goodywhyte

Your job sounds great! No one, unfortunately, will pay me for what I love to do! I love to read and research. I love to take a subject and delve into the depths of it from every aspect until I "know" it. And I love to "organize" things...order out of chaos...wonderful work for me. And troubleshoot...yes, that's fun for me. I like to fix things...anything, from a toaster to a medical problem. Ahhh, there's the research again. Had I to do it over again I would have gone to medical school and become a diagnostician. However, research types are not good entrepenuers....nope, not at all. I think that's what puts me off the legal nurse consulting thing...having to market and *do* all that's required to get it up and running. Networking amongst my peers holds no charm for me. So, I'd be pretty sorry at it! I have a month before poverty sets it. Hopefully I will have figured it out, pursued it, and gotten hired at it by then... :) Nikki

Wow Hoolahan! I was packing the kitchen and thinking about you so logged on to write you a note...and there you were! I have ze goosebumps :) I finally resigned my position and am very happy with the decision. I enjoyed the work itself, though. So, I'm "looking". I interview for a clinical field supervisor next week at an agency that's kind of far from me. But I'd better go see. And, since I have the opportunity I have even looked on these boards to see if anything else appeals to me. I don't feel driven to go back to the ICU, and need regular hours. My mother is moving in with me and I have a 15 year old daughter so I need to be home in the evenings and on the weekends. I am certified as a legal nurse consultant but haven't been able to pursue it because I've been so busy being a chaos magnet this year. Perhaps I'll give that a run. One thing I'm stuck on is salary...despite salary.com. I'm not sure what I should be asking for when the ask me my range? Have you any ideas what a clinical supe is worth? What are you doing now...and do you love it? I want to *love* what I do, because I invest alot of "meself" into it...I take full ownership of my positions. Unfortunately, that last one took advantage of that...turned into indentured servitude! :) I'd thought about starting my *own* home health agency...and know a CNA, LVN, scheduler, and secretary who would come work with me....however, I've no earthly idea how to do it? Do you? Shall we start one? Goody

This is very interesting to me, the soon to be jobless one with a house and dogs and cats and daughter to support. Are you talking home health or hospital agency staffing? Can you make a good income working per visit? Or, agency at the hospitals. I may have to consider any and all of these!

Ohmigosh I don't know! Can you believe I resigned without another job in sight. But, every week my job description changed and expanded, bearing no resemblance to the one I took 6 months ago. I was admissions/qa/case manager/clinical supervisor/and in the field...salaried with 50+ hours/week and no comp time..."paychecks held" if paperwork exceeded 48 hour deadline. In all my years as a nurse, usually at supervisory level, no one has had such a strange attitude toward the RNs. So, wherever I go it will not be a mom-and-pop type home health company. I don't know, maybe I'm spoiled, but work should be a blessing, not a curse that chokes life out of one. Not expecting daily bed of roses, but a sense of satisfaction, at least. How are you doing dear Renerian...better or still thinking "field"? goody p.s. I would still like to find that Bean bag! lol

I looked on the Bean website but didn't find one described as "teardrop"! However, I did find a nifty double compartment straw bag with a zipper compartment in the middle and little pockets everywhere at Walmart. So, for now I'm using that as my Spring bag...and light colored for "insect observations". On a grimmer note, I resigned my positon... So, my bag and I shall be looking for new stomping grounds. Nik

Hmmm, paperwork, patients, managment...oh, my! How would one organize their workload to case manage 25-35 patients (including therapies), schedule the recerts and sups, "do" the recerts and sups, plus admits, and adhere to the "all socs and recerts must be in by 48 hours" rule...in a territory that extends to about 40 miles or so out? Just can't figure it out... goody

Cherry...please tell how you came by this job. I have been very much wanting to have a job like this, and with defense, and even have clnc. My life has been a chaos magnet recently, though. Will you part with all the lovely details? Thanks, Nikki

I'm a little late to this discussion but, as the admit nurse for our agency, it is I who determines frequency, not someone in the office! Isn't that who should determine whether it's a legitimate admit, determine frequency, and set up the treatment plan? Sometimes docs just refer to home health because they don't know what *else* to do, or they don't really know how it works. As part of my admit process I teach the family, first, how home health works, how it's set up, what the "rules" are and etc etc etc. Not about reimbursement issues, just all that has a direct effect on them.

Our company in Houston pays $60 for an admit and $38 for a visit, I'm not sure how recerts or post hosps are counted...somewhere in between those figures I imagine. I'm paid salary, but don't know if that is an exception or a rule!

I originally found this board because my work schedule was killing me and I didn't know if it was par for the course and I was a baby or if it was too much. Regardless, my weeks were getting to be 45-50 hours long with paperwork piling. I had to do the usual admits, recerts, post hospitals, etc etc, everything except revisits. Along with alot of case management, etc etc. Anyway, I did go to the fellow there who hired me, reminding him in a very professional way that when I was hired it was to be 60/70% in office and 40/30% field. Now I'm in the office 4 hours and out 4 hours, with some late days due to distance, complicated patients, or whatever. I am now a sane and rational being. I could love my work again. It's only 3 weeks though since the change and I don't know if it will last. I do know that I will last only if *it* does. That last schedule was adding on more years than raising teenagers, having to get divorced unexpectedly, and all the rest! lol Now, I'm probably way in the minority of the home health field. But our company only has one full time RN (me), one 3/4 time, and 1 part time who says *no* alot. We also have 1 full time LVN and 1 part-time. No one there knows what the census is, which just slays me. But I think it's close to 90-100. I don't even know for sure if *this* is an average ratio!!! Nik

Oh what an interesting topic! I have a black (now I'm thinking about roaches) bag with a zipper compartment that holds thermometer, probe covers, alcohol wipes, scissors, business cards, next compartment closes with a snap and holds BP cuff, steth, next section open and carries drug book, cotton tipped applicators, wound measuring thingys, last compartment zips...and its the dirty section. Somewhere in there are a few gloves, I forgot where, and my bag is in the car. I keep everything I need for blood draws in a little tackle box and only take it in if I'm drawing blood. We also use the Lab in a Box...a wonderful "invention". Do you all use hand cleaner? Should I? I usually have a papertowel and use patient's bathroom to wash hands because it's such a good way to check out the house/bathroom for DME, etc. I've learned alot about...alot...from those little trips down the hallway. And if they are going to have alot of visits from SN PT OT I usually recommend they put a roll of papertowels in the bathroom for the visits. Now I want a backpack from Bean!

SOC packet: The exact count (culled from my 3 admits, 2 recerts and 4 visits I have yet to write, sigh): 9 signature lines (10 if CNA) plus 9 initial lines equals 18 places for "patient participation"! 16 page Oasis for SOC Recert Discharge: 10 page Oasis plus Discharge narrative, Discharge instructions. We use this Oasis even if thy died! That's nutty to me. I do have to code everything, prioritize the DX (which I should actually do that) and turn it in so, if all goes well, it gets typed and the DON signs it. At post hospital I do a SCIC Oasis which I don't have with me, but I assure you we don't have an Oasis under 10 pages. I had no idea there were even options! I kiss the tiny little toes of all of you...and I will pm you Hoolihan, as soon as I figure out how to do it. I will, though...and thank you so much. BTW, I'm not a supervisor!

I very much appreciate all your responses. This company wanted a nurse to primarily focus on admissions so they would have a comprehensive assessment, complete Oasis, and plan of care. Here an admit consists of the Oasis, 485, med sheets (of course), CNA orders (of course again) SOC conference narrative, referral sheet and completed signature packet. I think there are about 10 or 11 pages requiring patient's signature and 12 spaces requiring their initials. By the time I have explained everything they are signing, set up the home chart, explained the focus of home health, etc etc, it's about 2 hours in the home...1 1/2 if there is no particular "skill" involved (wound, IV, etc). Then by the time I have completed everything, including calls to physician, ICD and CPT coded, set all the goals and frequencies, written the 485,it's about another 1 1/2 to 2 hours! Obviously I'm taking way too long! Although, it's not the Oasis...that's not too bad actually. Much of it can be done in the home. How do you handle discharges? We are supposed to write a discharge Oasis, based on the most recent one, whether we visited or even saw the patient. So far I haven't done this...it doesn't seem quite cricket to me to write an Oasis based on a previous one! Why then, would they be discharged? I was asked to write on up on a patient that died at home. His Oasis reflected a living person for heaven's sake! I've just come off 2 weeks of straight 9 to 11 hour days and am now brain dead. The other thing...I also have to problem solve and troubleshoot most of these cases as they go...including anything that comes my way when I'm in the office. That's where I try not to be anymore, though...because it seems to come my way. The DON is not very competent apparently. Sorrry for being so chronically witchy.

Wow...thanks for that. Now I can compute my visits. Usually an admit takes me about 2 hours in the home by the time all the paperwork is signed, assessment completed, teaching started, in home chart set up and "skill" done. Then, for me, the entire packet takes about 2 hours. We have the Oasis, with all diagnoses prioritized, dated, and coded, then the 485 with all the frequencies, med sheets written and coded, the start of care case conference narrative, a report sheet to be given to the visiting nurse (ok, I added this...but there was no communication between the admit nurse and the nurse who was doing the visits!),any orders that need to be written, and the referral that goes to the scheduler. I think that's about it. Except for the phone calls. aagh Also I have to track on a spreadsheet *all* the admissions, who did them, and follow up to make sure contracted therapies were started. All in all it takes about 5 hours to do an entire admit: visit, travel time, paperwork, care coordination. I think I'm too slow! Good grief! I like the idea of doing the visits and going home to do the paperwork. If I can do it. I'm supposed to be in the office, too. I may have to speak with the director about that part! Thanks alot everyone! Goody P.S. of course, any more advice, suggestions, critique will be most welcome!

I'm full time 8:30 to 5:30 (the hour lunch is total illusion) and do not have to take call or work weekends. I am available to the weekend nurse though if she has a question. I get mileage or can drive the company car. Do you all actually do 25 or 30 admit/recert/sup visits a week *plus* the paperwork?? What in the heck am I doing wrong?