've told them I cant keep doing this. More promises that never happen. No help. I average 6-9 patients a day most of the oasis assessments. Our oncall weeks are 7 days and you have at least 3 admits and 1 roc every weekend day. You work 12 days in a row when you are on call. They have had 6 clinical managers and 4 DOOs since I started 5 years ago. 3 Regional directors. 2 CEOs.

i absolutly love home health. This is my area of nursing I was made for. However, I have three kids 4, 2 (autistic), and 1. There are many times I don't see my kids awake for DAYS! Thank God my husband is a SAHD and a great husband too.

I'm totally exhausted and in tears as I write this. I just don't know what to do anymore. I'm the sole provider for my family and I make 70-75k a year with this company. All the other companies around here only pay 50-55k. I can't take the pay cut but this company is killing me.

If I say NO to visits then there isn't anyone else to do them. I just really need some encouragement and a

[Libby1987]

You're going to need to say no, which will be hard after tolerating those conditions for so long.

How are you paid? Salary, hourly, or PPV?

ETA 350 patients for 2 nurses to cover? What's going on with the other 250 patients?

[caliotter3]

You are going to have to bite the bullet and leave, or put up with this. Do not see any way around it.

[jeepluv818]

We have 6 LPNs, I'm only doing oasis assessment s and sup visits only. They had to down grade the patients but the lpns starve so they increase again.

I'm paid per visit. That helps with some of the conditions because it's larger checks. However, I'm working ave 120 hours biweekly so it doesn't quite balance.

I keep my head up as much as I can but have moments where I just need to vent for a minute.

Thank you for your comment

[jeepluv818]

Does anyone know anything about Kindred? A new office opened locally

[LPN2018, CNA]

They were previously known as Gentiva. It seemed like the case load was balanced and they were pleasant with family member.

[juliemck, BSN]

I feel the exact same way, but not because of the patient load. I drive 100 + miles almost every day and document until at least 10 & 11 most nights if not every night plus weekends. This is due to trying to complete OASIS visits. I've only been doing this 6 mths and I'm putting in my notice already to go PRN. My family life is suffering tremendously and it's just not worth it. The pt/nurse relationship is very rewarding, but the documentation has taken complete control of my life and I am at wits end with it all. I'm so sorry for what you are going through.

[sacajundude]

Do NOT put up with it. Many, many agencies have been abusing their nurses like this since Medicare/CMS has consistently lowered reimbursement and elevated the bar with documentation demands. The agencies just roll it over to the nurses, increasing points required weekly and nutty on-call rotation expectations. They don't care if you drop dead, as long as the documentation is done. I have backed away from full-time salary in favor of per visit so I can effectively manage my time & have at least some semblance of a work-life balance. I don't work for just one, but several different agencies in order to maintain enough visits throughout the week. Once you are PRN, the ball is in your court, depending on your negotiating skills.

[ErnBlz]

I suggest you go somewhere else. If the RN managers aren't willing to go out there and help by doing oasis admits and discharges and supervisory visits, then they are just using you to be more profitable so they can get bonuses.

[I<3H2O, BSN, RN]

Jeepluv, I think we work for the same company! í ½í¸”

[livelaughlove09]

1 RN for 350 patients is ludicrous. there is no way you can provide any type of quality care for those patients. Your agency is also probably not getting your LPN supervisory visits completed as required.

Home Health is difficult to staff and keep staffed when you are understaffed. Someone quits before you have a full staff because they get burned out, and the cycle repeats. Contract nurse or traveler? PRN staff to fill in until your agency can get a few RNs on board and properly orient them?

How many CMs do you have? I'm a director and it doesn't hurt my feelings at all to go see a few patients when things get tight. I'd rather help my nurses out and keep them around than have them jump ship and deal with situations like this.

I wouldn't recommend just saying no. I would, however, recommend a sit down with your supervisor and tell her you're drowning and you need help, that you can't effectively manage that many patients. If she has field experience she knows what you're dealing with because I've never held a home health job where the caseload doesn't get crazy from time to time. What you are explaining is extreme though.