tinybbynurse

I just started in HH about a month or so ago. I'm currently the DON, but until another RN is hired, I'm doing field nursing 2x week. Pros: Flexibility - you can run an errand in the middle of the day, meet a friend for lunch, run home if you're in the area - things like that. Hours - it's nice working dayshift. I used to do nights mostly. I work between 9-5, so that's nice as opposed to all-nighters. Patients - I enjoy being able to go in and not just educate or change wound dressings but actually visit and make these people feel good. They appreciate it so much. I work with Medicare ppl only, so it's a lot of lonely old folks who love the company. Sometimes I feel like I get paid to visit with them. Low-stress cases - the actual stress level of your patient acuity is so low—nothing like the hospital or even urgent care. So chill and relaxed. Make a difference - it's nice when a patient's wound gets better from your interventions or their dependent edema greatly decreases because they're actually listening to you when you educate them about elevating and wearing compression stockings. It's nice to see positive changes over time that you helped to implement. CONS not as many as pros, but big deals nonetheless. Pay - I was getting paid per visit plus hourly for the actual amount of time I was with the patient. Now I'm salary because I'm DON but still seeing patients. Technically I'm compensated, but I'm not specifically paid for the exact mileage I expend nor the time it takes me to chart. Schedule getting thrown off - as someone said, your day could be going smooth, and then patients need to reschedule, and it honestly effs up my whole day. I try to see them in order of distance, so I'm not all over the place, and sometimes, like today, when I should've been done charting right now, I'm waiting around taking an extra long lunch until my last two patients are ready for me. It's frustrating when you have to backtrack and waste gas. My pay might compensate, but I have bills to pay and other stuff I'd like to spend it on, I don't want all my pay going to gas to go to work. Charting - I may finish up at five and sometimes before, but then I'm charting at home. And I don't get paid for the hours it takes to chart. I like finishing up early or mid-afternoon because I have time to chat and be done by 5. But on that same note, if you want a full patient schedule, you very well may not even finish seeing patients til five or later, and then you have to chart on top. And resorts + admits take forever. Even regular visit charting takes me 20-30 min per pt. So you take an average of 6 pts, and that's roughly 3 hours of charting tacked on to my day. No benefits - I don't have benefits. I don't like that at all. I love the patient aspect for the most part. Not sure I'll do home health forever, though.

Being new to this area I have a few general questions for those of you who deal with Medicare patients / OASIS charting. The old DON and other RN left recently and it’s a small company - and my supervisor isn’t an RN and has some answers but not all. 1. Say a patient doesn’t need skilled nursing services anymore, but could benefit from continued physical therapy, at time of recertification, can I discharge the patient from skilled nursing but recertify her for physical therapy only? Or would it not require a discharge at all, but simply a recert only including PT visits? 2. Are you allowed to discharge a patient BEFORE the end of their next recertification period? (I’m pretty sure I heard yes...) Thanks!!

Fairly new to home health. Wondering if I should recertify this patient - as far as I know, there are no specific guidelines in place, it’s based on clinical judgement. However, I was told sometime next year Medicare will have a specific guide to go by, which I’m ok with. my patient was admitted to HH with a primary dx related to gait abnormality. Another major issue was frequent running of her eyes from both macular degeneration and corneal dystrophy. While her right eye causes some blurred vision still, they rarely run or cause her anywhere near the major discomfort her eyes used too. Gait wise - she’s been working with PT, and feels she is getting stronger. I do think she could still benefit from further PT visits. Eye wise - I think she’s been taught all she needs regarding that. She also has a dx of HTN, and that’s my main concern with her right now. It’s been high the past few visits - systolic 150-160, diastolic up to low 90’s. So it would make sense to recert her, right? This would be her FIRST recert, so it’s not like we’ve done all we can do quite yet. thank you for your help!! I’m hoping to continue to gain perspective on when I should discharge or recertify patients so it’ll get easier with time!

I just started working at a HH agency and actually really love it. The only thing I found to be really weird is this week the administrator, who was out most of last week when I started so just had me fill out new hire paperwork this week - had me hand write on a paper the words to a (clearly) made up “contract” basically stating I won’t slander the agency name, speak against them on social media etc, which I was fine with, I remain professional in that regard. The part I DIDN’T like was the part about committing to the company for 2 years or I will be “fined” $10,000-100,000 for leaving early. Oh, and I’m to give a 1 month notice if I leave, or can be “fined”. I clearly remember signing actual legit paperwork stating that this is an at will employer. Not to mention the “90 day” probationary period. The “contract” also included rqnsom weird bits like swearing not to tell ANYONE, including the “law” about the “secrets” of the company. There was other weird stuff in there too. He literally has me hand write what he was reciting. No legit document. I don’t plan on leaving this company any time soon, however, I don’t like the idea of being fined an insane amount if I chose to leave before 2 years. I honestly don’t think this thing he had me write up (which I basically scribbled and was hardly legible Bc he was freaking reciting parapgraphs to me) would hold up in court or actually be legit. But it’s really fishy that he would even try to push it. also, this company is owned by a former non US citizen, and there are definitely cultural/slight language barriers. I just wonder if he realizes that here in America, we don’t just make up hand written documents without lawyers consulted and specific wording and clauses typed up to make it legit. Half the stuff he was reciting wasn’t even proper English. He’s a nice guy, just seems fishy. what do y’all think? ever heard of this? Did I sign my life away for 2 years or do you think it’s truly a non-binding contract that has no actual legal value?

So ridiculous!! All over potatoes? ? supposedly... some people are just in positions of power who shouldn’t be.

Right. Very true

@T-Bird78 thanks for sharing!! Look at that - what’s up with the weekend trend of letting people go from their jobs at the end of the day?! I’m sure you’ve come a long way since then. I appreciate your words of encouragement. My parents can’t wrap their head around the fact that I was simply given the reason “not a good fit”. And that I was “let go” by a tech. They said they can’t legally let someone go without a specific reason - however, many of you said when you got the boot you were told something similar or that very same classic line. It can be so frustrating trying to explain things to family! I know it’s just because they are angry for me, but unfortunately places can and do just get away with letting people go without giving them much explanation.

@T__BSN_AGNP21 I’m glad to know i’m not alone. Thanks for the encouragement! @Davey Do oh my goodness I didn’t mean to come across like that ? I figured you meant in a long time span - my reaction was more geared toward how awesome it is that you persevered on 3 separate occasions, I wasn’t judging you at all! Sorry if it came across like that. ? @Workitinurfava I hear ya!! It blows my mind how people can be so cliquey and talk behind people’s backs. I try to make a point not to participate. I know it happens everywhere but it seems small clinics/private practices are breeding grounds for it! @brandy1017 yes I’m the same way!!! I’m friendly and easy to get along with but am not a social butterfly at work, either! I agree with you - I’d also prefer to go in, do my job, have an arms length relationship with the providers and go home! I suppose at this clinic if you weren’t on a personable liking basis, a good working professional relationship didn’t matter. @Bloop41 thanks so much for sharing! Glad it worked out fine for you. I agree about being wary of working for a place without a solid or involved HR- they act as checks and balances for staff I feel like. Well, lesson learned. I’ll be extremely weary of working in a small practice again. It’s not worth it to me to take a chance and *see* if I fit in or not. I’ll be looking for a bigger staffed facility with other nurses I can work alongnside instead of being rudely isolated by the one and only provider on a daily basis. I thank you all for sharing! It feels better to know that this can be a common trend among small practices - being let go over mystery reasons or simply not being liked by someone. I appreciate all your comments and am looking forward to a better working environment to come!

@Forest2 I totally hear you. I’m generally an easy going person and get along with everyone. A lot of people were buddy-buddy there though and would crack jokes with each other and have in depth personal convos - I suppose I assumed a more professional stance - and it generally takes me a good several months at a job until I feel really personable with my co-workers. None of which is a bad thing, but I can see how I maybe wasn’t a good “social” fit. Doesn’t make any of it ok, but yeah I can definitely recognize the very real possibility of that being a factor. @Waiting for Retirement I feel sort of in the same situation! I think most people liked me - as far as I know. I got along lovely with a couple of other providers, problem was they were only on the schedule once in a while -the main provider I mentioned is the one I worked with more often than not. and I actually think I may ask one of the other providers I jived with to be a reference for me if they will. I think everybody is probably right - there’s probably more going on that I just don’t know about that played into the ordeal. @JBMmom I’m so happy to hear that you ended up excelling in an area you were previously told you didn’t have the capacity for! I’m a firm believer that if we let others tell us what *they* think we can or cannot successfully do, then so many successful people would not turn out to be successful. Believing in yourself is so important! @Hoosier_RN ya know, ideally, I should have asked for further clarification. But as you can all imagine, I of course fumbled and was in shock and didn’t really know what to say, let alone ask conducive questions regarding the situation. Actually, haha, I was probably a lot more nice and accepting than I should’ve been - not that I regret not making a scene of course- but looking back on yesterday I think I could’ve said a thing or two firmly but professionally instead of just “taking” it and walking out in a confused, shocked trance. Of course, I’m sure their minds were already made up and it doesn’t matter either way, but we always think of what we *couldve* said or done after the fact. ?

@Oldmahubbard thank you for your words as well!! It’s terrible that personal favor by one or two people plays a role in some nursing jobs. But I know this is just the way it is sometimes. I’m so glad to hear that you ended up becoming an NP and perservering!!

@ZenLover I totally agree - Justification and truth ARE two separate things. And you’re right - I don’t want to work so closely on a regular basis with a provider who is cold and unfriendly on purpose. I find that to be blatantly rude and not necessary. You’d think I’d rubbed him the wrong way on a personal level the way he treated me - but who knows, he never communicated that anything was wrong. Did I mention he didn’t even do the dirty work of letting me go himself? He had someone else do it. While he was in a room with a patient.

YES!! This is EXACTLY what I told my SO the other day! I was like... ya know...they could’ve just let me go in the morning or called me or something, so I could spend the day figuring out my next move, it truly takes A LOT of time searching for jobs, submitting applications, and the sooner you can get in apps the sooner you can get a call! I had worked 4 long 11-12 hour shifts in a row when they told me, and yes, I was very exhausted and weighed down! Haha.

Three times? And you persevered - that is so encouraging. Thank you for sharing! I am naturally still in shock seeing as how it’s been less than 24 hours and I’d be lying if I said I don’t feel immensely insecure and crushed af the moment, but I’m trying to process those feelings, cry if I need to and move on to something better that I know is out there.

Thank you for your words. I definitely agree with you. This clinic actually often hires friends of employees, so I wouldn’t be surprised at all if there’s someone else someone, perhaps this provider, “preferred”. It almost seems old fashioned and outdated - the provider alone (I assume) being deemed all or most of the power in hiring or firing. In most nursing jobs, the provider has nothing to do with it. It’s the head of nursing, the supervisor above that person has to weigh in, HR...you get my drift. And come to think of it, while I was working there, I got word of some techs on the job who had been apparently “bullied” out of their job and left on their own. I don’t think that just because a few people have been there for years on end it should give them power to choose who works with them based on how much they like them. BUT, I do recognize that this is unfortunately a real reality.

Anyone ever had that happen? I know many have. I never expected to have it happen to me. I started a new job not even 2 months ago, and when they let me go, they didn’t even give me specific reasons besides “not a good fit”. They mentioned the whole 90 day period thing most employers have, but they didn’t even give me a full 90 days. What bothers me is that they must have known ALL DAY and chose to tell me 20 minutes before close. To me that is rude. I worked there all day alongside them, being out of the loop to the knowledge that they already planned to “let me go” at the end of the day. I could also tell the past week or so one of the providers acts very cold towards me. How am I supposed to improve or know what I need to work on if no one communicates? I tried my best to communicate and do what I needed to do but I don’t feel that communication was reciprocated. And as nurses we all know how integral communication is in our field. I’d try to be friendly. I didn’t get that back. The provider would literally talk to everyone but me...it was kind of awkward but I decided to pay no mind to it and just do my job. But he was very rude and now the vibes I got have come into full play, since he obviously wanted to let me go. I worked for a smaller private clinic so you basically worked with the same 2 or 3 people all the time. The main provider I worked with seems to have held all the “power” in the decision , which I don’t find fair. It’s as if I didn’t jive with this provider well enough, and he just didn’t like me. I got along fine with all the other providers... no one else made me nervous but I can look back now and see that I felt nervous around that particular one. I’m kind of crushed and I don’t think this was fair. I feel like it would’ve gone down a lot different were it not a private small clinic. I suppose just one or two people hold all the power in smaller places. anyways, just looking for encouragement. Obviously at the moment at least, my confidence is temporarily shot.