So overwhelmed..any advice?

caliotter3 · Apr 21, 2009

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.

This reminds me of the time one of my DOCS told me that she knew my other DOCS. I picked up on the undertone in her statement quite easily.

Rachelks · Apr 22, 2009

I find this all very sad because it seems to me that home health can be such a great place to work if you have a good staff and great upper management that really cares about the nurses working for them. I can no longer work the way I have and be treated with such little respect... Some days I feel the nurses get treated like we should just be grateful they are letting us work for them... So I have decided to go back and do hospital nursing, I have put in 2 applications so hopefully I can get an interview. Even though hospital hours are long and not as flexible at least once you put your hours in you are done and I have never been treated as poorly in the hospital as I have been while doing home health. You nurses who have good management in your agency hold on to them, That really can make or break this job.

YogaloverRN · Apr 22, 2009

Hello all, thanks for letting me rave. In answer to the question, how do we get paid, I get paid by the visit and this is another reason for my frustration, I may be in the home for 45 min and not have done any charting, and I have a laptop but this is time consuming and if the patient and family need teaching, I can't type and teach at the same time, sorry can't concentrate. So.....then I get home and chart on this patient and probably spend 20 more minutes charting, that's IF it's an uncomplicated case. An admission usually takes me an hour if uncomplicated, and then 1 hour doing the OASIS paperwork in the laptop, and then another 10 minutes or so filling out all forms to turn in at office, all for 65.00. And now, the patient's are coming home sicker and sicker. Saturday I admitted a patient with 2 wounds on wound vac system, another wound to sacrum and a picc line with bid iv antibiotics. That admit took me an hour and 10 minutes in the home + over hour doing all of oasis, 3-10 minute phone calls about when iv due and how long to run,wound care report, etc, and then filling out forms at office. Geesh, that one was soooo complicated. And to start off with, the hospital was originally supposed to send home friday night for me to admit at 7:00 am with IV antibiotic due and no one even left me a message to let me know? And then there was the write in patient with directions to the home but no soc date or telephone # to call. She was new, so there was no MR #, so.....I spent 20 minutes at office searching for info on this patient due to fact that we are told we must call first. Well, give me a number please!

In answer to the questions, QCC is the Quality Care Coordinator, I think, anyway these are the nurses who screen our oasis and do all the coding, they have to call us and discuss every Recert, Admit, and Post hospital oasis that we do. CM is the Clinical Manager. They don't work on the week-end when I have a question, and yes we have an on call nurse, she can answer some questions, but again, since I am so new, many times I didn't even realize there was a question about a problem, because I don't realize it's a problem, does that make sense? Our office has over 400 patients. Is that a lot? They make us do all the test runs for any new software, Point of Care, and now Frequency Based Scheduling, try doing new stuff AND seeing 10+ patients in a day, and driving over 60-80 miles in a day. I AM EXHAUSTED. Sorry this is soooo long but I have NO ONE to talk to and I am about to pull my hair out. :bugeyes:

caliotter3 · Apr 22, 2009

The posts above about visits are exactly why I do shift work. I am in the home for eight or 12 hours, do my nursing care, do my charting; then I leave. I don't do extra work at my home that I am not compensated for. Any necessary phone calls are made from the home while I am on shift. My pay pretty much reflects the in home shift time that I put into the case, that's all. I get all my work done while I am on the clock.

YogaloverRN · Apr 22, 2009

I agree, shift work is much better, but they didn't even offer me the choice. And down south, the home health care agencies are few, and with small towns, the DOO all seem to know each other here too. I am really beginning to dislike working as a nurse, I love nursing, just hate working for others. :madface: I don't feel like I am appreciated by the staff, and now, a lot of the families and patients are rude, thats not even taking into consideration for the nasty working conditions.

caliotter3 · Apr 22, 2009

Based upon my present location, I would not do home health if I weren't given the option of shift work. I have already trashed one car because of home health, and refuse to put myself through what others describe so well. I have done uncompensated work before, and refuse to do it on a daily basis. I also will not drive from one address to another in the traffic and go to the neighborhoods that are around here. When there is no longer shift work for me, then I guess that is the end of it.

roxyo · Apr 22, 2009

I normally don't post on forums, I usually just read and learn but today I felt like I needed someone who "has been there" to listen. Then I come here, and read other posts that sound just like me. We work, work, work from 8-5, then come home, work more...STOP!!! dinner must be prepared! so I pull out a Sam's frozen dinner, pop it in the microwave for 15 minutes and yell "Dinner is ready" I grab my plate and go back to hiding in my room to continue charting, of course I'm stepping all over dirty laundry on my way to my room, because guess what??? No time for that either!!! Went away for Easter weekend and, of course, my charts and laptop went with me... Why am I doing this to myself??? Because, like others I am afraid I won't be able to find another job... even more afraid that the next one will be worse... This is the second HHA I worked for in the past 10 months and, also like others, considering going back to the hospital where you can leave your work behind you at the end of the shift...

Thanks for letting me vent!

muffin7 · Apr 22, 2009

roxyo,

I am starting per diem at a HH agency this Mon. I left the OR after 2.5yrs and will continue to look for OR, but the job market is so bad. I have excellent experience in the OR (Level I trauma), but it is difficult to get a job.

Why did you leave your first HH job? Don't quit until you have something really solid in a hospital. I'm not familiar with the paperwork, but it seems to take a lot of peoples time. Are you knew to it, or is it just a lot.

nurseby07 · Apr 22, 2009

I think that if you work for a bad company and couple that with really bad management, you get a job like the ones listed in some of the above posts.

Their jobs and mine are like night and day. It's 2pm, I just got home and have about two hours of calls and charting to do. Then I'm done. Night and day differences.

muffin7 · Apr 22, 2009

nurseby07

Do you have any advice for me just starting out in HH.

Do you get paid by the visit or the hour? Your hours sound perfect. Do you think that they are taking too many visits or what is the difference.

roxyo · Apr 23, 2009

muffin7,

The first company I left, because they were doing things that seemed "fishy" to me. At least 80% of the census were patients that had been on service for years. One episode would be billed for DM as main dx, next episode for HTN, third episode back to DM, fourth on HTN, fifth... you get the point. I was taught that only the last 2 episodes are kept in the chart and that if audited, those 2 episodes were the only ones the state would see. On top of that, many patients were not homebound, they were driving on a daily basis and management knew it well. The last thing that did it for me was when our manager asked a nurse to make up a recert OASIS because the recert window had been missed, it was billed as a "recert visit". I ran out of there fast!!!

I still have much to learn about HH, but common sense told me that was fraud. I do not want to mess with the feds in order to keep my manager happy.

The company I currently work with does not have any of those issues, the problem we have is that they keep accepting referrals even though we don't have the staff to care for the patients and even accept patients as far as 2 hour away drive!!! How in the world are we supposed to provide adequate care to pts who live so far away??? As a result nurses seem to only have time for a quick assessment and then on to the next patient... at the end of the day, you try to put everything together but often don't have time to finish and you start falling behind. You fall behind one, two, three days, then a week, then 2 weeks, then a month!!! You ask management for office time and you are told we can't right now, next week we'll try... Next week comes along and then the same story. Oh, this is where it gets interesting because at this point you have fallen so far behind the billing department is on your tail asking you to finish this and the other so they can get paid, LVNs are out there working without orders because the RNs have not been able to finish the 485s.

Like someone else mentioned earlier in the thread, when you finally burn out and have a mental break down is there anyone there for you??? NO!!! In fact, when I called in sick my phone kept ringing all day... You then realize you don't matter as nurse to them, much less as a person... Morale is way down around here guys... Can you tell? ;-)

nurseby07 · Apr 23, 2009

muffin7,
The first company I left, because they were doing things that seemed "fishy" to me. At least 80% of the census were patients that had been on service for years. One episode would be billed for DM as main dx, next episode for HTN, third episode back to DM, fourth on HTN, fifth... you get the point. I was taught that only the last 2 episodes are kept in the chart and that if audited, those 2 episodes were the only ones the state would see. On top of that, many patients were not homebound, they were driving on a daily basis and management knew it well. The last thing that did it for me was when our manager asked a nurse to make up a recert OASIS because the recert window had been missed, it was billed as a "recert visit". I ran out of there fast!!!
I still have much to learn about HH, but common sense told me that was fraud. I do not want to mess with the feds in order to keep my manager happy.
The company I currently work with does not have any of those issues, the problem we have is that they keep accepting referrals even though we don't have the staff to care for the patients and even accept patients as far as 2 hour away drive!!! How in the world are we supposed to provide adequate care to pts who live so far away??? As a result nurses seem to only have time for a quick assessment and then on to the next patient... at the end of the day, you try to put everything together but often don't have time to finish and you start falling behind. You fall behind one, two, three days, then a week, then 2 weeks, then a month!!! You ask management for office time and you are told we can't right now, next week we'll try... Next week comes along and then the same story. Oh, this is where it gets interesting because at this point you have fallen so far behind the billing department is on your tail asking you to finish this and the other so they can get paid, LVNs are out there working without orders because the RNs have not been able to finish the 485s.
Like someone else mentioned earlier in the thread, when you finally burn out and have a mental break down is there anyone there for you??? NO!!! In fact, when I called in sick my phone kept ringing all day... You then realize you don't matter as nurse to them, much less as a person... Morale is way down around here guys... Can you tell? ;-)

YUCK! Does anyone else have any "good" stories? This is just ridiculous and sounds just like Amedisys to me. I had a case load of 30-40 and an LPN. I had no idea who needed what or what was going on. God shined down and I got this job and I can't fathom the difference. The schedulers know their stuff! I know my patients! Things do go wrong, but not often.

Maybe it's because it's a big hospital system?