ctrn3478

I have never worked in a hospital but have for a long time felt the way you do now. There arent a lot of hospital jobs around here to work at but I recently started sub-acute& left my job. It depends on the agency for HH but i just didnt wanna take my chances ever again, my job NEVER ended. If i worked 24 hours a day my charts wouldnt be perfect yet im never seeing enough patients to make anyone happy

Thank you for your response!!! I do feeel very much on the same page with you about home health, I don't feel like ever I could work somewhere and get the same level of patient and family appreciation. I have worked here for a year have improved SO much as a nurse and with documentation. However, my concern here does not lie with home health but mostly this particular agency. I am so offended they truly wanted to hold back my paycheck. We are having a lot of trouble here but I along with many other nurses know it is not going to get better here, its been this way for 5+ years and declining. I almost feel its a liability for me to be working here. Prior to this weeks events i was telling myself the same thing, I am stuggling but I am SO thankful for just having a job. But now what is a job worth if they are going to force me into and impossible work load and then not pay me for not completing in on time.... then what is the point of working here at all if they continue threaten my pay? I may have started as a new grad but the people alongside me in this issue have many years in nursing and home health and are in the same spot...its extremely depressing and stressful for me to think I worked 50 something hour week couldnt finish some work, and each work willl now have to stress as to whether i will get my earned pay i need for my loans, rent, basic living expenses : ( I have also tried other home health and considered but am beginning to get worried about my car...

Hello, So to try my best to make my situation brief, I have been working for a home health agency for several months as a new grad. I have gained great experience and learned a lot. But from Day 1 I knew this company was disorganized, and it is. I am salarly paid and there was never a set minimum or productivity level, though when hired I was told 5-6 per day. now this is being pushed further to 7 minimum, now 8.. and on going with no consideration for recert, ROC, SOC (ex ill be seeing 8 pts sun one is a ROC for a pt i have never met). Basically, they push us to our max and were salary so we get nothing extra. SO lots of vists, on top of hours a driving makes it impossible to do paperwork on time, even with the addition of computers which I love bc I do mostly all visists in the house. However, when we first switched to electronic it was a MESS. Scheduling was done incorrectly, many days my comp schedule was nothing as it should be and the visits werent opened to me by staff until way later...when I had a whole new day/week of work i cant back track to old days! A few of us full time employees fell far behind, and we notified our case managers and admin about these issues along the way. Some nurses quit abrutly during this time and they begged me to take ROC/SOC that i told them i would have absoltely no time for. Result: this week despite my emails and many offers attempts to help resolve or even sit in the office to complete this work, they told me they were holding pay checks two days notice for those with any missing notes, for any reason, no exception. Which is illegal (of course I contacted the state for help). I put up quite a fight, and eventually got my pay check d/t fact that I am working this weekend and was unwilling to work without last weeks pay of course. After months of managing my heavy caseload as best I can and feeling overworked, I now feel absolutely disrespected. Im in a competitive job area, even experienced nurses here find it hard to find work. I want to leave immediately (after handing in paperwork on time of course, i do know that is my responsibility just want to be given reaslistic expectations.) I am upset, i feel stuck, and insecure in my job knowing they will continue to do this despite my ongoing efforts to ask for help and to please decrease my caseload!!!! I am so upset to be behind on paperwork, I never was like this before and it does not make me feel good but its out of my control im doing my best and sacrificing a lot of time for little compensation. Just looking for thought, advice on this situation, or maybe I just really needed to vent and find someone who can relate and doesnt think I am crazy, so I appreciate anyone who read this crazy message!! Thanks!!!

We have this problem with our agency too, which is especially tricky for some of us when salarly paid. However, it looks like you have taken your first step which is set an absolute limit to your work load, now stick to it do not negotiate. Do not feel guilty that they do not have appropriate staff to fill visits, your responsbility is your work only! And their job as administrators is to assess appropriate case load, hire according, and possibly hold off on new admissions until staffing is adequate. At least that is my strong opinion on the on-going battle I face with my agency as well : ) If you truly don't think its going to change then definitely beginning seeking other employment, you don't have to let your family/personal life suffer!! : ) Good Luck

In one instance my pt pcp requested pt to travel to ER by ambulance non emergent for eval. he refused. i called back and documented this bc he was urgent (requiring assessment d/t SOB and hemoptysis but no change in VS). and let the MD know. other nurses have had to call ambulances for pts, when EMS arrives the pt can turn them away, they document, and you document, and then you always call PCP to let tthem know. Another situation I have heard from a coworker is a pt, DNR, requiring ambulance to ER for severe SOB with decreased O2Sat. pt did not want to pay, but of course this did not fall in his DNR and living will orders and we are required to act. took a while but the nurse needed to call the doctor to inform of his refusal who then could legally section him, therefore using legal force to require them to go to the hospital (while explaining they can refuse certain treatment there, why etc.) i believe the police came to assist with EMS (they were nice, calm, it was not a forceful situation but rather a mediation), PCP and nurse faxed orders regarding this and social work assisted. HOwever, i do not know much how billing would work in situtation like this, it does sound terrible a patient would be forced to pay for a service that we almost legally must force them to take

I try to think of visits like drs appts... you have choice between these times no reaon needed nothing else is available. if they have legitamate reasons i can schedule around them or if theyre being particularly difficult, but only if its doable either by me or another nurse (some pts will only be seen between 8-9 so fine no other AM pts theyll go first). But if they arent available for the choices the pick its hard to accomodate and its unfair to any other patients that wait! i always say a one hour range for when theyshould be awaiting a nurse to arrive ( bc who wants to feel badly about being 10 min late when who knows what happened with any previous pts). i try to get them to think of visits as appts bc really theyre similar, if they miss one i mark it missed visit. just bc we can chase them around doesnt mean we should. its hard bc we need to work with them to ensure compliance but if someone is noncompliant with MD visits they are most likely non compliant with other aspects of care.

thank you both!!! they came monday, i wasnt chosen for a visit with them and havent spent much time in the office so havent heard the outcome. My agency is pretty disorganized tho I do not feel they are doing anything wrong it had me worried, but i made sure to take care of my personal skills and organizaion the week before. thanks for you advice ill keep it in mind in the future!

thank you this is definitely straight forward and helpful. I am only concerned now about in home med lists, i gave up on those for most patients since many of them were losing them not keeping with meds or med boxes for whatever reason, i have many patient that i let organize themselves as long as they can repeat back to me what theyre doing and it matches my list. guess all i can do is make sure i have up to date med list with me that day for all patients. thanks again!

Sooo long story short cms is coming in for a on site survey saying theyre gonna pick at least 2 charts read them and go along with nurses on visits. i know this is happening at many agencies and i also know many agencies (or as it seems from reading this thread) have difficulties with organization, making it easy for cms to find things wrong. Really I just want to know what to expect, how bad/mean/intimidating they will be. QA has given overall pretty good reviews on most of my charts and ive been checking through them myself to make sure nothing is missing etc. were also right in transition to electronic so things are a mess, things like checking to see if doctors signed and returned all faxes is hard to keep up with for example, as full time RNs we are responsible for everything (hha and lpn supervisory notes and careplans and all OASIS) so theres a lot to keep up with. really just looking for advice from anyone who has dealt with this. im almost overloaded with patients and have continuously talked to the agency about being realistic with what i can actually do while following policy almost perfectly so just seeing what i can do in preparation for this surveyor to come! are they looking at nurses individually and/or just the agency?! i dont think i am doing anything terribly wrong but when it comes to medicare they can find anything and i dont wanna get in any trouble! Thanks!

nooooo way. RN's should be doing skilled nursing work..wound changes, med teaching and admin, bloodwork, assessments, while aides and homemakers would take care of those things. if you are full time you could never have time for that. and from what i understand medicare will pay only for skilled nursing usually about 45min-1hr visits and would not want to pay for SN for those things which take up a lot of time. talk to your administrator, DON, or other nurses at the agency about it if thats what youre being asked to do by your pt and get the appropriate staff sent in.

unfortunately it sounds like youll need to call to verify which meds are even incorrectly written that note sounds too vague and confusing..where did you get the last med list, the last 485 or an updated list in the file? whenever i get confused i just call and request they fax over their most recent list asap

this is my hardest part of home care... recently i was told i had a pt s/p cabg unable to stablaize on coumadin unable to stablizie INR (freuqnetly well above 3 and for a week under 2.0 pcp aware) go to the ER and found 2 dvt's. i saw the pt that day or the day before and had no s/s whatsoever was actually my healthiest pt (considering he was post-op and ambulatory w/ no complaints) my supervisor was upset thinking why hadnt i noticed this? but bottom line is things happen after we leave and sometimes very quickly, and pts dont always tell us everything. I would have probably done the same, as I am frequently reminded that sympotomatic presentations are not usually considered appropriate for ER but require immediate attention. If you have documented the PCP request, and her canceled visit, then that is really the best you can do. However if you are like me I often find it frustrating that I cannot know more about a pts condition (ex. cant quite get an EKG or echo done in home for answers in 24hr)

new grad salary of about 58,000 a year full time salary which equals 28 per hr (expected to see 25-35 pts a week). however being not electronic paperwork takes longer especially oasis admits &recerts & wound care documentation as well as all other little things (md telephone orders, hha care plans, a million other things) and can build up around visits taking up a lot of time. I also work 1-2 weekends a month which i make$2 more per hr but dont get overtime for.

South Shore suburbs and some neighbors of Boston, MA Salarly- I work full time (not per diem or per visit) I get $28 an hour for a set 40 hrs a week. I am expected to see an average of 5-6 pts a day, we also are responsible for the majority of all of our pts case coordination and home health aide and LPN supervision as well...its a lot. Also this is new grad salary Benefits- working for a small agency health insurance is offered but for a high price (i believe 400 a month) which i do not pay and get elsewhere. also offered vision and dental which i do use yet but will soon, i believe price is MUCH lower Perks- nothing really...its been discussed about being provided with tablets once we go electronic soon (thank god) but im not sure if that will come through. I get $0.40 per mile. drive a newer jeep compass and this covers gas prices but not much more (such oil changes or maintenence). generally i claim 200-500 miles per 2 week pay period (some of my visits are 18-30 miles apart and must be seen in that order... )

I'm a new grad RN in home health, i was a HHA in college. I love my job for the most part, and like others said i really wish i had a more organized training in documentation. It is disorganized where I am now (we have paper documentation only and are slowly changing to electronic) and I wish I knew better guidelines for simply what they wanted and when they want it, I was getting difference answers from everyone in the beginning. A do not use list would have been great (ex. I was asked to not write N/A in certain OASIS sections that did not apply but to put zero or leave blank..). I would say set them up to care for the patients they train on along with a nurse present for a certain amount of time until they are comfortable with a familiar patient and are able to be own their own with patients in which they fully understand the patients baseline and care plan. I found it was very comfortable learning procedures with patients who I knew what their normal reactions and VS/assessments were. Even then though there are times when new things arise and I just wasnt sure, in this case it is important to make sure they know when its emergent to contact the agency, PCP, and/or 911, provide them with specific guidelines for the agency w/ s/s and VS ranges if possible if they are not specified in the care plan. Finally, there were several times I was unsure but knew a situation was not emergent and was able to step aside and contact another nurse. It would be helpful to set them up with 1-2 preceptors and make them familiar with all the other nurses, especially nurses with common patients for support in these situations. Make sure you stay in touch with them and know if they are ever overwhelmed or uncomfortable with an assignment but afraid to say why. Its definitely hard and not the ideal first job but I think with proper training, communication, and support it can be do-able. sorry this is so long but hope it helps!