livelaughlove09

I would definitely clarify the on call responsibilities. If you will be case managing I see a future of assessments for you and not many routine visits. Will you be working with an LPN? In that case, and if your agency has a steady census and referral stream, I would not do salary. Salary is usually to the benefit of the employer, and they will always tend to max the salary person out before assigning to PPV nurses. It's just financially advantageous to the employer. People get scared when they see the PPV model, I did, but it worked out very well for me to where I was averaging around $50 an hour.

I wouldn't do salary home health unless your agency has an issue with census and referrals. There's a lot more to examine here, what is expected productivity? How far will you be traveling? Are there on call responsibilities? Do you case manage or do you walk in daily and get presented a schedule? What state are you in? How much experience do you have? If you're a go-getter you can write your own paycheck in home health. That salary is low in my opinion, but it depends on the circumstances.

1 RN for 350 patients is ludicrous. there is no way you can provide any type of quality care for those patients. Your agency is also probably not getting your LPN supervisory visits completed as required. Home Health is difficult to staff and keep staffed when you are understaffed. Someone quits before you have a full staff because they get burned out, and the cycle repeats. Contract nurse or traveler? PRN staff to fill in until your agency can get a few RNs on board and properly orient them? How many CMs do you have? I'm a director and it doesn't hurt my feelings at all to go see a few patients when things get tight. I'd rather help my nurses out and keep them around than have them jump ship and deal with situations like this. I wouldn't recommend just saying no. I would, however, recommend a sit down with your supervisor and tell her you're drowning and you need help, that you can't effectively manage that many patients. If she has field experience she knows what you're dealing with because I've never held a home health job where the caseload doesn't get crazy from time to time. What you are explaining is extreme though.

I'm afraid I'm too idealistic. I'm actually reeling and so irritated I want to jump out of my skin. Here's my situation... I want to spew all the information but of course you never know who's reading so I'll just be somewhat vague. I work on a busy inpatient unit, absolutely love my job, love my patients, love my coworkers (mostly..). We have all worked with those who are less than thrilled with patient care, but I have been working with certain nurses who hate patients. Not one difficult patient, but patients in general. All patients. Not nurses who have been nurses for 30 years and they're a little jaded or a lot jaded or tired of patient care, new nurses, nurses who haven't been nurses for a year, not even for 6 months. Im disappointed that these people care for my patients. Sometimes, in certain circumstances, I'm afraid for my patients, because their care is entrusted to someone who will tell you from their own lips they don't want to deal with patients and they retreat to their workstation to make up their charting. Really. Does this actually happen often?? I worked with someone who was just so ethically challenged that I couldn't help but report to the nurse in charge who immediately made excuses for her and waved me off. So I decided to report to the oncoming charge nurse who said she would speak with the nurse manager. I am not a troublemaker. I am well respected by the majority of my coworkers, highly respected by my doctors and my nursing administration. I act as a charge nurse as well, I just didn't happen to be in charge when this was all going down. I try to be personable with everyone I work with, but I am there to do a job, as is everyone else. I get the feeling that those coworkers that I have that are less than thrilled with me (and there are only a couple) are that way because I am this overachiever, type A, go get em and do the best job you can do every minute of the day type of person. Now, that being said, I don't hold everyone else to the same standard that I hold myself to, but I have a really serious issue with people who don't care to the point that they are neglectful and dangerous (as was the case here.) I just don't know how to handle this without blowing a stack, mostly because this isn't a one time occurrence, but a continuous problem.

Usually the mileage is not paid to the first patient and from the last patient to your house but everything is in between. That's odd. Mileage is a big deal, it adds up quickly, and is sometimes the only reimbursement you get for your time when you're paid per visit.

Hi there! I graduated from Mercy and was in the accelerated program. Mercy gets two thumbs up from me. They have a fantastic program with knowledgeable educators and give you every opportunity for success when you apply yourself. Accelerated students are chosen after admittance into the nursing program. During the first semester the accelerated students are chosen based on interest in the option and current success in the program. Sure your GPA makes a difference in selection if there is a lot of interest but it is much more based on how you are doing in nursing school at the time. They never want to set someone up for failure and if those nursing tests are giving someone a difficult time they would rather see success at a slower pace. It's definitely an option to look into. I owe my successes in my career to Mercy and their educators. Best decision I ever made. Best of luck to you.

That's a terrible shame the experience you had. I'm sorry for that. Not all agencies are like that. Good luck to you.

Same thing. Work all day, try to get all charting done in home and handle issues there but it can put you in a time crunch if you're carrying a full or overfull load. I myself would work 24/7 if I didn't have other responsibilities. Love the job. Sometimes complain about not having enough downtime when it gets really crazy and I've done 5 admissions and 30 visits that week (which for a long busy period that was every week). What's interesting to me though is the "not being paid for time worked." No, I'm not management, but my thought process here is this...are you being paid by the hour is the #1 question. If so, all the hours you spend seeing patients and documenting or working should be compensated. If you are being paid per visit, that payment is for seeing the client and doing the documentation that goes along with that visit. I can't wrap my brain around how that can be against labor regulations when you agree to that method of compensation. I know nurses who do visits then go home and have to do their charting but think that's wrong and they don't want to spend the time doing the paperwork. If you didn't document it you didn't do it, right? Documentation is how your agency gets paid which in turn provides you your income. In the hospital you wouldn't assess a patient and then not chart it. I am paid per visit. The rate I am paid per visit when broken down covers the time it takes to see the patient and the time it takes to document on it. Of course there are those visits that take extra time (multiple wounds, or PICC dressing changes plus labs plus G tube care plus catheter) but then there are those where you go in, assess, teach, and you're looking for something else to do because you feel guilty about not spending at least half an hour with that person. My biggest pet peeve is sitting in traffic (if the wheels aren't turning I'm not making money.) I guess my point is if you're working for a per visit rate, keep track of your actual time working then divide that down into a per hour rate. If it's less than what you feel you should be making, assess the situation and figure out why. Be honest with yourself too. Are you taking time chatting with patients and spending too much time in the home? (I do that, that's why I say that) Are you efficient at the documentation or do you struggle through taking more time than should be on each chart? Do you have a difficult case load where everyone needs a lot of care? (time suck, been there too) or is your visit rate just too low that it doesn't cover the average time needed to complete the work? (I have heard other agencies per visit rate in my area and I cringe at some of them, but a couple of them are a little higher than mine). I have done the breakdown on mine multiple times for comparison. I have estimated I make between $30 and $50 an hour including travel time and time spent documenting. When I have a ton of admissions I can make $60 or more an hour. That is excellent pay based on my location, experience, etc. No matter what we make we always want more. Just a fact of life. More you make the more you spend and then you want to make more. I live it too, but when I look at the whole picture sometimes I think wow I'm overpaid for once in my life. I have those days when I hate myself because I did 4 revisits and 3 SOC's and I'm getting home after 6 and thinking I've got dinner to make, laundry to do, and a mound of paperwork ahead of me. And I'm on call and the phone is ringing (factor in that on call pay too) and it feels like no amount of money is enough to tackle all that tonight because someone sitting in an office believes I've got no life and they want everything turned in within 24-48 hours. Still, voice of reason prevails and I have to remind myself when it's all said and done I made $15 more an hour than I'd make on my feet running back and forth on a busy med surg floor with call lights going off every 15 seconds because everyone needs pain meds, from the pixis, which was moved to another unit because they're remodeling the med room, and that traffic jam I sat in today where I was thinking those wheels aren't turning, I'm not even making mileage here, doesn't seem so bad.

All this really depends on the agency. I never considered home health, in fact it was at the bottom (rock bottom) of my list of nursing jobs I was interested in doing. Surprise surprise! I love home health. I am paid per visit and there is never a shortage of work for me. Sometimes I get calls begging me to take on another client because schedules are so full other nurses can't take them. I have had multiple paychecks where the take home was double, yes double, what a hospital paycheck is. Yes that does mean I'm doing plenty of visits but the stress level is much lower. Ive never, even during slow times, made a paycheck less than the job i left for home care. Yes sometimes the paperwork is daunting but it helps just to stay on top of it and not let it pile up. Organization is important, and confidence is key. No job I've ever had has every been so rewarding. Sometimes you're all these clients have and seeing you is the highlight of their week. The home setting is very intimate and I've learned so much about people's lives and the dynamics surrounding them. Sure some places are not the cleanest of environments, you learn to say "I'm here to see you not your house" when they comment about their messes, but you're seeing a whole picture of a client and not what you see in the hospital. Maybe they need social work for community resources because they are unable to sweep that 10 year old dust bunny out from under the couch. You can help people in so many ways that they didn't even know you could help with, and there's. Itching that makes you feel more worthy than the client who says "you are such a good nurse," or "I don't know what I would do without you.". Hardest part is getting attached to these people because of the one on one care. I always say discharge is bittersweet because on one hand you know you've done the job you were sent in to do but you are going to miss seeing that person. It's just extremely rewarding. I work for an agency that is not huge and we as clinicians are appreciated by the administration as well. It really makes a difference how you're treated as an employee. You get difficult clients here and there but I smother them with sweetness and show them that I am attentive to their individual needs and it always breaks them down. People have a really hard time being grumpy to those that treat them with dignity and respect, and a little humor goes a long way.

I like to schedule with mine for their next visit as well, I just can't lock down a time with them unless day they're the closest ones to my house. I have a very large area and we get SOC's the day before so I never know until the night before after 5 where all I have to be. We also get that no show or refusal pay, which is okay, I just hate having the rest of my schedule off because of a missed appointment. I'm sure we all do lol.

I shouldn't be giggling at this but I am. You'll get it in a second. You HAVE to be reimbursed mileage, and run run run if you don't. I actually bought a car to use for work (used...4w drive) because I didn't want to run up the mileage on my family car. We get reimbursed $0.45 per mile. Of course I do use my car for personal use too, but just some local driving (kids to school, store, whatever) but in the 10 months I've had this car, I've put...drumroll...30,000 miles on it! You must get mileage in a job like this.

"if you have a better social life than I do, you're not homebound." :)

I have this problem sometimes. I'll tell you what I do. First let me say I am NOT the most organized person, but it can bite me sometimes, so i just keep it simple. I make my schedule for the next week late in the week (Thursday or Friday.) I always ask my patients about next Dr. Appt. and make a note of it so I know to not even bother with that day. Usually I'll even plug them in on the following day on the schedule and tell them I'd like to see them to follow up on their MD visit, get new orders, med changes, etc. Then I look at patients who have regular orders (wound care mon/wed/fri, infusions that have labs every Monday) and I fill those patients in first. Then I take into consideration acuity level, visit pattern, last visit, and of course location (lol) and fill those patients in. I always call patients the night before to schedule the appointment, unless I'm swamped and I don't get home from work until after 8, but sometimes when that happens I just stop and take a few minutes to call and schedule. Some agencies I know call same day, and it's great to have the flexibility to do that last minute but I find on rare occasions I don't schedule the night before I'm almost begging my visits in. If I don't get in touch with someone (and it's not an ordered visit for labs or what have you) then I fill them in with someone else who is conveniently located near my route who actually answers their phone and move that person to another day. It doesn't take too long to figure out who never answers their phone and then I just leave a message "Mrs. Smith, it's the nurse, I'm planning on seeing you tomorrow between 10-11." Sometimes I get there and they've gone out to the hospital, but if they're one of those that never answers there's no way to know that and oh well it happens. There's always those new admits that take longer than expected, but I mostly manage to avoid those visits you think are going to be in and out and you get there and find out the patient fell two days ago so you need an incident report and yesterday they went to the PCP and he decided to change all their meds around and they're holding a Spiriva playing with it saying "how do you use this thing?" because they're going to spill all that when you call to make the appointment so I know ahead of time to schedule a little bit of extra time to deal with all that. I can normally manage to stay within the arranged times though, and the patients are there expecting me. Oh and did I mention I REALLY dislike having a bunch of "oh no you can't come until after 11" at the same time.

Kaplan is supposed to give you a money back guarantee. At least they did when they pitched it to my school. I didn't personally use them, because they told me they didn't review content in the course I thought it was pointless.

Then again, some of it could be the forum, because it just reformatted my last post.