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Home Health Nurse

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  1. paradiseboundRN

    Why Do People Bully Me?

    Who is the target of bullying in the workplace? • The self-starter who is feisty and independent • A person who is technically more skilled than the bully • The target is more emotionally intelligent and socially adept than the bully; the target is well-liked • The target is ethical and honest to a fault • The target is not a confrontational person. He or she does not respond. Frankly, the target is stunned and bewildered. The target is convinced he or she can overcome this. It’s all shame-based; the target feels shame. The target comes to believe he or she is incompetent. It’s a disassembly of the target’s personality. Interesting. I have a lot of knowledge and experience in home care and I felt bullied by my last 2 employers. I didn't think it made sense. Why bully someone who does good work, is well-liked, offers suggestions, etc. After reading this article, that's exactly why!
  2. paradiseboundRN

    Nurses: Oppression Can Stop With You

    I don't know the answer. I recently left a job with a national home care company because it was a "hostile work environment". The surprising thing is that so many others put up with it. Where I live there are plenty of home care jobs for nurses, so why stay? When I ask they respond that they think they can't do better. But then I find out they haven't even looked. We will continue to see this oppression as long as the nurses stay and put up with it. I did my part by leaving and writing a complaint to the corporate office about the behavior of my supervisors. Corporate said they are investigating it. Of course, they may not do anything about it but at least I complained instead of just ignoring the problem.
  3. paradiseboundRN

    Nurses: Oppression Can Stop With You

    Yes, raising the salaries would certainly help but due to the cuts in Medicare reimbursement, its not going to happen.
  4. paradiseboundRN

    Nurses: Oppression Can Stop With You

    Great article! The specialty of home care used to be a better environment than the hospital but no more. Because there is a huge shortage of home care nurses (at least in Metro Detroit) there is lots of drama due to lack of nurses to cover the cases. The management wants to cases open for the profit but then they can't find a nurse to manage the case. This causes overwork and stress which leads to back-stabbing, infighting, bullying etc. This leads to high turn-over, even with management. And the problem goes on and on....
  5. paradiseboundRN

    Accepted a job in home health...how to prepare?

    I would recommend buying "Home Health Standards...." by T. M. Marrelli. Its worth every penny and I wish I would have had it from the beginning. Good luck!
  6. paradiseboundRN

    Is Home Health Nursing still Growing

    The jobs are out there in home care but not for new grads. And, all of the private home care agencies are struggling while the agencies owned by hospitals are booming. I was told that the hospitals used to give at least 10% of their referrals to home care agencies that were not related to the hospital. This showed good faith that there was no collusion and that the patient had a choice which agency to pick. Now, the hospital keeps 100% of their referrals and it is frowned upon by the hospital corporation if a physician tries to refer to another agency other than the one the hospital owns. So, if you want to work, you need to hook up with a hospital agency.
  7. paradiseboundRN

    forced overtime??

    I am so feed up with the forced overtime. As a salary employee, we have a point system with the SOC being 2 points and the D/C, ROC, recert = 1.5 points. All other visits are 1 point including high tech wound vac and IV's. This is just not right! It takes just as long to do a ROC as a SOC. And with Oasis C, the discharge and the SOC is longer but they are not going to increase the points. What? Am I working for free? I told my agency that I wanted to go to contingent status and get paid by the hour. Suprisingly they are letting me, because they don't want to lose me. At least with this change I can bill them for every minute I work!
  8. paradiseboundRN

    Start of care orders

    I can't even get the Dr's to call me back when the pt is having a problem! They are certainly not going to return a call to discuss frequency of visits, etc. I leave a message with his receptionist unless I need clarification or there is a problem with the patient. I have never heard of Medicare denying SOC visits for those reasons.
  9. paradiseboundRN

    Switching from O.B-relatively new nurse

    Good for you to get hired per diem! If your income is flexible, that is the way to go. Plus, when you do have kids, you'll still be able to work if you want. Everyone is new to home care at one point, so don't expect to know it all after orientation. I would recommend buying "Home Health Standards...." by T. M. Marrelli. Its worth every penny and I wish I would have had it from the beginning. Good luck!
  10. paradiseboundRN

    forced overtime??

    I'm salary so I often work more hours than I get paid for!
  11. I have worked in home health for almost 8 years with various agencies. Last April I started with an agency that is a "corporation" which means that no one is allowed to think for themselves. Anyway, things had been going ok. We do 5-6 patients or points per day. SOC is 3 points. The contingent nurses were doing most of the SOC's unless the full time nurses had room that day in their schedule. After the SOC the full time nurse continues with the revisits. This week the "corporation" decided that the full time nurses should do their own SOC's and give the revisits to the contingents. So every morning at 8 am they call the FT nurse and ask her to "give up" 2-3 of her scheduled patients to do a SOC. The corporation states its because of the Oasis C that is coming. I think its because they have to pay contingents hourly and the FT are salary. Either way, the patients are furious because they have no continuty with their nurse and they have no idea who is going to show up at their door. I have let my concerns be known but of course, "the corporation" could care less. I am now considering going contingent because I don't want to case manage patients that I don't even know. What do you think? How does you agency handle it?
  12. paradiseboundRN

    Pay scales

    There are multiple ways that home care companies pay. You could be paid per visit. The average in Metro Detroit right now is $50 per routine visit, $85 for opening visit, plus mileage. The visit would include all your documentation and travel time. Meetings and inservices are paid extra. Some companies pay per hour. Or you could get paid a salary and you would get paid the same amount no matter how many patients you see. But they will have a quota for you to fulfill. The average for salary is about $60,000. Which is the best? The forums have discussed this constantly and I think it really comes out about the same. If you are new to home care you won't have much to negotiate with at this point. The best you can do is compare benefits, your service area, training, and the amount of weekends and on call you have to do.
  13. paradiseboundRN

    Home Care Census Requirement

    I think the requirement refers to obtaining your certification. Of course, when you are surveyed again you will probably need to have the same minimum number of charts for them to review. It used to be 7 actives charts and 10 charts total, at least 1 using each discipline (PT, OT, HHA). As far as I know, if you are CHAP certified then you are Medicare certified as well. Medicare does not do its own certification anymore, you have to go through CHAP or JACHO to be certified.
  14. paradiseboundRN

    Home health start of care for a cancer patient

    The plan of care for a cancer patient should focus on managing their symptoms. Usual problems are constipation/diarrhea, pain, malnutrition, nausea/vomiting, fatigue, skin breakdown and mouth sores. The amount of symptoms that you'll see is based on whether the patient is having chemo and/or radiation and what stage the cancer is in. Also, make sure that they have an advanced directive or bring MSW in to assist with one.
  15. paradiseboundRN

    Patients & Pain Meds

    Yes, I have been having a problem getting my patients pain meds also. I have an 85 y/o man who has gastric pain and rates it 10/10. He is not eligible for surgery due to his multiple other problems. He really should be in Hospice but doesn't want to give up dialysis. He has no abuse history. I finally got a pain management dr to accept him if he went for a drug screen FIRST! Unbelieveable!