BBP42

As an Epic user I think this "no notes" plan is ill- advised and will change after it bites them in the behind a couple of times. I would continue to chart information that needs to be there, taking care to make everything factual. The visibility has made me more careful about stating dispassionate facts: no longer "patient was upset about..." but "patient stated (direct quote in quotation marks)". I think overall it has made me more attentive to defensible documentation. And as another member noted there is a button to click that hides a note from the patient, that states reading this note could cause harm to someone. We generally use this for details related to mandated reporting, I.e. kid being checked out for abuse and the abuser may have access to their mychart. In the end I always remember I could end up in court years down the road with only my notes to refresh my memory, and it is my hard earned license to maintain.

Different parts of the country, salary varies widely. As a community College associates degree RN I have made over 110k working less than 40 hours a week in home health in CT. On track to make 100k this year working in a doctor's office full time with regular small amounts of OT. If I chose to pursue a RN to BSN program it would open up more roles and higher salary, but I am not willing to spend that money because I do not see it having good return on the time and cost involved. I know nurses in the southern and Midwestern states with lower cost of living make far less.

I also worked SNF prior to home health and found it a natural transition. The wound care and postop care at home was similar to the patients I was caring for at the rehab, the OASIS assessments at home ask the same type of questions as the GG questions we completed at the SNF, the information gathered at Start of Care at home was similar to the admission to SNF. And nursing home experience surely gives you the time management skills required for home care. I found I did a lot more patient education in the homecare setting than I had time for in the SNF - diabetes teaching, CHF and COPD management, etc. So gathering good teaching aids was helpful. Also tasks such as changing a catheter and wound vacs are a different animal in the home setting - often no hospital bed to raise to the right height, no nice clean bedside table for a sterile field, dishes in the sink when you go to wash your hands, that took some getting used to. I also had to learn about insurance more than I ever wanted to! In the SNF that is someone else's headache. But I much preferred home care to SNF due to the uninterrupted one on one focus on each patient. The skill that was new to me when I switched was pleural catheters, asept/pleurex which I had not practiced at my SNF. Also my homecare agency did not do home blood draws but I know some do, and a lab used to do ours in the rehab. At home we did finger stick INR tests that were also done by the lab. I think those were the only new things I had to learn.

I was able to find a home health position which gave benefits for 24 hour employees at a slightly higher cost than those working 30+. I chose to work 3 days on salary with the ability to pick up extra patients on other days at a per diem rate. Often I ended up working 2 half days and 3 regular days, but it was my choice. If I felt like 4 days off every week I could do so. Other employees negotiated 4 days at 7-8 points (30 total) for a 40 hour position, 5 days at 4-5 points for part time etc. to get the balance they needed between personal time and $$ and keep benefits. As you said, they have a lot invested in your training and might be willing to be flexible about how to spread out your points rather than lose their investment. Maybe it is worth a conversation with management

If I understand you correctly, yes. If the surgeon is signing for the overall plan of care for a postop patient, and the primary care MD orders something new, say a change in medication, where I work we would send an order for that med change to the second MD that actually ordered it.

As a mom who has done home health over the last 5 years, I think that it is possible to see your patients within school hours and I often wrap up my charting after the kids' bedtime to spend time with them. Depends on agency expectations. Where I work, you generally see 6 people a day and schedule them on your own. We get a list of names in the morning, make calls to set times with the patients from around 8-9, then you could schedule people out roughly one per hour and be done by the time the kids are headed home. Depends on the agency, but this could work. My agency did a lot of visits for wound/postop care, where visits took about 40 minutes on average and the charting had to be signed and uploaded by the next morning so later charting was OK. My patients tended to be less than 20 minutes apart. Extensive driving combined with the same productivity expectations would mean needing good backup emergency childcare though, I was fortunate to have a spouse with a schedule that meant he was home after school hours if I couldn't finish my day on time. My agency hires even new graduates and they would consider hiring with less bedside experience because they are part of a large hospital system willing to spend a lot of time and money on training to keep staffing up. A smaller agency would probably not be as willing/able to accept someone with less than a year of experience.

I work for 2 home health agencies in CT. Both have a 30 pt per week full time salaried expectation. One agency gives 3 points per soc or roc, 2 for recert and 1 for revisit. The documentation at this agency is much more time consuming. The other agency gives 2 points per soc roc or recert and one per visit but due to easier charting a full day takes a lot less time including all documentation. They also pay a little less on average.

I went to pinning. A small ceremony with the students who survived clinical and studied with me and faculty I knew. I skipped graduation, with a thousand other students herded through to collect a piece of paper from some college official I never saw before. Never regretted not going.

I have been a home health RN the last 5 years, currently working a salaried benefitted 24 hour position at a large hospital based agency and per diem for a smaller agency. At both agencies, I have always had so many patients that there was unlimited overtime available. I love home health but if I were in your shoes I would check out other agencies. I like to move employers by starting per diem for the new agency to make sure I like it while keeping my current job, and if it works to then apply full time for the new company. I am also open about this when I apply for per diem, that I want to see if the company is a good fit before jumping in full time, no one has ever had an issue with that. Is there another agency that you can try out per diem, that allows you to set your own visit times to work around your schedule?

My current primary employer now requires eye protection for all patient contact. Very annoying to me as I am not a fan of wearing goggles over glasses or the face shields that get in my way. I was working extra shifts for them, now I cut back to my scheduled hours and am picking up shifts at a new per diem position that does not require eye protection. Both jobs do require vaccination and masks for all contact which does not bother me. The infection control dept had one article to support this, and when I read the article it actually said if we are going to tell the general public to mask we should also tell them to cover their eyes as both are potential routes of transmission.

I currently hold positions with 2 home health agencies covering the same area. The one that falls under the umbrella of our large hospital system expected me to request a salary when I applied then made a counteroffer of a small amount less than I asked, which I accepted as it seemed quite insignificant and I came in with no experience. The other company, where I am doing per diem work, has set standard pay for experienced and for inexperienced RNs with no room to negotiate. Since that pay does not work for me I will just keep on being per diem. No one was offended by questions about salary or me saying that this salary would not work for me. I would not count on renegotiating after a year. Once you accept a salary where I work, raises are the same % annually for all and there is no negotiating. I would make sure I found the salary acceptable going in just in case that is how it works.

Home health RN here. In my company, Nurse Care Coordinators are office staff who triage who needs visits that day and check in with patients who are referred and waiting to start services, coordinate with IV companies and MD offices. Nurse Case Managers are field RNs who see patients in the home and manage their plan of care once they are on services. In the hierarchy of who reports to whom they report to the same manager and are considered equal level, at least in my organization.

The last employer I left offered me the option of having PTO accrued paid out in three equal amounts in weekly checks to minimize taxes. I did not take them up on it as I would just as soon have it paid into taxes and owe less come next spring. I did not know the option existed until the HR person asked as it was not listed in our handbook.

I think he may have meant to say WITHOUT having a PCP? In my state at one time that was true, they required you to see a PCP as part of setting up a Medicaid account and they were named on your medicaid card. I do not believe my state has this as a requirement anymore although they do strongly encourage it.

I remember working at a nursing home where we had to call several different MDs regularly for labs or change in condition, and there was one everybody dreaded calling because he always asked for a ton of information that others didn't and had no patience for waiting if we had to look something up. I learned to line up everything possible before making the call - their chart open to last set of labs, MAR open to their med list, vitals written down, etc. because he was impatient with me once and I never wanted to go through that again. We have all been there. The issue seems to be more with seeing the big picture in order to anticipate questions and that will improve with time and experience. I have seen more than one new nurse who really wasn't bad driven out by similar situations and that is a shame, because if support and education are provided facilities would end up with better nurses and less turnover. I am glad to hear your facility seems to be willing to manage this situation the right way. Don't be discouraged, you can do this if you are open to the advice and training they seem willing to give you!