LenoraRN

I am a clinical nurse supervisor in a small home health agency in a large city in NC. I'm curious as to how other home health agencies pay their full time nurses, either per diem or salaried, which works better, and why do you think so? The home health agency I used to work for paid nurses on a salary basis, and this one that I work for now pays on a per diem basis. Personally, I feel salaried nurses work out better because they are obligated to come to the office, whereas per diem nurses feel it's a huge hassle to come into the office. I have read literature that says most HHA are getting away from per diem with PPS, as it's not feasible enough. Any comments would be appreciated. Lenora Ramsey, RN, BSN Clinical Nurse Supervisor

Mijourney, I wholeheartedly agree with you. We, as nurses, need to unite together to get something done about all the bureaucracy there is today in healthcare. I witnessed it in the hospital, doing med/surg, when I had so much paperwork, I didn't have time to spend w/the patient. Now it's almost the same in home care. And you're right...I remember a time in HHC where, when the patient came out of the hospital, you saw them daily for 21 days then 3 times/week. If they were hospitalized w/in that time, when they were discharged, you saw them at the same frequency. Not so anymore...you're lucky to be able to see them once a week, and all b/c the government is trying to cut spending w/home health, when if they truly stop and think about it, it will save them money in the long haul, as HHC is ultimately less expensive than nursing homes, ALF, rest homes or retirement centers. I realize that they're trying to put the spending back to the states-so that M'Caid will pay instead of M'Care...but I have seen so many elderly get cheated out of their retirement, having to spend it on a spouse, who is in a facility, just so when the money is all gone, they can go on M'Caid. What's the use in having a retirement fund, when you're not going to be able to enjoy it in the long haul? I'm off my soap-box now...lol. Northnurse, I understand your frustration...at the agency I work for, they decreased the amount of paperwork for the admission. We have an admission booklet that has the information about the agency, safety etc in it. Then we have a secondary payor form, an indigent form, consent form, all the advanced directives stuff, and then the OASIS and 485 information. Our 485/OASIS is incorporated together---it's 20 pages long. And like I said, it takes me about an hour to an hour and a half in the home, then another hour in the office to do. I would suggest talking to the big honchos to see if you could incorporate some of the papers/info together to lessen the paperwork. I agree wholeheartedly with you that the pay for the amount of paperwork is terrible, but then, you have to consider...is the stress level, hours, etc of more benefit than working in a hospital environment? Just something to think about...*S* I appreciate the great discussion, y'all!!

In reading some of your posts, I feel as if the majority of the home health nurses posting are experiencing burnout. Now, I'll probably get a ton of back-lashing for saying that, but I can take it...*S* Why does it take hours to do an OASIS assessment? It generally takes me around an hour, hour and a half max to do an admission start of care, including OASIS. For the most part, it's just a check box; how long could that take? I'll bet the majority of you have computerized systems...the agency where I work is not, which makes it that much more time consuming. However, I still find that I'm not spending a lot of time on the paperwork. Is it redundant? You betcha...a hell of a lot of redundancy. Is it a pain in the bahonkas? Yep, sure is. Does the government know what they're doing? Probably not, but eventually it'll more than likely go back to the way it was, or change again. That's the good and bad of home health...if you don't like change, you won't like home health, because it is changing from day to day, week to week, etc. I was an ER nurse for over 5 years before I went into home health and worked as a home health nurse for 5 years before moving to a different area. I went back to work in a hospital, in the ER, and finally found a position as the clinical nurse supervisor for the agency I work for. I didn't know how good I had it until I went back into the hospital setting! Working long hours, having patients yell at you b/c the wait is so long, having people stand over you, telling you that what you're doing isn't the right way....nope, wouldn't want to leave home health ever again, unless I was burn out....and I ain't there yet. Sorry, didn't mean to make this so long...