psych HH with no psych experience

lsvalliant · Jan 2, 2011

You're to be considered an "RN independent contractor"---does that mean you will be paid directly by Medicare and/or the client or insurance companies? THAT does not sound good to me.

I have to submit an invoice of the hours I work directly to the agency that hired me for pay. Now from what I understand, I am working for a third party agency who is actually billing a home health company for my services. :uhoh3: So Its pretty confusing and it's all new to me.. but the pay is phenomenal for this area and the company is reputable. If it's not pretty cut and dry I'll just quit. I'm assuming they will have specific forms for me to fill out.

MauraRN · Jan 2, 2011

i loved psych home health but i left for more money. It is not unsafe - but most patients are very noncompliant - beware of the borderline personalities....

I left the hospital 6 weeks ago and started in psych HH for the money, lots more than the hospital was paying. I need the money so it was the way I had to go. In the past week from Christmas to New year's I did 2 admissions, 2 recerts, 9 pts a day, 250 miles a day in post-blizzard conditions. I have earned every cent and then some.

So tell me about the 'borderlines'. The drug-seekers I understand, even the schizophrenics, major depressives too. But the borderlines are freaking me out.

Help?

MauraRN

lsvalliant · Jan 2, 2011

So tell me about the 'borderlines'. The drug-seekers I understand, even the schizophrenics, major depressives too. But the borderlines are freaking me out.
Help?
MauraRN

borderlines are very manipulative and impulsive. they will love you one minute and turn on you at the drop of a dime. I think thats called splitting. They tend to have cutting issues and/or other forms of self harm and trouble controlling anger. i think in a hh situation it would be important to assess for suicide risk and teach coping skills related to anxiety issues or emotional trauma (perceived or real). Feel free to chime in psych nurses. I'm learning too.

I hope I get as many hours as you are working, Maura. I'm starting next week and supplimenting my income with peds extended care on the weekends. Are your hours mostly M-F??

NurseDaddy2006 · Jan 3, 2011

I realize people have different opinions about this kind of issue, but, as a long-time psych nurse and someone who has often worked with nurses from other backgrounds new to psych in inpatient settings where they had plenty of support and guidance (and they struggle more than enough in that situation), I feel strongly that a nurse with no psychiatric experience doing psych home health is a really bad idea, and an indication of an employer that doesn't really care a) what quality of care it's providing to its clients, and b) doesn't care what happens to its employees. I'm fully aware that times are hard and jobs are hard to find, but, IMO, this is just asking for serious trouble.

That's the nail being hit squarely on the head.

It takes a certain kind of nurse to work psych. It takes an understanding of the conditions, symptoms, behaviors, and an ability to look beyond what you're hearing from the patient and do an assessment of what all your senses, including your gut, tells you. It's also important to know what to document.

People who make the decisions of who they hire for various psych nursing positions should also have an understanding of what the role really entails. People and their safety are at stake.

Kooky Korky, BSN, RN · Jan 6, 2011

i loved psych home health but i left for more money. It is not unsafe - but most patients are very noncompliant - beware of the borderline personalities....

How can you say it's not unsafe to go alone, into the home of a stranger, a stranger with a mental disease? :eek:

Or any home of any stranger?

mentalhealthRN · Jan 6, 2011

Okay not for nothin here folks but how is the OP gonna watch out for the borderline or know that someone is escalting--the suble signs--when the OP has never worked a day in psych?? Around here (upstate NY) they would never hire an RN who has no psych experience to do HH psych. It sounds crazy to me, sorry. Not to say that the OP couldn't learn with some time on an inpatient psych unit and be a great psych nurse and that the OP isn't already a great RN--in whatever area she has experience in. However learning psych by yourself in the HH setting is not safe and just sounds crazy.

Sorry OP--don't mean to rain on your parade as I am sure you are really excited to get this job........but I also don't like to see any nurse get thrown to to wolves.....thrown in and expected to figure it out without the proper support and training. Thats how you have nurses end up frustrated and in psych--unsafe. It takes time to get to know the suble signs patient can show of decompensating mentally. To learn how to approach different patients knowing their dx. To learn de-escalation techniques to keep yourself and the patient safe. All these things take time and support from the experienced staff around you.

mentalhealthRN · Jan 10, 2011

I left the hospital 6 weeks ago and started in psych HH for the money, lots more than the hospital was paying. I need the money so it was the way I had to go. In the past week from Christmas to New year's I did 2 admissions, 2 recerts, 9 pts a day, 250 miles a day in post-blizzard conditions. I have earned every cent and then some.
So tell me about the 'borderlines'. The drug-seekers I understand, even the schizophrenics, major depressives too. But the borderlines are freaking me out.
Help?
MauraRN

Best way to review Borderline Personality Disorder short of reading your psych text book--Pickup a copy of a little book....an old one but its a classic and short and sweet and good. Called-- "I Hate You, Don't Leave Me: Understanding the Borderline Personality" by Jerold Kriesman. I have recommended it to both staff as well as pts with BPD and their families. Its only $7.99 on Amazon. I got mine at Barnes & Noble.

NPvampire, MSN, RN, APRN · Mar 1, 2011

I used to do medical and psych HH and my director had to get me approved by Medicare before I was even hired. I had to write a huge manifesto about all the different psych jobs I had had--luckily, they were good enough experience (4+ years). I have since left as HH doesn't pay anything in our area (and I got tired of people's pets and the litterboxes that give you an infection just looking at them, homes that were so nasty...*shudder* not to mention 110 degree heat with patients with no air) and I was spending hours doing the computer writeups for Medicare/OASIS after I got home.

The actual psych part was pretty neat, most of them were just glad to talk to someone or to have someone to talk to about their spouse/kid/whatever with mental illness. You spend a lot of time gophering between them and the doctor.

I've worked for the state and I think that's the most dangerous area of psych by far.

In a nutshell: you have to have special approval if your company's billing Medicare/Caid. Medical experience doesn't count. See if your new company will let you do a few "ridealongs" to see if you even like home health. It is not like the hospital...my director once said, "You have to remember, not everyone lives like you do." Indeed.

MrChicagoRN, RN · Mar 7, 2011

I used to be part of a psychiatric home-care team 10-15 years ago. I provided intermittent visits to the patient's home, operating under a form 485 signed by a psychiatrist.

IIRC, Medicare required two years of psychiatric experience in order to qualify as a billable visit. There was talk of creating the standard of mandatory psych certification, but that didn't happen.

I don't know the current regs, but I would guess that "psych visits" by a non-psych RN would not be a billable visit

It's good that you are asking this question. Of course, I'd also ask the employer and see what they say.