I do like home health, I love helping patients. But this is becoming a 24/7 job. I have given this job a year and things are still overwhelming. I know what to do, I have improved with my paperwork getting less and less handed back to me. But seeing 6-10 pts a day then coming home doing 1-2 hours of homework every night and rarely getting a full weekend off. They even hired a full timer which has not helped me at all. But I guess without her it would even be worse. I truly want to go in today and give a month notice.
I have started calling my contacts and sending a few applications out. Maybe I should just go work at a doctors office and be what a friend of my called worker bee nurse. She works 9-5 off weekends, no holidays and when she clocks out she is done. I know I will not make as much money but life is short and I just want to help people.
Each agency is different in terms of visit frequencies, etc., and I'm assuming (maybe wrongly) that you're doing Medicare skilled intermittent visits. So my first question is why are you seeing each patient 2-3 times per week? Are their needs that great that they warrant 2-3 visits a week (18-27+ visits per episode)? I cannot fathom seeing patients that frequently for our agency. Are you teaching/training caregivers? Is there a lot of wound care that patients aren't able to do and no caregiver in the home? Do the HHRG scores warrant this level of care? If you are solely responsible for your visit frequencies (ie., you don't answer to anyone who tries to adjust your frequency), you might consider starting there with new patients.
Are SOC, recert, ROC, and discharges weighted heavier than a revisit? If not, you might consider discussing this with your agency. An OASIS takes much longer to complete than a revisit and should be weighted accordingly.
What are your visit notes like? Is there a lot of duplicative charting that you can get rid of? If you have checkboxes, are you also writing a narrative? Why do both?
Are the therapists good at returning calls or do you spend a good deal of time playing phone tag? Can you set up a regular time to call each other? Or better yet, meet somewhere to discuss patients, or make tandem visits.
No MSW? Seriously? How?????? MSW is the greatest thing since sliced bread! Are you sure there's no MSW you can refer to? I've never seen a Medicare agency that didn't have at least a PRN person. Yikes!
How much time are you spending during visits? If you're there over an hour and a half (wounds and IVs not withstanding), you may be staying too long or not managing your time well within a visit. Think about how you can multi-task within a visit, like taking vitals all at the same time. (I know one nurse who inserts a thermometer and then waits for it to beep. Then counts a radial pulse. Then counts resps. Then does a b/p. I insert the thermometer, count an apical pulse and resps at the same time for 30 secs and the thermometer usually beeps right about the time I'm done, then take b/p. Takes me less than 1 minutes, takes her 3. Stuff like that.)
Are you following the 485 within the visit or are you teaching a bunch of stuff that's not on the 485 and not part of your patient's goals? Use the 485 to structure your visit.
Are there other nurses who have been there for a while who can help you with the agency-specific stuff? Can they show you a better way to do paperwork, manage your time, etc?
Do you spend a lot of time searching for things in your bag or car? Do you have all the supplies you need on a daily basis, including extra forms and copies of all paperwork? Do you have a day of the week set aside to clean and organize all your stuff? An hour spent on preparation on the weekend saves a lot of hassle during the work week.
Have you discussed your issues with your supervisor? Does she have any suggestions on how to improve or at least decrease your stress level?
That's all I can think of at the moment.
Maybe some of it applies, maybe it doesn't. And this isn't meant as an accusation or to make it out like I think you're an idiot or something, I don't. I was just mentally going through things that might be able to cut down on some of your time. Take what you can use and leave the rest.
I am a RN case manager for a company that see's both Medicare/Medicade along with private insurance and VA patients. I have been taught to see my patients at least twice a week unless they are close to discharge then see them once a week for the last couple weeks.
I do have some wound cases, many of my patients live alone or do not have family that are willing to do the care. I have been taught when someone comes out of a hosp or SNF or if BP meds have been changed see them 3x/wk for the first week or 2.
My forms have both check off and descriptive boxes. I have decided not to come home every night and type up all my notes. I have seen other nurses daily notes and I can not read them so why am I spending hours retyping my notes. It is not mandatory but since my handwriting is bad it was easier on my manager who reads the notes. But on the days I see over 7pts it is just too much.
We do not have points per visit but I do get paid more for SOC, but not for recerts or resumptions or discharges. I see at least 6 but usually 8 a day lately more like 9 and some days 10. And for example this weekend seeing one on Sat and one wound visit and one open on sunday. I do not get paid extra since I am not the one oncall.
It usually takes me close to 30min for a usual visit and of course over an hour on SOC. I try to keep my bag organized but there has been times when I have to go back out to my car to get extra wound supplies.
I do like home health just wish my company used computers and wish I had more weekends totally free from work. Have not had too many of those in the past year.
KateRN1
1,191 Posts
Each agency is different in terms of visit frequencies, etc., and I'm assuming (maybe wrongly) that you're doing Medicare skilled intermittent visits. So my first question is why are you seeing each patient 2-3 times per week? Are their needs that great that they warrant 2-3 visits a week (18-27+ visits per episode)? I cannot fathom seeing patients that frequently for our agency. Are you teaching/training caregivers? Is there a lot of wound care that patients aren't able to do and no caregiver in the home? Do the HHRG scores warrant this level of care? If you are solely responsible for your visit frequencies (ie., you don't answer to anyone who tries to adjust your frequency), you might consider starting there with new patients.
Are SOC, recert, ROC, and discharges weighted heavier than a revisit? If not, you might consider discussing this with your agency. An OASIS takes much longer to complete than a revisit and should be weighted accordingly.
What are your visit notes like? Is there a lot of duplicative charting that you can get rid of? If you have checkboxes, are you also writing a narrative? Why do both?
Are the therapists good at returning calls or do you spend a good deal of time playing phone tag? Can you set up a regular time to call each other? Or better yet, meet somewhere to discuss patients, or make tandem visits.
No MSW? Seriously? How?????? MSW is the greatest thing since sliced bread! Are you sure there's no MSW you can refer to? I've never seen a Medicare agency that didn't have at least a PRN person. Yikes!
How much time are you spending during visits? If you're there over an hour and a half (wounds and IVs not withstanding), you may be staying too long or not managing your time well within a visit. Think about how you can multi-task within a visit, like taking vitals all at the same time. (I know one nurse who inserts a thermometer and then waits for it to beep. Then counts a radial pulse. Then counts resps. Then does a b/p. I insert the thermometer, count an apical pulse and resps at the same time for 30 secs and the thermometer usually beeps right about the time I'm done, then take b/p. Takes me less than 1 minutes, takes her 3. Stuff like that.)
Are you following the 485 within the visit or are you teaching a bunch of stuff that's not on the 485 and not part of your patient's goals? Use the 485 to structure your visit.
Are there other nurses who have been there for a while who can help you with the agency-specific stuff? Can they show you a better way to do paperwork, manage your time, etc?
Do you spend a lot of time searching for things in your bag or car? Do you have all the supplies you need on a daily basis, including extra forms and copies of all paperwork? Do you have a day of the week set aside to clean and organize all your stuff? An hour spent on preparation on the weekend saves a lot of hassle during the work week.
Have you discussed your issues with your supervisor? Does she have any suggestions on how to improve or at least decrease your stress level?
That's all I can think of at the moment.
Maybe some of it applies, maybe it doesn't. And this isn't meant as an accusation or to make it out like I think you're an idiot or something, I don't. I was just mentally going through things that might be able to cut down on some of your time. Take what you can use and leave the rest.