Cmyst

One thing you have to get straight is whether the EXPECTATION is that 6 visits = 8 hours? Because if you're new to home health, they don't. If you take over 8 hours to complete the 6 visits, will they pay overtime? This sounds so elementary, but home health agencies play a little loose with rules regarding lunch, breaks, etc. Not to mention the scores of nurses who do paperwork while watching TV with family, eating dinner, etc. I'm not trying to scare anyone off from HH, because it is by far easier on your own body and IMHO better nursing practice than floor nursing, but because it is so easy to piece your personal day in with your work day, sometimes you end up feeling as if you NEVER finish working. Another suggestion is to consider working in the home health dept. of a hospital. Most hospital systems have home health, and they usually pay the same hourly rate as the Med/Surg floor and are based on your years of experience or seniority within that system. This has the added benefit of giving you an "insurance policy" of being an RN within that hospital system, and if home health doesn't work out for you, you can apply to move to another department without losing vacation time, benefits, etc. I've worked both for hospital-based, and independant agencies, and I've enjoyed both. But it's definately less stressful for me now to have the security of a hospital-based home health position with hourly pay and perks.

Yeah, this is a great thread and thanks for starting it, Hoolihan. :) I was supposed to go in for orientation to paperwork/forms today, but it was moved to tomorrow. Hopefully, I'll buddy up with a former colleague the day after tomorrow, THEN hopefully I'll be set to go and actually leap back in to HHC after 5 years away from the field. I already had an agency orientation last week. This thread has been instrumental in my decision to return to HHC, because really -- it sounds like things haven't changed that much since I left, and I always loved it. Hopefully, it will pay the bills! I left NOT because of paperwork, but because I did not care to work for hourly pay at a hospital-based agency and those were the only ones that had a steady stream of referrals after OASIS came in. I'm returning to the field per diem, to maintain a comfort level of control over my scheduling, but I am hoping to work full-time visits for the most part. Again, thanks for this thread!

For the legal definition, I bet you could check out some of the sticky threads at the top of the forum. I am just getting back to home health nursing after 5 years doing other things. It wasn't my role as a nurse that caused me to leave. I always felt that this was the most holistic form of patient care and the most personally fulfilling form of nursing for me. Of course there are drawbacks. Nothing in this world is perfect. The drawbacks that I recall were huge amounts of paperwork, dangerous neighborhoods, and enforced driving time in an urban area of ever-worsening traffic congestion. If you work with the public in *any* position, you will have to deal with rude or angry or hopelessly inept or uncaring people. There are some of those in home health, just like in the hospital, or on the other end of the phone line, or across the counter. Businesses exist to make money, and health care is a business. While we are more shielded from the financial realities as floor nurses, home health agency staff often emphasize these "bottom line" concerns, and that can be disconcerting for nurses who think of themselves as caregivers and not managers. This is really more a problem of perception and image, because floor nurses are very much impacted by cold business decisions as well -- those decisions just aren't discussed with them very often, and they aren't made aware of billing and coding guidelines in the same way that home health nurses are, and other professionals decide who and when to discharge. When I was in school, aside from the basic science and technological aspects of nursing, they emphasized assessing the patient as a whole. Physically, sure, but also psycologically and socially and spiritually. Teaching was emphasized. The patient as part of a family, a community, a culture. Home health nursing meets the criteria of that kind of care much more consistently than hospital nursing.

Even if no one is actively smoking, those who are sensitive to tobacco smoke have a hard time in a home where it has permeated the upholstery, air, and clothing. Does your employer know about your sensitivity to cigarette smoke? Is it possible for you to be assigned only to strictly non-smoking homes, where no smokers reside?

I would guess it would depend on just how structured and supportive such a program really was. If it's a good one, then -- yeah. I know where you're coming from. I wanted to do *anything* to stay away from floor nursing, and I did, for nearly 12 years. But I also spent 3 years as an LVN in the Urgent Care unit of the ER, and six months as an RN in the regular ER. And when HHC became hard to work in due to instability shortly after OASIS, I did Telephone Triage and clinic nursing and finally -- I ended up on a Med/Surg floor in a really big, busy urban hospital. I just ended a three year run as a Med/Surg nurse, and it was every bit as grueling as you think at first -- but I adapted. The money was certainly a lot better than I can get doing HHC, I'll tell you that. IMHO, I learned much more about assessment and teaching, and holistic nursing care, from being a home health nurse. If this program is a good one, and if you get good basic assessment skills training, then it will work -- but remember, the less stressful nursing jobs often don't require the sheer numbers of nurses, which means that it can be hard to find another HHC job if something happens to yours. Without the experience of working a hospital floor, it can be hard to then get a job in the hospital, if need be. It isn't fair, and it isn't accurate, but many hospitals do not view HHC nursing experience as "real". That was another reason I went into Med/Surg floor nursing; I wanted to travel, and no travel agency thought that I had the necessary experience to hire me, despite nearly 10 years of full-time work as an RN! So, if you're sure this is what you want, then go for it. But if you find that you need to go into Med/Surg, look towards the positives of the experience and not just the negatives.

Yes, you're right: Bakersfield is in the great Central Valley of California, which is in essence a scrub-land/desert. It's kind of desolate, but that is coming from my own perspective, as where I live is greener, cooler and surrounded by water even in the hot summer months. I'm going to PM you, so I don't take up too much bandwidth. :chuckle

I hope that you find a great position here in Cali; no matter where you end up be assured that we need you! The pay here is good, compared to most of the US, but on the other hand the cost of living is high here, also. It's a very multi-cultural, multi-ethnic state and there is the underlying California culture,too. I wasn't born here, but I've lived here for 12 years and no matter where I go from here, Northern California will always be where my heart is now. Scotnurse, where will you be going in March, if I may ask?

Well, it figures I wouldn't check the Allnurses forums for weeks and during that time someone had a question on Sacramento! I am familiar with MGH, but not with their OB floor. I did a bit of per diem work there in cardiac tele a couple years ago. There are four main hospital systems in Sacramento: UC Davis Hospital, Sutter General and Sutter Memorial, Mercy General and Mercy San Juan, and Kaiser. Most recently, I worked for 3 years with Sutter. Basically, all hospital systems in Sacto are going to offer very similar benefits and wages. They have to, there is too much competition for nurses. Mainly, I just wanted to put in a good word for Sacramento. While we aren't close to the coast, we are within a 2 hour drive of some of the most interesting and scenic places in California: Lake Tahoe, the Sierra Mountains, the Napa/Sonoma wine country, San Francisco (some people go there every weekend, and it's a lot less expensive to live in Sacramento and visit there whenever you want!), and the beautiful, foggy and rugged Central and Northern coasts. There is Old Sacramento to explore, with it's Wild West atmosphere and Sacramento sits where the American River and the Sacramento River come together -- they call it the River City. There is a beautiful park that extends well over 15 miles along the American River from downtown Sacramento all the way to Folsom, with great bicycling and jogging trails and fishing and picnic spots. In the summer, it's pretty hot here. But it's a dry heat, and the evenings are very pleasant. You can always go swimming at one of the river beachfronts, or go up to the Sierra to one of the numerous mountain lakes that allow it. In the winter, it is foggy and rainy, but never really cold. I never wear a winter coat at all. And great ski resorts are only about an hour's drive into the Sierra. The Redwoods along the coast and in the mountains are all within easy day trip driving distance. And Yosemite National Park, where you find breathtaking waterfalls and the famous Half-Dome, is also fairly close. So, if that Southern Cal deal doesn't come through, don't sell Sacramento short! I LOVE this place, and I've lived in many other cities. My dearest friends live in Orange County, and truthfully I dread going there -- the smog, the HORRIBLE congestion (Cali in general is pretty crowded, though), the Santa Ana winds and the whole general LA trip.

Thanks for the info. Their site makes a lot of promises, but doesn't have a demo of the product. Why does your friend dislike it? Is it because of the application itself, or does she feel uncomfortable with PDAs in general? Or, does her agency require her to use this program and conventional paperwork and it's double documentation? Computers can solve a lot of problems, and it's frustrating that they aren't used more extensively in health care. I read an article recently that said that health care was rare in the modern world for continuing to rely on paper documentation. Since paperwork is the overwhelming reason that most of the nurses on this board are saying HHC is struggling to attract and keep field staff now, and since the advent of PDAs that are really hand held computers with a price much less than a laptop, you'd think they'd be utilized a LOT more.

No, but could you give us some info on it? I'm interested in programs specific to home health that I can get for my PDA, but even a desktop software program would be interesting. Is this software for an entire agency, or is it for the practioner? Is there a web page that we can look at it?

The traffic does concern me. Since Interim was very clear that they didn't accept referrals outside of metropolitan Sacramento and that they did not want to send nurses outside their preferred area of Sacramento, I am hoping that I can keep busy enough while staying in a manageable radius of my home. They only require a monthly staff meeting and that opens be turned in within 48 hours, but even if I go to the office every day it is about five minutes driving time from my condo. The acuity of hospital patients on the general Med/Surg floors has increased, too. I guess I'm just going to have to jump in and see how it works out this time around. As my daughter said, "Better to beat up your car than beat up your body", and my knees/back/feet just are really protesting the stress of 12 hour hospital shifts. I don't think I'll be going with Gentiva, though. I think it's going to be per diem for Interim. If worse comes to worst, Interim would probably also be able to hook me up with a couple hospital shifts. Again, thanks for the input everyone. It's pretty groovy that if a company screws over nurses in one part of the country, a nurse in another area entirely is influenced by their treatment of those nurses and decides they aren't worth the gamble.

Trying to be objective, but also going into the meeting with the cautions given here clearly in mind: The office environment was quiet, calm, yet seemed supportive. Very professional. The area for field staff to document, etc. was satisfactory, but did not have any individual desks or booths. Since I like to do paperwork in the OFFICE as opposed to my home, that was a negative. The expectation was 6 visits per day for full-time. They pay an hourly salary, and they break down opens, recerts and driving time into various percentages of 6 visits per day. (This seems reasonable, but is influenced by ...) All staff begins the day at 8am in the office, where they review their assignments for the day with the Clinical Sup. (negative) The reimbursement rate is $0.30 per mile. (negative) The coverage area for the agency extends beyond Sacramento by about 20 or 30 miles, and Sacramento itself is quite a large area to cover. (negative) While there is an agreement as to what zip code areas one will cover, there is the expectation that if someone calls in sick, others WILL cover their areas. (negative) Their benefits include health coverage that will end up costing me about $200 per month as my share, and since I presently pay for my own coverage at $320 per month, that is really not much incentive. Their PTO plan averages "about 10 hours per month" of time off. That includes sick time and vacation time, and it is not very competitive in my estimation. Full time hospital positions in this area offer about twice that in PTO, and my first HHC job in Sacramento back in 1993, I earned 6 weeks of PTO per year. Hourly rate for my 7 years of HHC experience is $36, which is about $3 less than what I earned at a full-time staff position in the hospital. It seems about right, maybe even a little higher than what I could make on a per visit pay scale. Here's my take on it, though. One of the things I value about HHC is the autonomy. I am really concerned about placing the ability to control my own daily workload and schedule into the hands of a supervisor. Especially when I'm the one who will be managing the case in every other way. I foresee that "emergencies" dictating that I drive out into the boonies, or do mostly opens and management while an LVN does revisits, will be more likely. This is a real subjective point, as in reality any agency can/will ask you to do inconvenient things, and of course you will negotiate and end up doing some of them. But there's a big difference between being asked, and being mandated. And it's hard to define, and nothing that anyone said outright, but I got the feeling that their concern is that their staff be working up to their expectations -- and not that they will be able to meet the expectations of their staff. There's just a big difference in taking on that extra open, or visit, and knowing you'll get paid the per visit rate. So, at present, I am leaning towards Interim.

Thanks for the replies, so quick! Well, rats. When I left HHC around 5 years ago, OASIS paperwork had been implemented and PPS, so I'm not sure if the paperwork burden is increased now in comparison with then. The rates for about every place I worked at the time were $35 per visit, mileage at the then-standard IRS rate, and $50 per open. Now, what I'm seeing is $40 per visit and $60 per open, and I'm not sure if that's good or bad. I think I'm gonna have to call my last agency on Monday and see what they have to offer now, before I jump to conclusions that a national company is more stable and offers better benefits. So, is making 35 visits per week just really crazy, if they're all in the same geographic area and if there are a couple "opens" in there? My time management skills were always considered excellent, and I never thought the paperwork was bad until OASIS, despite people complaining about it.

Happy to see this thread! Does anyone out there know about Gentiva in Sacramento, CA? I have an interview with them on Tuesday, and an alternative offer as well. One question I have is re: "unreasonable workload". How do you define that? I do have prior HHC experience, and during the go-go years in the early 90's was making 40+ visits a week. My alternative offer is with Interim's home health agency -- not their staffing agency. Any info about them would be nifty, too. You guys are beginning to scare me. I had decided to approach large, national HHC companies because when I left HHC the smaller ones were scrambling for visits and dropping like flies. I figured the larger ones would be more stable, predictable, etc.

Another option may be to work in-house registry or float pool for the hospital you already work at. This option has kept me at my present hospital for months longer than I would have stayed had I not looked into it. The pay is much better, my schedule is totally under my control (I only call in 8 hours before a shift I want to work to give my availability; although I *could* submit a monthly availability,too) and since I work in 6 different Med-Surg areas I don't get burnt out on floor politics.

Another option may be to work in-house registry or float pool for the hospital you already work at. This option has kept me at my present hospital for months longer than I would have stayed had I not looked into it. The pay is much better, my schedule is totally under my control (I only call in 8 hours before a shift I want to work to give my availability; although I *could* submit a monthly availability,too) and since I work in 6 different Med-Surg areas I don't get burnt out on floor politics.

Thanks, Renerian, for the info. I was also offered a job in Monterrey a few months ago, for around $35/hr., through a travel company. Since housing was included, that rate was pretty good. Hours were guaranteed, too, as I recall, and mileage was included. I'd take a job like that if it were offered again, and if the agency agreed to count travel time in to the hours.

In the last year I've looked into travel nursing, agency nursing, and independent contract nursing -- so yep, I've considered just about everything :) If the job you took in Seattle is a home health job, could you tell me what it is paying, either per hour or per visit? Does your registry pay housing?

I did Home Health for many years, but left the field about 4 years ago due to decreased visits and increased paperwork and my aging cars. I'm beginning to miss it...... but I need to pay my bills, too. When I left, in the Sacramento area, visits were about $35 and an open was $50. I always considered a "normal" workday to be about 6 visits, or 3 or 4 visits and an admission (which is why everyone hated admissions, the reimbursement was awful for the time you put in). Does anyone know what the per visit rates are averaging now in the Sacramento area or in the foothills/valley of Northern Cali? At the old rates, I'd have to work two jobs (full time) to earn what I make at the hospital now. While I'm willing to make less and enjoy my career more, on the one hand, I really don't want to make half of what is paying my current bills on the other.

Wow, thanks TouchRN! I have to give my significant other (at my age, "boyfriend" sounds so hilarious) the credit with help with business. Well, at least 70% of the credit. Thanks for the encouragement!

RN 11 years Currently working Med/Surg, some Tele, some Neuro, some Ortho Nocs/Float Pool Sacramento, CA just under $46/hr

I can't really speak with any authority on this from the IC route, although I've established my own business, because I haven't gotten any contracts yet. I've pursued one that didn't pan out, and intend to follow up on some leads in the next week or so. However, speaking from the perspective of an ex-floor RN that switched to Float Pool/Per Diem and is making 25% more than I could as a regular floor RN -- yeah, the hassle and expense of getting your own insurance is worth it. What you have to take into consideration are the benefits that your employer provides, which may not be as phenomenal as you think they are. Mine actually *is* pretty good, but the ones that I use (health insurance, dental insurance, disability) are the only ones that concern me -- I can eventually contribute to a retirement investment plan (I didn't use my employers, either, I have to pay higher interest bills first) and I have no interest in employer-paid education at this point. As an IC, you can deduct *totally* (as opposed to percentages) the cost of your health insurance and disability, and your CEUs -- including any travel that you may have to do to obtain them. You have to be prepared to purchase the health insurance coverage that you actually use, in order to get the best deal. Do you really need a plan that will pay for unlimited MD visits, with no deductable, and unlimited Rx meds with $5 copay? If you don't, you can easily save $200 month with a plan that will probably cover what you actually use and will cover hospitalization that you might need. It isn't hard to do, either. You call an insurance agent that advertises that they handle health plans, or you can contact Blue Cross, Kaiser, Healthnet, etc -- probably by doing a web search right now you can get an idea of what it costs.

Congrats on your success, Retiredusaf :) The Workman's comp bit confuses me, though. I thought that workman's comp was to cover *employees*, and that to cover oneself it would be disability insurance? Is it because you have incorporated that you get WC on yourself? I'm a sole proprietor, working right now per diem and trying to find a contract. I have my own health insurance and disability. By purchasing the insurance that I feel is best for me, I have kept the cost reasonable while keeping myself insured and am making much better money now than working for the same employer in a benefitted position. However, due to the tax breaks that Retiredusaf already enumerated, working IC would be the best option and it is one that nurses have the ability and licensing to pursue.

Kimprn, (I know it's a longshot, this thread ended in March!) I am an RN trying to get a contract with probably the same place (NMR?) that you posted about. I want to work in the Sacramento area; there are two facilities there. I feel that my qualifications and experience are very good, and I am wanting the contract because I want to work as an independant contractor and this was the only place that I'd ever seen an ad for them. If you are still out there, can you give any advice or words of wisdom on my chances? The agency has all my forms, and they "presented" me to Folsom, but say that the prison has no openings right now. (September) If you prefer, you can email me at [email protected]

Thanks, Lavslady I understand how you feel about NAIN, and I have been a bit dismayed myself at what seems like very arbitrary decisions about the implied motives of certain threads and posters, when objectively I could find no impropriety in them. Because my ex has his own business, and I have intimate knowledge of what he spends on promoting it, I didn't feel that the cost of the Directory was bad at all, so I did put myself into it. And the percentages that agents charge don't seem out of line, if they are able to find contracts and advocate for their client's best interests. But, yeah, I share some of your concerns, especially since a free market-type system in which all are equally allowed to promote their ideas on marketing ICs to facilities is not really evident in the forums. There have been times I was truly puzzled at the vehement reactions to seemingly valid ideas, that were branded as attempts to run "agencies". I know a scam when I see one, and while it's true that I've seen a couple of scammers post on the NAIN forums, I don't think that all posters with alternative marketing plans are trying to scam us. I, for one, am more anxious to have a chance to judge for myself and wish they'd not started censoring the forums.