TweedleDee

With my agency the pay per visit is less than salary. I am however going to go pay per visit PRN in the next couple of weeks. $30 for a visit, 60 for a start, and 45 for a recert or ROC, mileage .45. Located in central FL.

"Hospitals are hell, but at least I can have a LIFE." Yup..couldn't have said it better myself.

Twokidsmom,rn: I've been doing HH since May so no expert advice here, just my opinion. My DON, who is fabulous by the way, said it took her a good 2 years before she really had a handle on all the paperwork. I have found, again just my opinion, that even though you might only be on the road and have patient visits that I have anywhere from 2-3 hours a night of paperwork and phone calls to set up the next days visits. The Oasis SOC's are especially time consuming. I try to fill out as much as I can in the pts home without asking every question verbatim but I still have to go over it once I get home because inevitably there's something I missed during the visit. I try to be thorough but I loathe getting paperwork back days after the fact. The day is definitely less stressful than the hospital environment, but I work a heck of a lot more. Probably 50-60 hours a week but only get paid for 40. I am considering going Per Diem and picking up a few hospital shifts. I plan to weigh the pros and cons of that today. IE..would I lose income doing it that way. Don't get me wrong, its not about the money, just need to make sure going per diem allows me to handle my financial obligations. I too am a new nurse with a little over a year under my belt. Med/Surg to ED to HH and still trying to find my "bliss" with nursing. Oh bliss and balance where art thou?:redpinkhe

Yup case managing stinks!! Took a day off yesterday, or rather tried to. 2 coumadin clinics called and 1 MD's office called...so I wrote orders, etc. Had to call the office to schedule the rechecks for the pt/inr's that the coumadin clinics called about. Clinical Sup took the call and said "thought this was your day off"...yah, me too. It never seems to end. Love the patients, hate having to be on 24/7.

Feel it everyday!! And yes the autonomy is great....Nursing directed care, love that!! Left the hospital to have a more balanced life. Just not finding that with home health. I guess you have the weigh the good with the bad, the bearable with the unbearable. I do miss the challenge and growth with hospital nursing. I just want to have it ALL. I have been seriously considering going back to hospital nursing for 3 12's and then working HH PRN. With my current home health job I case manage and that seems to take a lot of time, not to mention paperwork. I would love to just show up a day or two a week to do visits. I am curious to know about the proposed legislative changes I read about in another post and how that is going to impact HH. I just hope its not another new form to fill out..lol.

No admits would be great. I spent a whole weekend doing admits that I would not be compensated for because the previous weeks census was low. So I worked a whole weekend, 12 days in a row....if I were paid per visit that would be another story, but I'm salary because I case manage. One of my admits had inaccurate info on the referral. The address and phone number were wrong, the pt lives in an ALF, etc. Keep in mind that these referrals are supposed to be "verified" with this info. Not qualifying d/t non homebound status I get and probably wouldn't know until I made the visit..that's OK. But having to spend an hour chasing down this SOC, getting there and after talking with the pt realizing that she was in a ILF/ALF facility utilizing the ALF services (duplication) was 2 hours of my time for which the DON gave me a .5 unit to make up for that time...seriously? I guess I should be grateful she gave me anything at all. But as a new hire, according to my hiring agreement, I have 90 days to be pulling 30 units a week and case managing..but after I questioned no compensation for the 2 days d/t low census (not in my control) I was told that I "was" expected to be pulling 30 units a week..so no compensation. I've only been in HH for 5 weeks and still well within the 90 days. I felt like I was being penalized for being new at this.

Totally agree with you here!! I find most patients, even thought they are home bound...their caregiver is not, like to know when I'm coming. Calling them the morning of hasn't worked out well for me as the pt and/or CG get irritated.

Thanks Cali. I've read many, many of your posts and always respect your insight. And yes it has come down to working more and earning less if you look at it from an hourly perspective, which I am. The work itself is less stress than the hospital environment hands down. I know I need to decide if that's the trade off. I do sometimes miss the faster pace and that ability to clock out and leave it behind until the next 12 hour shift. HH offers a different set of challenges, primarily an uncontrolled environment and then there's the non-compliant pt that you do your darndest to keep out of the hospital even if they are hell bent on self destruction..lol. Still searching for my "fit" in this wonderful profession.

I recently switched to home health after working in a very busy pediatric ER. I've always enjoyed working with adults especially the more mature set. I was also looking for a better work life balance and hopefully less work related stress. I seem to be putting in a lot more hours these days hence the whole work/life balance goal has not been achieved. There are many things I like about home health..the autonomy, making my own schedule, and of course the time I get to spend one on one with my patients. There are a few things about HH I'm not digging. HH seems inherently disorganized although I do work for a pretty supportive agency, there is some frustration about getting my day scheduled only to have the office call and undo all of my planning. I'm fairly flexible and don't have a prob switching gears as I know pts. needs come first, but that's not the type of having to reorganize my day that the office is calling about..seems to be a lack of planning on their part. So when I need to revamp my whole day, it puts me running late to pts and late getting home and then a few hours with the paperwork..no work/life balance. The paperwork is a whole other deal, it just plain stinks d/t the shear volume of it. But I'm getting better at it. My base is 30 units a week which is doable. Averaging 90 miles a day even when I sort my day by zip code. And yes they pay .445 per mile. Cell phone stipend and what I thought was a good salary. Yes, I'm salary. The stress is less than in the ER for sure and most likely less than Med/Surg (did that too), but I feel like I'm really not making the money I was at the hospital given the number of hours I'm putting in and then I'm bringing work home with me. I recently worked 12 days in a row. Worked on my on call weekend and in order to make my numbers was not able to take a day off. That was really exhausting. Seems I could have taken a day off, but then would not have been paid the per visits I did on the weekend. Hmm..work all weekend (2 days) for one day off during the week. Not at all sure I like that. Just wondering what you HH veterans thought.

Hi BlueOrchid, I think you'll find most kids are pretty good about it. I always ask the caregiver if they take medicine easily..that at least lets me know if I'm going to be wearing it. Most kids medicines are kid friendly, like Tylenol and Motrin because they come in liquid form and have a pleasant taste. I always measure using a syringe for accurate dosing. If the child seems apprehensive, they may take the medication from their caregiver more readily than a stranger. Hope this helps and good luck with your future RN career.

Hi Leonurus, I could have written your post. I feel exactly the same way and I too have been researching HH as a way to be the nurse I truly want to be. I currently work on a med/surg/tele/oncology unit and while the experience I am gaining is invaluable, the job satisfaction is not there. I so wanted to love, love, love my first RN position but to tell you the truth I feel so rushed and pressured throughout the day that sometimes I have to remind myself to breathe. I haven't been able to find any definitive salary differences between being a hospital RN and a HH RN but then again my search is just starting. I think caliotter3's suggestion about continuous care or shift work my be right up my alley.

mapper and Ayvah, Thanks for replies. I too had been feeling like my preceptor should have been there a bit more to back me up. She's been very good, but she too is still a relatively new nurse with two years under her belt. My preceptor has been giving me the whole group for the past couple of shifts. Managing 3-4 pts I've got that pretty well under control, but add in another 2 and well... it becomes quite chaotic. Our charge does not have a pt load of their own and she was great in helping me deal with my N1H1 potential pt earlier in the day when she was SVT @ 243 bpm. I'm spending some time this weekend reorganizing my paperwork..ie, how I get report, how to keep track of things throughout the day, etc. Ironically, a nurse that was my preceptor for the day a few weeks back (yes, there's been iconsistancy with preceptors as well) made the comment "that her worst day in the ER (she's charge in the 5th busiest ER in the country) is better than her best day on this floor", so maybe its just the nature of the beast. Thanks again for your reply.

Hello all....In my 7th week of an 8 week orientation as a brand new nurse on a med surg floor. Orientation was originally 6 weeks, but I asked for more. The past 2 shifts have been a nightmare. Both days, with my preceptor encouraging me to take the whole group, have been incredibly inconsistent. While I'm aware and try my very best to 'roll with it", these past 2 days have seen a shuffling of patients just about every hour. Day one included a patient death with a shift of patients mid day that I knew very little about (received a mini-report from my preceptor) but I still felt clueless, then one of my pts. pased away (my preceptor and I worked this one together as it was expected, but happened faster than we originally thought). As this was a first, I felt I earnestly tried to take advantage of the learning opportunity here..ie how to care for the pt in the final minutes, how to assist the family, what phone calls needed to be made, etc. all the while dealing with my own emotions. I felt that the charge nurse should have reassigned the other pts in my care, so that I could properly attend to the situation. The second day, I received report on a pt that I had care for the day before and was told that the pt "did not look good". Made her a priority and found her to be more than just not "looking good". Notified charge and Dr and recieved a whole host of STAT orders. Charge reassigned my pts to my preceptor, who assessed 2 of the 5 and gave no morning meds to. After my one pt was stable, I found myself once gain trying to play catch up. Pt was later found, after numerous tests, to be in CHF and a potential N1H1. Pt was assigned to my preceptor as I did not pass my fit test and am unable to wear an N95 respirator. Needed to do IV restarts on 2 pts with altered mental status, missed with my first pt and she wouldn't let me come near her the rest of the day. Pt reassigned to another nurse by charge, nurse accepted pt..sort of. Find out at the end of the day, RN didn't actually take pt much to my suprise. Received new admission I wasn't told about until pt was on the floor, needed surgery consents for other Altered Mental Status pt signed by daughter and of course needed to chart (which I was horribly behind in) and take care of the other 5 pts I had. My preceptor asked me if I needed help, which I did, but I didn't even know what I needed help with. To compund all of this, the CNA was not reporting to me unstable VS on one of my pts. So at 7 pm, during change of shift report, I look up all my pts vitals and find an unstable BP. Is this a normal day and/or days on a med/surg floor or am I just an overwhelmed new nurse?

My old faithfuls Saunders 3rd and Hurst review have gotten me this far so I'm sticking with them instead of buying more...bought enough books during NS to fill a library. Also using NCLEX RN 3500 online. Also have Lippincotts 9th, but the CD is no longer working..guess it just got tired..lol. Taking the exam soon, but I feel that I'm ready. Had to do the HESI all the way through school and did pretty good with that.

I would love to share Nclex materials..what did you use?...what did you find was most helpful?.....what did you find was least useful?

I not sure if anyone ever feels ready. I too struggled with picking a date, but after a few weeks of studying (Hurst, Saunders, NCLEX RN 3500) I moved my date up. Basically I'm just tired of studying and readt to get it over with. When I 1st started studying it was so overwhelming, I mean really..where do you even start?!? But every day I was able to whittle away at it and break it down into more manageable chunks. What started out as "global" studying has become more focused, especially in my weak areas.

Great question..wish any of my instructors would have asked this. There is the obvious like time management with the demands of reading, studying, etc. In the very first semester I remember my instructor talking in nursing lingo that I didn't understand. She referred to giving "report" and I, as well as just about everybody else, really didn't understand what she was talking about. Of course that all changed once we got into clinical. Don't assume new nursing students understand the nursing terms/lingo. I had an amazing instructor my third semester who, much to my dismay at the beginning, would include 5 calculation questions on every test. Well wouldn't you know it I became proficient at med calculations and as I study for the NCLEX I thank Ms. K every time a calc question comes up. Explain how to do a calculation question to your students..they will be forever grateful to you for it. A required calculation workbook is no substitution for actually being taught how to do them. Please don't tell me the NCLEX book is wrong just because you need to be right. When choosing NCLEX questions for your tests, use tried and true questions with understandable/explainable rationales. This is where a lot of learning takes place. Even if I get the question wrong, I need you to be able to explain "what I needed to be thinking as a nurse" to have answered the question correctly. The answer "because I say its right" does not help me grow into my role as a nurse. If you don't know the answer to a question I may ask in class, please admit that you don't know. I will respect you more for that, than a load of BS. Case studies done as class helped me to connect the dots. Teach me about all the disease processes and pathos associated with them that you want, but if you don't tell me what I need to do as a nurse with a pt. with a particular disease, it will be really hard for me to pull it all together, hence the case studies. I think your going to be a wonderful, appreciated instructor simply because you cared enough to ask how to make a difference. I wish you the best of luck.

WoooHooo Congratulations!!!!!!!!

Found this website with good info on infection control for those studying for NCLEX. Seems a lot of posters are saying that they are getting quite a few of these questions. http://caring4you.net/tests.html

jenniferlee... THANK YOU for the best laugh I've had in a while and you are so right!!! Every time I answer a question I hear Marlene saying, "What can I do to fix the problem?!?!" I'll keep my fingers crossed and say a prayer for ya that you made the NCLEX lady proud of you!!! I think I'll add "the core of the core" to my list of things to study....oh, and maybe a bit of infection control too.

Jenniferlee..remember what Marlene says..students always feel that they are tested in their areas of weakness. But you and I both know that the computer has NO idea what our weaknesses are. I have studied this "core content" for a long time (about 1.5 years faithfully all the way through school) My school, the most dreaded on the face of the planet- not because of their content but due to their lack of organization, but that's another story, gave us a HESI every semester. I bonded with "Aunt Marlene" prior to taking and scored very well on each and every one. For the exit HESI I took last month, I studied nothing but testing strategies and still scored high. I'm telling you all of this cause I know your scared and I felt like you needed to know that in my opinion Marlene rocks. Your going to be OK!!!

Thanks for your input jenniferlee. I'll keep my fingers crossed for ya!!! I too have done Hurst Review and am hoping for the best. Testing in a couple of weeks. I'm just having a hard time figuring out when enough studying is ENOUGH. How long did you study before boards? Wishing you all the best too choppinbroccoli!!!

I've done something similar to this using Microsoft Excell to create a spreadsheet. I used it for medications. I have thought about doing the same thing your attempting using my Saunders Nclex book for the info.

Oh the joys of nursing school. Former straight A student until nursing school. It is especially frustrating when you know you study so hard and barely pass a test, then next time around you change the way you study in hopes of doing better. Then when you finally get to an acceptable passing grade because you've finally figured how the instructor tests, the semester's over and you have to start the whole process over again. Its enough to take sane people right over the edge. Our class has adopted a mathematical equation to add a bit of humor to a seemingly endless plight. Just remember that C=RN. Best of luck!!

Hang in there!! Last spring I too was ready to "throw in the towel" for various reasons. But I stuck it out, still not sure how I did it, and will be graduating in May but is has been worth it. How many times as students do we hear that?!? It is worth it..they were right after all.