danarooo

Ugh. I figured I would likely have to go back to home health. The $$ is great but I’m tired of fighting traffic to see patients all day then come home exhausted with a ton of charting to do then calling the next days patients to confirm visits. It’s a ton of work and tends to take over your life ?. It’s really frustrating that you end up getting stuck in one area I.E. Home Health. For a profession with high stress, high turnover and a “shortage” employers sure do make it hard. L. Jey, I hope you have luck finding something. When I graduated I had a very hard time finding work as well.

I recently moved to Ft. Worth, I am an experienced RN. I realize this is a huge area but I did not realize it was going to be this difficult finding a position. Is anyone else finding this to be the case? I've updated my resume and researched the best resume layout etc... and have thrown out my resume to many different types of places but I'm only getting a few interviews here and there. I know it can be hard to move from one area of nursing to another but I had no idea it was going to be this difficult.

I don't have a life and I'm tired of it. I work all day, do as much charting as I can in the home and if I'm able I'll finish in my care right after the visit but unfortunately those days of having the time aren't frequent enough. If you have a bigger territory or are in a high traffic area then that can put a kink in your day, then if you have a territory where the pt's are non-compliant then you will run into more snags which prolong visits and eats into your time. I plan my day in advance, call and confirm my pt's the day before and try to do as much as I can in the home BUT, when you have a wound care pt like a wound vac you really can't do much documentation in the home. Then if your management isn't supportive or they only care about getting visits done i.e. SOC/ROC/picking up extra then your having to constantly try to avoid having extra work piled on which then prolongs your day. I see 6 to 7 pt's per day, anything more then that is too much. It also depends on the pt mix on a day to day basis, there have been days where 5 pt's took me the full day b/c complications etc... I am where you are, I want a life. I love my job (the pt's, hate the ridiculous amount of charting and the constant additional crap being thrown at us) but the money isn't worth the fact that I have zero family time and no hobbies. I can't even take care of myself. I'm not willing to work so much for very much longer so I'll be thinking about what I want to do. I really believe that very few HH agencies make it to where the nurses aren't worked into the ground. If you find one stay!!! Unfortunately I don't know of many nursing jobs in any area where you can make a good living and have a life and it's getting worse and worse.

HH can be very brutal. Document Document Document when a pt is demanding something that is not needed/unrealistic and the Doc says no. Patients in HH can be very manipulative at times, and as another person said often you get patients with other issues i.e. psych and that complicates things. Your going to get beat up in HH, but if you do your best and document what you discuss with the patient/Doc then you should be OK. Your management should back you up as well. They should know well how your job goes because they should have plenty of experience having done it, if they are good they will support you and let you know they realize the reality of situations like this.

This is absolutely true. It very much depends on which location. The management in the office can make your job out in the field great or a daily nightmare. I've experienced both, if you don't have good Clinical Managers they will work you into the ground without a second thought. This is an overly numbers driven company and that can greatly impact the care your able to provide. Numbers are a very big focus, so if you don't have good managers in the office it can be hell. Also, it can be extremely hard to get time off. We were told we have to provide coverage for our patients when we take leave which is not right. If you earn the vacation time then you take the vacation time without having it made as hard as possible to do so. You can always look on glassdoor.com and look at the company info/ratings as well.

Your experience in your new job may depend on a few things. HH can be great if you live in or close to the territory you will be managing, your caseload (# of patients you have) and the office requirements. Even in the same company some things will and do vary from office to office as far as what is required (forms to fill out etc...). Management in the office also has a big impact, by this I mean are they really good, knowledgeable, ethical, do they go out into the field to help their team and keep their own understanding of case management sharp and current? All these things can influence your day, the time you spend working and your happiness with the job. If your new to HH the one thing I will say is that it can be very stressful, very hard and very frustrating. Give it at least 6 months to a year because their is a big learning curve. Once you get over the hump and have learned enough and feel more comfortable it gets easier. One big thing that really helps is having great management. If they keep up to date on their understanding of what it's like to be out in the field TODAY (not 4 years ago) then hopefully they will be more realistic in expectations and supportive. Reading reviews can be informative but it's still important to get in their and decide for yourself how you feel about an HH company and how they do things. Every company has their good and bad and one person may love it and one may hate it. Just give any place you work a good enough chance before making up your mind.

I understand where you are coming from. I think that maybe some who read your post are focusing more on the venting then the valid frustrations your having. Your tired and overwhelmed and hitting a wall. The fact is that with the focus on ratings healthcare is being driven in the wrong direction and nurses are bearing a large brunt of the demands/blame. I'm an HH RN in a very tough territory, a large majority of my population is under-educated, poor, very sick and very non-compliant. And no matter what I do or how I do it a decline is a decline and it's held against us. This places the majority of the responsibility on the shoulders of the nurse, not the patient where it actually belongs. Believe me, I feel your frustration. We are almost always short staffed and pushed to perform...perfectly. You are constantly being told what you missed in charting, asked to do more paperwork, see more patients and held to a standard that no nurse can maintain. The bottom line is that as long as we are rated on what the government/insurance companies and corporations consider "standards of care" this will not get better but worse. Nursing will continue in this fashion until we stand up as a whole and work to stop it. The only problem is we are all too busy and exhausted to do much about it. As an RN in HH you are in a patient's home, and with that comes pt's who are extremely difficult...and feel they can dictate your schedule to you - they won't care that you have 9 pt's to see that day either. You'll go into houses that are so bad they need to be condemned -- and we do call to have this done sometimes. You will have pt's who are never sober, share their homes with roaches/rats/bed bugs and even scabies (yes it has happened). You may have pt's who's families are crazy, abusive, violent even. I can say I've seen more in HH then anywhere else. I've also done more in HH and been able to have a more direct impact on my pt's lives too. All HH agencies aren't the same, some are good and some are bad. You will be pushed to your limit in HH as well. It's no cake walk. There have been many many days I've logged 16 plus hour days between pt visits and the sometimes unbelievable amount of charting. A medicare OASIS start of care/recert/resumption of care is I guarantee much long then any documentation done in the acute care setting and you'll be doing a lot of OASIS documentation. One thing that may be better is that you may find areas where you are better able to set boundaries which are important. As another OP has said, the first year can be extremely hard, but if you can get over the rough parts it can get easier. I've considered getting out of nursing many many times. I do love my job (most the time), but I can see that the emphasis on ratings are making nursing harder and expectations more unrealistic which will end up driving a whole lot of really good nurses right out of nursing.

I am a little over 4 months in and some days are great, others horrible. It does get better and I'm seeing small glimpses of this, what really gets me is we have an office full of nurse managers yet our office is the only one where the managers in the office WILL NOT help their field staff with patient visits when they are in the weeds. We have a high patient census and I know they have hard jobs too but the buck gets passed to the case managers ALL the time and we are overloaded already. The job is great, the unrealistic expectations from management and lack is support makes the job almost unbearable much of the time. Most the staff is seasoned and that is the only reason their hasn't been a mass exodus. I have heard from so so many of my fellow coworkers they are just waiting for management to change so things can be better again. I am not sure I can wait for that as my stress levels can't get much higher w/out a serious health event coming to pass. The lack of organization and communication is absolutely astounding and the reason for about 80% of my daily stress.

Thank you all for the input, I really appreciate it. I feel that there is a combination of things happening. Some bad management, intake not gathering enough info for us -- I mean really --- taking a referral for a patient who doesn't have a pcp...come on! The report emails are total bs. Why the packet can't just be sent out to everyone and a note on the start visit would be fine but if other people can't click a link to open the start packet should they be caring for patients? I'd say no. I'm getting bogged down in the minutia, and trying to get ALL the info before I turn over to case manager so I've got to stop that. I'm likely by far way more detailed then the other SOC nurses, but to me that is sorta scary. If someone were handing me a patient I'd never seen with major health issues it's would be nice to follow a thorough SOC nurse. I do need to pull over and power through more often. I think I could do this job and do it well but I'm sure having some serious growing pains right now trying to really learn the ins/outs. I did have trouble initially after nursing school finding a job, however that was 4 years ago and I've done teaching to include taking patients into clinical in assisted living and special needs pediatrics with lots of serious and rare disorders/diseases, vents/trach's etc...so I'm fairly comfortable (with what I know of course) but I do have so much more to learn for sure. I like HH, and some day I'm looking forward to case managing - I think it will be good for me since I'm anal retentive and organized (for the most part). You guys are all great and I love being able to come and sound off. I appreciate all your wisdom and advice. Lord help me I'm just trying to hang on for dear life at this point!!

I am a new SOC nurse, and new to HH. I am already feeling extremely burnt out. I spend my day driving around hunting patients who about half the time won't answer their phone, don't want me to come until afternoon or aren't home and we have to make 3 attempts before we can finally call their Doctor and say we can't get a hold of them/they aren't returning calls. The driving isn't a big deal, the problem is that patients are hard to get a hold of and sometimes the information is bad or they end up being a duplication of services etc...there just seems to be a lot of problems getting my 2 to 3 SOC's a day. On top of this, I spend ALL my evening charting my SOCs - and there is so much duplication it's maddening. I have to have the patient sign twice in my computer but then sign a paper copy of the contract, then fill out multiple paper forms, then I have to send a report email to multiple people and part of the information from the patient packet received (and forwarded to all the people on the report email) I still have to type out in the report. It's tedious and frustrating. My husband is getting very irritated which is unusual for him, he's usually really laid back. I spend zero time with him in the evening because I'm charting until bedtime, stressed out and don't have time to do basic things for myself such as go to the store to get snacks to put in my car! How is anyone doing this day to day? I like the job, I HATE the unrealistic expectations and fact that I work hours and hours five days per week. I want a life, I want to be able to come home and RELAX, to de-compress and rejuvenate myself. I want to go to the gym, go to dinner with my husband or be able to run to the store. Is anyone doing start of care in HH able to have a life? Why is it so hard to find a good paying job that isn't made more stressful then it should be, full of drama or their is bad management who doesn't care if they work you into the ground?

I am a soc nurse and at my 2 mo'ish mark. I am coming home stressed and livid. On days their aren't SOC's (which I'm told isn't often but lately it has been) I get loaded up w/patient visits but I'm the last to know and the visits aren't given until mid morning, then they are across several different close but rural towns. I'll arrive at a patients home and be told their regular was already there hours ago. I'll call to confirm a visit I've been given on a non-soc day and the visit falls through, but then I get stuck on the phone b/c patient family has questions and their 485 isn't locked, I have no answers and no info and managers in the office aren't helpful. Or it's a possible duplication of services and I don't do insurance I'm a nurse but when I'm asking for help I'm told it's my job to figure it out -- meanwhile the patient is calling me over and over while I'm trying to get into see my next soc and I can't count on help from managers in the office. Then if I say I'm in slammed don't give me more until I catch up I get a call from the head honcho and get a talking to and get to come in to a meeting w/the office managers and head honcho...I'm sent of evals which I've never done or seen or been trained on and then called the next day to tell me I should have admitted that eval and made the company look negligent by not doing so and should have FOUND a reason to admit. I like the autonomy when I actually have it, what I don't like is being thrown out to sink or swim and those who are supposed to be my managers will not pick up visits, will get angry when your asking for help that requires them to do something that they think is your job...meanwhile they can eat lunch, pee, go home at 5 and eat w/family etc...and I'm working all evening. I was told I was off orientation pay...5 days after the fact so guess who didn't transmit any tracking hours because I've been busy trying to visit patients give to other nurses or going to a start that another nurse from our company did the day before...but no matter what I say things are turned around on me and it's my fault. I'm on the radar now so I'm going to either have to "conform" and take it or look elsewhere. I was lectured about critically thinking through my job (about the eval patient I didn't admit) and in the same sentence told I should have called the managers in the office to ask if I should admit or not. I hope I find a company that treats their nurses better and doesn't play games. I feel like I can't be a nurse, make good money AND have a life and free time like a normal freaken person. I am apparently like the 6th person in this position, the clue hasn't been caught yet though that maybe it's not the people in the position but the position and managers/process... Bottom line, I HATE my job right now and if this is how it's going to be most days then to hell with this.

EXACTLY. Calling outside of normal business hours about something that HR or a day manager can call about with a vague statement like this is harassment. If there was really something they needed you to fix i.e. charting etc...they could leave you a message stating what they need, or send you a letter. Calling at 11 pm with a vague statement like that was meant to scare you and leave you to stay awake all night scared and worrying. If you tried to give notice and they would not accept then manipulated to get their way then you did not abandon your patients -- document everything, put dates/times/specific conversations and with who just in case. Maybe text her back and tell her straight up that she can leave you a message during daytime hours, send an email or write a letter about what exactly she means and if she isn't willing to do this then you'll just add that to your existing documentation of events and that she need not contact you with statements like that again. They sound like bullies, not professionals. Professionals don't make veiled threats. That is what their lawyers are for.

I just started in HH and as a SOC nurse with no HH experience. I've been doing this for a little less than 2 months. This IS NOT a 8 to 5 job, many times I'm charting until 9pm and that is on ONE SOC because I'm new and this is a very LONG learning curve. The fastest I've gotten out of a home was in 3 hours. The OASIS form is ridiculously long and not cut and dry at all, sometimes the questions conflict each other but the way you answered them are right for the patient. It can be absolutely ridiculous. Like others have said, things can really slow you down like wound care during your visit. The company I work for wants 3 SOC's per day, but as I'm at the end of my "orientation" I'm quickly seeing that this is not doable while having a life and I will not kill myself doing 3 per day to make them happy. Our management either hasn't been a SOC nurse or hasn't been in the field in many years. Most SOC nurses at my company either leave or transition over to case management because you can see patients, way less charting and be done by 5 and have a life most days. Unless you find a way to get fast and accurate at doing SOC's prepare to spend most your waking hours working. I'm looking for ways to speed my process up while doing a good job, but I can tell you I'll likely be case managing once I'm able.

I love it. I've been in some pretty bad neighborhoods but haven't been messed with because the neighbors know I'm the nurse and who I'm there to see. Just be smart about where you are and you should be fine. It's is an extremely bad area your agency should provide you with an escort/security and in that case you can also say no. The great thing about home health is that it's so different from patient to patient and in my area NEVER boring. Last week I had to jump a chain length fence (in 105 heat mind you) to get to a little old lady w/dementia because she lost the key to the padlock on the fence surrounding her home. I've done care on front porches and in garages. It really makes you resourceful and adaptive and you can make more money then being in a hospital where your stuck for hours on end and overloaded with too many patients to give safe care. I look at it as an adventure, in some other cities/towns it may be better or worse but I'm in a beautiful southern city with both good and bad areas and it's been pretty fun so far for me. :)

Always "paint a picture" of your visit, including the continuing home bound status and the continuing need for homecare because Medicare is picky and they are always looking for a reason to say "nope, not gonna pay". Like another person said, ask to see some good examples of the type of documentation your agency is looking for or ask your supervisor for any good "rules of thumb" to help guide your documentation.