So overwhelmed..any advice?

[NRSKarenRN, BSN, RN]

My Central Intake Depts been processing 90-100 + day Mon-Fri for new starts of care...

The volume + itch to go visit patients rather than sitting behind a desk had me out admiting a patient on Saturday (old patient of mine from 2002). Monday took me 3 1/2 hrs complete paperwork as never oriented to OASIS or 485 computer entry.....call to IT manager required to activate my access to care managment software seciton; called on-call RN who happened to be Coder/UR for one of the branches who walked me through specifics pulling up library text to complete 485. All for $70.00 WE admit fee. Wonder what messages MC UR will have for me upon return from vacation this week.

Learning to say NO is just hard for some of us folks....

Per Home Health Line, 6-7 pts per day is national average.

I managed 32 pt caseload comfortably; 37-40 do able with LPN assist for followups. If patients all in one geographic area or city zip code and simple CHF, BP, med prefills averaging 20-30 min with 5 minute travel, could do 10 in a day, especially when had Senior high rise to case manage..... Doing Infusion nursing I sometimes only managed 2-4 day as was driving 125+ miles and had lab drop offs along the way.

Sometimes admissions just needs to say NOOOOOOOOO when staff stressed to the max and new hires not on the horizon. I have had on occaison to tell VP patient services and CFO along with referral sources we cannot accept patients as know everyone full and 1wk delay for therapy so unsafe to accept patient if we can not meet needs.

[RNRutRO]

I agree that 6-7 pt's a day is doable. In fact 10 is too. BUT when you add admits, RCTS, PH, etc, that takes a huge chunck out of your time. As you realized after your admit this weekend:bugeyes:. And if you were told one thing, then asked to do more with no pay, that's just wrong.

I agree it's hard to say "no" If it weren't for the psycho DON that came in and 5 people quit in the four weeks she was there, I'd most likely be doing call q every week, and 10 pt's a day. My point is, there are people out there that will NOT abuse you, and really do care!!

[Rachelks]

I think 7-8 may be "do able" every day if they all live around the same zip and are routine visits. I am a nurse for a rual area and drive anywhere from 100-150 (sometimes more) miles a day and visits usually include wound care or infusions. I think all agencies should take in to consideration the acuity level of the pt and not just the numbers.

[Rachelks]

Thanks everyone for your views... It is always helpful to hear others opinions on this.

[paradiseboundRN]

I'm reading these posts and thinking....why would a nurse stay at an agency that treats them like this? I don't know about other areas of the country but in Metro Detroit they are begging for home care nurses. When I left my last job, I had 3 solid offers (full time) in 1 week. Is the market for home care nurses that bad or is it low self-esteem??? or fear of change?????

[muffin7]

Well said Paradisebound, but here in so cal I have had difficulty finding fulltime HH work I have only found per diem. I have been out of school for 3 years, and I went into the OR right out of school and was there for 2.5 yrs before I wanted HH.

[BabaLouRN]

I feel better now that I see I am not lost in the whirlwind of letting this job kick my butt. I feel the same way you do. I CARE about the kind of care that I give my patients. I also care about my family and I get frustrated sitting on the sofa while my family watch TV and see me night after night lost in a pile of papers filling out one OASIS after another until my eyes won't stay open. I too feel like I am working 168 hours a week and only get paid for 40. By the way, are you having to handwrite all of your paperwork ?? I am and it sucks

[muffin7]

If I take the per diem job I was offered last week I will be doing the SOC in writing. The visits are on computer and are one page

[YogaloverRN]

Well, I also feel overwhelmed, I work for an agency that was mentioned. And I DO see 10 or more in a day. And I travel 100 miles. I work the week-ends and 1 day during the week. When I get home, i am so tired, I usually do my charting at 5:00 in the am on my day off because it has to be in by 9:00 am, and then there are the QCC calls on my supposed day off. I feel like I never have a "day off". I have only been working here for 15 months, but sometimes it feels like only a few months due to the learning incidents that happen. For instance, this week-end I am sent to admit a patient, well, it seems she can't get out of bed, and is left alone from 7:10 until 4:00 pm. When I call the cm to report, she tells me, "that is an unsafe environment, we shouldn't have admitted her", to which I said, "Well, I wish I had known that!" I told her it would be nice if we had a hand-out with situations in which we should not admit the patient. It was the week-end with no way to call anyone, however, I didn't know about the safety issue and the State law saying we can't see a patient in this situation. Well, enough raving! I am getting sooooo burned out, and SICK of working every week-end!

[LuLu2008]

I am fairly new to Home Health nursing. I would like to know how others in the field get paid. For me, it is "per visit" no matter how much paperwork and phone time I spend outside of the patient's home. I am considered the "team leader" and "case manager" to coordinate and communicate with everybody else on the team. Is it just me, or do others feel as if they are earning minimum wage by the time all of this is accomplished? Does anybody ever get a differential for acuity???? And how much help is the office for other nurses, e.g. with sending faxes, following up on orders that have not been signed by doctors, correcting mistakes generated in the office such as incorrect patient addresses, obtaining written orders for orders a receptionist has taken per telephone, etc.?

[LuLu2008]

Well, I also feel overwhelmed, I work for an agency that was mentioned. And I DO see 10 or more in a day. And I travel 100 miles. I work the week-ends and 1 day during the week. When I get home, i am so tired, I usually do my charting at 5:00 in the am on my day off because it has to be in by 9:00 am, and then there are the QCC calls on my supposed day off. I feel like I never have a "day off". I have only been working here for 15 months, but sometimes it feels like only a few months due to the learning incidents that happen. For instance, this week-end I am sent to admit a patient, well, it seems she can't get out of bed, and is left alone from 7:10 until 4:00 pm. When I call the cm to report, she tells me, "that is an unsafe environment, we shouldn't have admitted her", to which I said, "Well, I wish I had known that!" I told her it would be nice if we had a hand-out with situations in which we should not admit the patient. It was the week-end with no way to call anyone, however, I didn't know about the safety issue and the State law saying we can't see a patient in this situation. Well, enough raving! I am getting sooooo burned out, and SICK of working every week-end!

Very interesting post, thank you! I just would like to know what these mean:

QCC

CM

Also: when you are called to admit a patient on the weekend, what type of prescreening process takes place? In my agency we have office staff to verify the physician order and eligibility with the patient's insurance company. We are not expected to stay with a patient from 7:10 am until 4:00 pm as that is not the purpose of home health nursing, we are there to perform a visit which can take anywhere from 1/2 hour to longer if it is an initial evaluation or a recert.

Concerning getting phone calls on your days off, you need not be obligated to answer your phone if you are off duty. That is what the on call nurse, on call doctor, and Emergency Room are for.

Eager to hear more from you!

[LuLu2008]

I'm reading these posts and thinking....why would a nurse stay at an agency that treats them like this? I don't know about other areas of the country but in Metro Detroit they are begging for home care nurses. When I left my last job, I had 3 solid offers (full time) in 1 week. Is the market for home care nurses that bad or is it low self-esteem??? or fear of change?????

I can tell you what goes through my mind when I think of looking for another job. The directors of the various home health agencies in my city all know one another and compare notes. I would not like my agency to know if I am inquiring about other positions and the working environment in those other agencies because I fear it will be held against me, all without my knowledge. But I would really like to work at a place where computers can be used for our charting and where I will be given a laptop to take into the field.