Question on home health


Hello all, I am new to the boards and have a question. I've been in nursing for 20 years in both LTC and home health. I have recently relocated back to the Dallas area and secured employment at a very small agency. This agency serves all of the Dallas metro area. I don't mind the driving as that is part of the job and it is giving me the opportunity to relearn the area since I have been away for the past 19 years. Anyway, the woman who owns the agency is also DON, administrator, well...she's everything. This is my first week there and she has given me a full load and expects me to start at 8 in the morning (that's not the problem) and be done by 2. The problems lies in the fact that she wants me to see 10-12 patients in that time span and the patients she gives me are at least 15-20 miles apart. Then when I cant produce she yells saying that her other nurse does it and even is able to give patient a shower if they need it and yells at me saying that I need to work on my time management skills. She continues to berate me and then turns around saying she is only trying to help me. At my previous job I saw 10 patients or more a day and my time management skills were very good and my boss there was always complimenting me on my work. Now with this agency how am I supposed to go and see that many people in that time frame with that much distance between them and still provide good nursing care? It's only been two days and my confidence has gone so far down I don't even know if I want to stay in nursing. Sorry for the length but I just need advice from experts.


38,333 Posts

Whether or not you could get up to speed is overridden, I believe, by her choice to berate you. Not good for the long run. For your own health, I would look elsewhere for work now rather than later. Don't give her a chance to wear you down. JMO


462 Posts

It's never okay for someone to berate you. And no, I certainly don't think it is feasible at all to see that many patients in 6 hours, especially if you are doing what you are supposed to and fully assessing them. Time management and planning out your route to be efficient is one thing, but to accomplish that you would surely have to cut corners. I've done 8 visits before in a day with about 120 miles of driving, and it was a 10 hour day for me. Surely with your experience you can find a better agency that is respectful to you.


3,726 Posts

That many patients would be fraud as there is no way to meet compliance and reimbursement criteria.

Not to mention insane working conditions.

6 visit equivalents for a fully oriented nurse with moderate driving is reasonable. (in an 8 hr day)


30 Posts

That is the most insane thing I have ever heard!!! Run away like that place is on fire! I work 8-230 as that is my chosen times. I work in a very small territory with some days having 3-4 pts in one ALF. And they still don't allow us more than 7 pts a day. Which is fine by me. I like 6-7. As far as I understand that is a Medicare expectation. Each pt deserves 40-60 min of undevided attention. There are so many times I would not have seen subtle things without that. So thankful for my DOO and management team that are so supportive. Please know agencies like mine exist. Move on. It is not worth the heartache.


13 Posts

You need to leave this job asap.....Medicare reimbursement are going to be for agencies that get high star rating, and this sounds like a mom and pop agency, that will not survive....most pt you can see is 5=6 pt a day for routine followups. you can not see 12 pt and give any time of reimbursable care.


6 Posts

Hi, I am considering going into HHC and this story is concerning. Anyway, I know RNs in south FL that are/have seen 4-5 pts an hr. when their pts. are in a highrise condo some days and have always wondered how that was viewed by Medicare. I will be in the Midwest.


38,333 Posts

Nurses who see 4-5 patients in one hour are not putting that on their documentation.

Specializes in Med./Surg., Diabetes, Med. ICU, home hea. Has 36 years experience.

Yes, find another job, quit without notice and don't look back. If you're spiteful, know that she'll likely stroke out from her own stress and failures.

Leave! This is completely unreasonable. First of all, why does she insist you start at 8 and end by 2? The great part of home care is being able to set your own schedule, within some limits. I turn in my schedule (which I create) to the office weekly, but I don't give them times, etc. There are days when I know I'm going to have to see a patient later in the day for one reason or another, so I begin a little bit later in the morning. When I worked in a rural farming area, I had no problems getting patients to agree to early morning visits. But now I'm seeing lots of patients who worked in factories for much of their lives, working odd shifts, and they don't get up that early!

For you to do what she's asking, you'd have to provide substandard care, with extremely brief visits (which would probably be considered fraudulent by Medicare). And can I add, having driven in Dallas about a year ago, that driving 20 miles can often be a nightmare! The traffic sure has gotten nuts there.

My advice would be to look elsewhere. Every agency is different, and Dallas is a large enough area to have lots of them. Good luck!!

Specializes in Public health program evaluation. Has 7 years experience.

In my agency a 12 client visiting load is considered the maximum for a very experienced nurse and they are allowed to set up their day with their clients however they prefer. As a new grad, I work in home shift nursing with clients that require fewer skill sets while I gain experience. It sounds like your boss has a lot to learn about how to treat staff and keep clients safe. It sounds like a job hunt is coming. I wish you all the best