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.

The rules are different, KelRN215 said all Pediatrics NO Medicare. It's Medicare that says injections/labs are not a skilled service but Pediatric patients aren't on Medicare (LOL)!!

Ok yeah this sounds like private duty not home health. Home health is intermittent care and you are in then out and on to the next patient. In private duty you can be asked to cook/clean and do laundry etc...which is why I no longer do private duty but home health. Since you are likely private duty then you are likely also not getting insurance or benefits and are PRN, which means you are a contractor and you just need to put your foot down and not let them try to keep you on a case. Be straight up, tell them you are not a good fit you don't want the case and they have x amount of time to get someone else in to replace you end of story. With these agencies that do private duty they like to try to wheel and deal and make it seem like you have to stay or whatever and you don't. Switch to home health, you make a lot more money and your not stuck in one spot for hours and hours. You also get to use your actual nursing skills instead of being paid virtually nothing and being treated like a maid/nanny etc...

When you work with kiddos, your going to piss parents off sometimes. That is the reality of it, some parents are easy going and some are extremely difficult...but they are the parents so you have to respect that. Just follow your company protocols and stay within the scope of your job duties and try to be sensitive to both parent and child. If a parent denies a treatment, says their child is ok then your only action is to document which will be your saving grace. Talk to the mother, explain where you were coming from and apologize for possibly upsetting her. If she is understanding she might realize you were looking out for her child and be ok. Just try not to cause any issues especially right before your walking out the door. Being in healthcare is tough, unfortunately you'll run into a lot of unpleasant people (both patient/family and fellow healthcare workers). Don't over analyze, just learn and move on. Best of luck.

I'm in this math right now, week 2. It is easier but it's a LOT of work and very time consuming. It is easier than the college algebra which I attempted twice and had to drop. I really wished UTA would understand that after working all day it's exhausting to come home to several hours of homework each night, then no time to actually sit and study for the upcoming test before the test is due because it's taken you all that time to get the homework done after listening to the lectures. Overall the contemporary math is easier then the algebra but it still is time consuming.

I'm an RN with 2 years PDN experience and an agency starting w/an "M" pays $7 and change per hour of orientation! Now, tell me that would happen for ANY other profession? NOPE. Health care wouldn't run well if at all without nurses, yet we put up with this...have no idea why.

An agency will follow the money EVERY time. To them this is a business and no one is in business to not make money. These agencies will keep the difficult family until an incident happens which forces the agency discharge them (if an incident even happens). It is exactly right that the nurse is expendable. What I don't understand is why oh why do nurse across our country put up with this crap? I don't know any other professional in healthcare who would put up with what we do. Try telling a Doctor he's going to be paid $7 an hour to "orient" like nurses are with these agencies...that would never happen. Try telling a PT that after they do a home visit w/a patient to go start that patients laundry...that won't ever happen. But here we are, nurses, putting up with this crap. Nursing will NEVER advance as a profession when we allow ourselves to be worked into the ground and paid nothing, insulted and treated like "the help" in ANY healthcare setting. When will we learn and do something about it? That is my opinion on it anyways.

This is what I'm dealing with right now. I took a case, a pre-school child who has full cognition but can only move fingers. She does need stimulation for sure and I'm ok with playing with her and trying to find ways to keep her occupied etc...but not to the exclusion of doing my job. I am an RN, I am not a teacher or nanny and I HAVE to be able to document the care I provide and do my job but I'm expected to play with her and keep her from fussing the entire time. I was also told I need to do her laundry. The 485 actually says "SN to provide stimulation and active play" or some such thing. Because that crap is in the 485 I literally end up going 4 and 5 hours before having a chance to document anything. Every time I go to document one of the parents is like "would you like the nurse to read you a book?". The HH agency told me that while I'm in the home I have to provide holistic care which includes ADL's and went on to say I can prepare light meals, do laundry and fold/put away laundry, clean the patients bathroom and kitchen and of course wipe down and sanitize DME and other areas of patient care and if the parents give me permission I can answer the front door. Since when is answering the front door or laundry an ADL for a pre-schooler? I don't feel like an RN, I feel like an over educated nanny/house keeper. On top of this the parents micromanage so much that they will come and take the suction out of my hands and push me aside and do the task I was doing 4 out of 5 times per shift. I was given a word for word typed out script of what to say if I ever had to call EMS by the parents. There is a two page typed "if sats drop to this, do this" typed set of instructions the parents put in the home chart. I actually got a "you did a good job" when one parent asked if I or his wife put on the patients bipap mask, like this is the ONLY bipap mask in existence and no one in the world has ever been able to correctly put it on this child before. I understand the parents feel a loss of control over the situation their child is in, and it must be incredibly difficult BUT at the same time there has to be a limit set. I feel that they totally disregard my education/training/knowledge/experience with the over-bearing micromanagement and need to control EVERYTHING I do. I can't even do my job because they continually step in, and it's teaching this little person that no one is competent to care for them but their parents so I get to deal with this child fussing and not wanting me to suction, or fussing after 5 minutes of an activity that child chose and me having to spend 10 minutes going "do you want to do this, do you want to do that" until I get a "uh-huh" for the child to then repeat this 10 more times. Yesterday alone a video had to be changed 3 times in the span of 20 minutes because all the sudden the child got bored and began fussing. I don't have the time, energy or desire to play that game with a pre-schooler all day then when I'm trying to get my documentation done be told to go do the patients laundry. This is the first case I've ever left after accepting it. I don't even think I want to do any patient care in PD/HH anymore because to me this BS is setting nursing back about 60 years. If this is what nursing is in this area of nursing then no thanks.

Congratulations on passing your NCLEX. I'm sure your license has shown up by now on the SC BON site, and yes they are SLOW! I've been an RN now for 4 years and just recently moved to the Charleston area. I have heard that MUSC does prefer their own graduates, which as a military wife I can tell you that is the way many areas with hospitals affiliated with a university or that have their own nursing programs. It's infuriating and it makes finding a job very difficult. I've only been here for a few months and I'm really just now starting to get serious about looking so I'm hoping to find something that is a good fit relatively soon. I had a very hard time finding work after graduation. I ended up doing flu/wellness clinics with a nursing agency at first. I then ended up working private duty which gave me two solid years of great experience however it's not easy to jump from one type of nursing to another anymore, and getting into acute care is extremely hard. The days of nurses having their pick of jobs is over, and I can't tell you how frustrating it is to hear "oh your a nurse, you'll get work anywhere easy" by people outside of this industry because it's just not true. Continue throwing out applications. Also, consider looking at nursing agencies. Some agencies require acute care or previous home health experience but there are some who will train you. This will get your working while you continue to look around if that is not you want to do for the long term. Also, correctional nursing is something to look at as well. Look for any new grad openings, for openings with the state and federal jobs on USAJOBS.COM. Hope that helps! It can be hard to get yourself in the door, but keep looking it will happen!

Would love to know the same! I've read on these threads that the academic advisors aren't giving consistent information on the ability to take math 1301 rather than 1302 or what class is taken as a transfer etc...have you tried to ask your academic advisor? I am very frustrated with the fact that both college algebra and statistics are required. I have stats already but now have to take the algebra. It's really ridiculous! Not sure why people aren't throwing a fit and complaining, maybe something would get changed!

I would like to know the exact same thing. I'm in the same boat as you are. All I have left is Algebra and capstone and I'm finished. I tried to take 1302 twice but the course load is ridiculous and I work more than 40 hrs per week so it just wasn't doable. I too would appreciate ANY information on this class!!!