tennesseeRN

whether one performs the vp bevel up or bevel down i don't know that it makes that much of a difference (i do it bevel up). however, if one retracts the needle into the safety sheath while it is still in the arm then that requires two hands (at least for me). even if one put a piece of gauze over the vp site (which would obstruct your view of retracting), then what is preventing the stream of blood pouring from the vp site and the hematoma from developing until you get a hand free to hold pressure? myself, one hand is holding the needle in place during until completion of the vp while the other hand is changing tubes, holding skin taunt, and so forth. after all, the patient can feel most every time that needle moves.then when i am finished i take a piece if gauze and gently hold over the site and remove the needle while immediately placing pressure on site. then i retract the needle.

Just posted this in another thread, but really belongs here I think. First link is http://www.thestreet.com/story/10434865/1/amedisys-cfo-carousel-misses-the-mark.html I have read this story before, as well as this link..http://www.citronresearch.com/index.php/2008/08/12/seeking-healthy-returns-in-amedisys-nasdaqamed. I can say that I have felt pressure to change my oasis answers to reflect a different score. I have received requests to look at my answers and to " think about them in a different way" but I feel that I was the one that was in the patient home, it's my answer and I'm not changing it. It's always been wrapped in "what about this" or "do you feel that this patient can safely do this if you picked this answer" so I can see how someone without many years could question themselves. Home health has always been about the wording. Word it one way, not billable. The other way--passes. There is a fine line and it's hard to stay on this side of it so I can see where newer nurses could wobble all over the line unintentionally.

I have read this story before, as well as this link..http://www.citronresearch.com/index.php/2008/08/12/seeking-healthy-returns-in-amedisys-nasdaqamed. I can say that I have felt pressure to change my oasis answers to reflect a different score. I have received requests to look at my answers and to " think about them in a different way" but I feel that I was the one that was in the patient home, it's my answer and I'm not changing it. It's always been wrapped in "what about this" or "do you feel that this patient can safely do this if you picked this answer" so I can see how someone without many years could question themselves. Home health has always been about the wording. Word it one way, not billable. The other way--passes. There is a fine line and it's hard to stay on this side of it so I can see where newer nurses could wobble all over the line unintentionally. I could go on....

"although we are paid per visit, we were told- verbatim--, ' we own you for 8 hours a day regardless of the fact that you are only getting paid per visit."" well! when my director came back from florida several wks ago after a big director's meeting she had a meeting with the entire office and stated the same thing. i thought she was just having a bad day, or directing her comments to the many to get the point to a few but i guess i was wrong. :uhoh21: i am so busy with my day usually that i don't have a problem getting in my 8 hours. in fact my hours would run more to 10+. this is because we have so little help. no one will stay. we have a few like me that has been there for years, from back before it was amedisys. but for the most part, when we get a new nurse, they leave for 2 reasons--worked to death cause we are so busy and as i saw in a previous post amedisys micromanages everything!. another thing i wonder about being per visit is the fact that while you are busy sitting charting and faxing and such, that is your own time having been built into the per visit rate. and while i'm at it...if i have to hear about the proverbial bus one more time, i think i'm gonna

In addition to my previous post...It depends on your management whether or not there is other ways to make $$ if census is low. My director is good--she will find something even if it is auditing charts :trout:or checking on discharged patients.

If your office has good management, then your census should match your staff/productivity. In other words, for a full time position at my office, I have to see a minimum number of patients a wk. Management should have looked at the census, pattern and projected growth, and know that they x number of nurses for x number of patients. I remember back in 1997 ( I think) when the venipuncture rule went into effect. All the home healths had to start discharging patients and the census dropped waaaaaay down, some home health closed. Our agency lost several nurses. Tje point is that normally, the staffing patterns in an agency allow for rise and fall of patient numbers without dramatically affecting your paycheck. But occasionally things do happen. I know that I make more money pay per visit than salary but less than I would if I were hourly. And I'm not afraid of losing money due to census drop. Pay for visit-Usually more money each patient and different pay scale according to if the visit is a regular, or start of care, or recert, ect. Don't get paid if patient isn't home or refuses visit(do on salary) All nurses usually eager to see the visits (its your paycheck) Sometimes some nurses get a little greedy and try to get all the visits You sometimes have the feeling your working for "free" when your sitting and doing paperwork becacuse alot of agencies (Amedisys included) feel that this is built into your per visit rate. Ample opportunity to make $$ on OT. Just my opinion....hope it helps.

Just a thought---and I feel your pain in busy-ness-Todays schedule consisted of 2 admissions, 3 patients and 1 recert, approx 100 miles, and that is a light day. Now I'm sitting down to do paperwork. But in terms of quickness, medicare's standard for a regular billable visit is 30 minutes. Just poking my nose in here, but when you said "quick...15 minutes..." I just had to ask!:uhoh21: Sounds like your agency has some unrealistic expectations concerning any new nurse (both new to home health and nursing in general). Don't let them get to frisky with you--good nursing jobs are easily found. Good luck

I would have to agree with Traumarus in that perhaps in your search for the "perfect fit" maybe you haven't given each area enough time. Or perhaps if you have difficulty managing stress or are easily burnt out, then maybe bedside nursing/home health isn't your fit either. BUT!!! That's what so great about nursing. There are soooooo many options to choose from. Maybe your skills lean more towards the teaching aspect--perhaps in a nursing program or maybe a diabetes educator. Nursing is NOT a family friendly career, nor wealth, nor fame, ect. ect. Most all we nurses have sacrificed time with our families, time to ourselves, time in church. Something else to think about--Looks like your fresh out of school. That is a big adjustment. How many of us nurses started school with lofty ambitions and know exactly which nursing career path we are going to take. Then by the end of school we have taken an entirely different direction, or we have been shown so many choices that when school is over and we have that big RN by our names--BAM. Reality sets in. This doesn't mean your a failure. Your human. Sounds like your too hard on yourself. But--As a veteran home health nurse, I don't think home health is the place to be for you. Not right now.Not only do you have to learn how to be a nurse (school IS different than real life) but also how to be a home health nurse, case management, IV's at 2am, wounds and someone forgot to leave supplies, demanding directors, little oversight, outcomes and PPS. Good luck in your search. Sometimes it takes a little time to find our way.

I am guessing most if not all of the amedisys offices are per visit. It goes to follow that if your census is low then your pay might be low. Everyone has an opinion on which pay is better--salary, per visit, hourly. I have been both salary and per visit--never hourly. My own opinion is per visit is better than salary, but with long hours that comes with home health I would make more money with hourly, which is why I'm betting that is why we are not hourly! But, my census isn't low and my paycheck is good.

We have only had the computers for several months and they are frequently upgrading them. I am really hoping that the limited access we have will change. I'm not sure if the way the system is set up is because it is so new, or because Amedisys is very strict about privacy, hippa, fraud, ect. (one cant "mess" with what one cant have access to). This one area (besides the fact that I'm soooo busy), really bothers me. I think Amedisys is a good place to work, however I think it one should have 2-3 years home health experience before going to work at this particular company. Not only would one have to learn the particulars of home health, but also oasis, possibly case management, the computer system and all the while in this fragmented structure. Not for the faint of heart.

I have worked with Amedisys now for several years, and have been in homecare for over 15 years. For me the PRO'S are: the company is very diligent with prevention of fraud, and has a zero tolerance for anything like false billing, coding or falsifying oasis and data to increase reimbursment. (plus I don't wanna go to j-a-i-l!), I know of several nurses in our region who have been terminated for falsifying info.Good benefits,good educational benefits.Good opportunities for transfer as they are everywhere. The computer system/laptop. The CONS are: The computer system/laptop.I feel the clinical structure/information is very fragmented.The nursing staff doesn't have access to most information-height,weight, previous nursing notes. If I want to send MD a list of blood sugars, I need to ask the manager and she has to manually look at each note within the computer and get the information.Each person within the office seems to have a part of the whole with no one person that knows all. When was the patient due his injection? Go ask the manager who has to manually read the notes to find out. Overall, I think it's a good place to work. Thanks for letting me put my 2 cents in.

I am in an office close to yours. I wonder what the difference is. The morale is pretty low at our office, and I can't really see the " good " in Amedisys yet...But I'll keep looking:coollook:

Our Call is every 4th week for the entire 7 days. And you bring to mind all the time I spend looking for papers/charts ect. I talked to a friend earlier today (nursing administration), and she pointed out one could look on this as a marriage, for good or bad, and I may be hanging on "hoping things will get better", because I do like homehealth. I think I would have a more positive outlook if I didn't feel as if I give 120 %, yet my manager can still point out "well if you had planned better", or "a prudent nurse would..." Morale is low at our office, yet the manager isn't leaving, our "numbers" look good so it's up to me to fix me. 16 years at one office is a long time. :stone

Just wondering if any Housecall nurses here? How are you all or your office adapting to all the changes?

i have been a home health nurse for about 16 years. i have always loved the job (still do). i have only worked at this particular agency, tho i have had different supervisors and different owners (my agency is independent and now part of a larger multistate company). my job is so difficult at times. i am wondering if perhaps it is just me, my particular office/company or is my frustration typical of the nurses/industry. 1. how many patients are you required to see a week for full productivity?30-35 visits 2. how much mileage do you average, and at what point does mileage get factored in with respect to the visits you are required to make?between 75-150. varies. get paid for milage. 3. how much time is spent on an "average" visit?minimum 30 minutes but depends on the patients needs/education,ect. 4. are you frequently "hassled" about productivity?somethimes 5. do you spend time on paperwork off the clock? dailyif so, how much?minimum 2-3 hours 6. do you accrue overtime hours?nothing i get paid for. i'm per visit so tho i work more like 50+hours week it isn't considered ot if so, how much on average? 7. are you required to do chart audits in addition to your visits? yesis time alloted for this or are you just expected to "fit it in?"fit it in. usually fits in after the patients and before the paperwork 8. what is a typical case load for you?i manage approx 42 patients at last count..for visits/oversight/paperwork/ect. 9. is your paperwork all written or do you have a palm pilot or laptop to make it easier?handwritten 10. have you ever been denied overtime your earned because you were not "productive" enough according to administrationyes in addition i am considered preceptor. plus case conferences. plus obqi committee (i didn't volunteer) i could go on and on and on about the paperwork. it is nothing for me to see 8-9 people in an day which typically includes an admission, 1-2 recertifications maybe a resumption. i wouldn't necessairly consider myself "burned out", but i just don't know if i can do this another 20 years. any thoughts... thank you all for letting me vent.