I hear you! I am in a very similiar situation working for a smaller agency with branches in other cities in this state. I have worked home health prior to Oasis. It is very different from my previous experience, and my patients are far sicker now.
Hospitals are sending home patients that are still so very ill, and I have been told that the agency gets bad marks every time our patients get readamitted to the ER, so we have to really try very, very hard to keep them home like getting an order for IV diuretics, waiting for delivery of supplies, getting the IV started (hopefully we can start it), and monitoring them all in one visit or two so that they won't go into CHF? Hello? Is this realistic?
I very much worry about being thrown under the bus in many situations. I had an SOC recently who had so many problems that were not on the referral form, and that there were no orders for (just one example of many).
The hospital nurses sometimes are young and inexperienced. They don't always tell the coordinators the full range of problems that the patient has. Leaving out "a few things" like hemodialysis 3x per week, 4 lumens in substernum, pressure sores, no orders for flushing the J tube or the IV lumens, or the wound care. I did know that my patient had a recent transplant (not a kidney!), was on insulin, and that I had to teach the caregiver how to do tube feedings, and did I mention, the colostomy? Of course, the fact that the CG was in terrible pain from a back problem was not mentioned either. The provider for tube feeding equipment was royally upset when they found out about the central lines that might need flushes (patient has no money). We still don't know if dialysis is going to manage them or not. Very scarey!
Then there is the hospitalist issue. Many do not allow access to them for orders, and "call the patient's PCP" is a standard answer from their staff if you can get an answer. Of course, some patients don't have a PCP. Frustrating? You bet! We all just want to take care of our patients and keep them safe, but this is very, very difficult.
And yes, we do work many hours for "free". The hour it takes just to schedule the cases for the next day is a good example. You get most scheduled, and the ones who didn't answer the phone call back to say that there is a problem, and you have to juggle.
Or you find out the next day when you are already in the field.
I am all over the whole county, and spend lots of time traveling. Oncall usually every 3rd week for a week which I hate. Sometimes more often if one of us is on vacation. Maybe a bigger agency, better organized is the answer, and maybe not. Maybe it's just how things are everywhere. I truly don't know but I am fast approaching burn out.