RN Case Mangers: How long was your orientation and what did it involve?

annaedRN, RN · Feb 27, 2011

Yikes!! We have our new RN case mgrs follow the preceptor 3-4 weeks - depending on skill level, experience, etc of nurse. They then start to do visits independently, the first few OASIS that are done - she/he comes into the office and charts most of assessment with a nurse that is COS-C certified - to make sure that they really understand the MO questions. Orientation is really for the first 3 months - slowly building up case load, meeting frequently with preceptor for new skills and to go over how things are going. Also, meeting with the clinical supervisor to discuss how the case mgmt is going. Having a thorough orientation definitely helps with staff retention - and leads to better prepared, more confident employees. There are some things that "jumping in with both feet" may be beneficial - but IMO, orienting someone to HH and OASIS should not be one of them!

twokidsmom,rn · Feb 27, 2011

I became a RN 2008 worked on a med/surg floor for 18months and 6 months at a local VA. Then got my current job as a RN case manager for HH company. I was with someone for 1.5 weeks because I was going to cover her while she was on vacation. So I was on my own after 1.5weeks and have been ever since. My manager went with me on one open and was with another nurse once for an open and that has been it. I have been lectured about my notes are not up to par and getting called in on my oasis all the time.

I was thrown to the wolfes right away. I asked for help was told I have help a phone call away. Was recently told that my manager will be going with me one day because she wants to see what she can do to help.

I have been with this company for 7 months now. No computers, I see 6-9 pts a day, come home do my notes in the evening. I have bad handwriting so now I am typing all my daily notes every evening. I cover 1 weekend a month but have also done opens on my "free" weekends.

So I know exactly how you feel at least they did help you after you asked for help.

KateRN1 · Feb 27, 2011

Because I had done home care in the past, when I returned to home care a few years ago, I was given zero orientation. I had one ride-along with another nurse who I thought was just about the worst home care nurse I'd ever seen. It turned out that was his first visit for the agency also. Since then, I've worked for three other agencies, only one of which gave me any kind of orientation time. This is one of the biggest problems with home care, in my opinion. Lack of orientation is such a huge drain for the agency in terms of staff turnover and lack of consistency in OASIS data collection, directly leading to a reduction in reimbursement. Someday, I hope that they will learn that hiring and training the right people is much more effective than hiring the first person who comes along and then throwing them to the wolves.

lou12 · Feb 27, 2011

This is great information! I started one month ago in home health after 20 years working in a hospital in various departments. The staff turnover is incredible, probably because there isn't much orientation. I insisted I needed more time which they gave me, but now the other RN case manager just resigned- I am afraid they will now throw me to wolves. Why is this so common in home health?

shondaRN · Feb 28, 2011

Yikes!! We have our new RN case mgrs follow the preceptor 3-4 weeks - depending on skill level, experience, etc of nurse. They then start to do visits independently, the first few OASIS that are done - she/he comes into the office and charts most of assessment with a nurse that is COS-C certified - to make sure that they really understand the MO questions. Orientation is really for the first 3 months - slowly building up case load, meeting frequently with preceptor for new skills and to go over how things are going. Also, meeting with the clinical supervisor to discuss how the case mgmt is going. Having a thorough orientation definitely helps with staff retention - and leads to better prepared, more confident employees. There are some things that "jumping in with both feet" may be beneficial - but IMO, orienting someone to HH and OASIS should not be one of them!

I'm curious. What agency did you work for? Thanks. :nurse:

Isabelle49 · Feb 28, 2011

A thing to remember is time to the agency is $. Proper orientation is generally lacking in Home Health across the board. I am a field rn, and have been for 8 years now. I really think it is unjust for agencies to skimp on orientation, especially as concerns collection of data for OASIS. For some reason, management doesn't understand why it's so hard for a new HH nurse to get it right. The reason for this, in my opinion, is that management/office staff have never been in the field and do not realize the challenges there. If an agency is not willing to provide appropriate orientation, quit the job. If you don't quit, you will be setting yourself up to take a fall, or you won't be able to cope with the requirements. Best of luck to you.

annaedRN, RN · Feb 28, 2011

"I'm curious. What agency did you work for? Thanks"

I work for my local, free-standing, non-profit VNA. They aren't perfect, but they really do care about their nurses and really try to have them educated and comfortable. We do not have a big turn-around of staff. You do not make quite as much money per hour as the big agencies will pay you - but there are good benefits, pto, mileage reimbursement, etc. Look into the established non-profit agencies - they tend to treat you better.

shondaRN · Mar 2, 2011

"I'm curious. What agency did you work for? Thanks"
I work for my local, free-standing, non-profit VNA. They aren't perfect, but they really do care about their nurses and really try to have them educated and comfortable. We do not have a big turn-around of staff. You do not make quite as much money per hour as the big agencies will pay you - but there are good benefits, pto, mileage reimbursement, etc. Look into the established non-profit agencies - they tend to treat you better.

Thanks for your response. I've submitted a application for a nonprofit agency in the area. Now I know what to look for in a home health agency.:)

zulla · Mar 23, 2011

Hi,

I am thinking of doing HH nursing. Can any managers let me know what kind of orientation is out there?

KateRN1 · Mar 27, 2011

That's like asking, "How long is a piece of string?" Orientation is totally dependent on the agency. Some give a great orientation with OASIS-certified nurses, ride-alongs with all disciplines, and a lot of initial supervision. Others throw you out there after a day to ride along with another nurse who may or may not have a good understanding of home care at all. Best bet is to ask the agencies where you interview what kind of orientation they offer.