Staffing

[Jeanne Marie]

I am struggling with how my agency staffs. I have worked there for almost eight years and have seen alot of changes. For a long time, when a new admission referal came in, the intake nurse would just call around to any of the nurses who might do it based on location, case load, specialty etc. This eventually became a problem as we became a bigger and busier agency. Each nurse has been able to make there own schedule. They schedule the patients they case manage to be seen by themselves or if needed another nurse. So, as admissions come in a nurse could say they were not available. We basically just had to make sure we got 40 hrs/wk in and now we do a min. of 28 visits a week. We have tried to implement having each of us take certian days as our admit days. Now if we want to take a day off it is hard to get another nurse to cover for you if it is your admit day. Also, my biggest frustration is that even when I am off, if anything comes up concerning a patient that I case manage, I am expected to deal with it even if it is my day off (short of having to make a visit) I have loved the flexability and working independently in Home health, but the feeling of never getting away from it is getting old! Any suggestions?

[Aridaveli]

I feel your frustration. I am a nursing manager for a homecare agency and have to schedule the staffing (as well as carry a caseload). Does your agency employ perdiem staff to work on the "busy" days? How about hiring a nurse just to do admissions? This may be tricky if you are doing Oasis since it is so lengthy and most nurses cringe at the thought of an admission.Your time off should be exactly that or they will find you walking!

[Ellen]

On my days off I am just not available. I let my answering machine take all calls and it won't be long before your office will figure it out, too! I even had a Supervisor call me in the hospital when I was being treated for kidney stones!!! It's the Nurses that always wear their beepers (24 hours a day) and go to the office on their day off that cause these misconceptions that we ALL want to work that way.

My hours are 8 to 5 and that is all I am available for. Now that is not to say I don't work over, but it is my choice.

Taking our work home is one of the major drawbacks in home health and some just are not cut out for it! It is especially difficult with small children at home.

I just got back from a weekend trip..3 phone messages from work...Oh, well I guess it will have to wait until tomorrow...

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[herik]

I work for a fairly large agency in the outside of Philadelphia. The full time nurses are case managers and have a geographic territory. If a new pt for that area the nurse does it, if she already has an admission, it is assigned to another nurse. We also employ perdiem and parttime nurses who do not case manage. We do have a scheduler that assist with the process. If we have an admission and too many patients we choose who we give to the perdiem or parttime nurse. We routinely see 30-35 pt per week. 7/day without an admission and 6 if we are doing an admission. Weekends are bad though we can do 7-9 per day and may have 2 admissions. Of course though we do get paid the OT. We also are computerized and do all of our documentation on laptop including the oasis which is incooperated in the laptop charting. We are a very busy agency and get many admissions. The oasis though is sure a pain when you only get 2 visit from an HMO and then have to do the d/c oasis.

[rn2468]

Jeanne,

Been there, done that, etc....

Scheduling was one reason I left home care..pay was the other. If you were full time they would "own" you. I felt like I was living to work and not working to live, if that makes sense. They would say we had a "quota" but if you completed that "quota" of visits and your weekly hours "added" up to like 32 or 33 hrs per week, they griped and tried to pile more visits on each day. Sometimes we would have a "light day" and be done by 1-2pm and we would hear re: it big time..they wanted us doing visits right up til 5 pm. The full time people were sent from one end of the city to the other in a day's time while the per visit nurses were allowed to pick and choose pts within like a 3 mile radius of their own home. I tried til I was blue in the face to explain if they let their full time people stay within such a radius, they would get more visits out of us..let the per diem people do the driving. Instead, they had the full time people doing all the miles..we spent more time DRIVING then seeing pts which means they were paying us to DRIVE instead be with the pts. All of this was met with blank looks and "oh, but we can't MAKE the per visit nurses do that". So, instead, they wore the full timers to the ground and burnt us out. Many left...MANY left. And looking back, I did all of it while living paycheck to paycheck, doing paperwork til 10 pm, sitting in traffic for 2-3 hours/day, being told everything was being done "wrong" by management , and "oh, we have to cut your pay again". You get the picture.

I will never, ever work full time home care again. I feel for you nurses who are strong enough to stick it out...

[theleader]

A year ago I employed 7 full time nurses in my HHA. Now due to the cutbacks and lower reimbursement, I am the only fulltime nurse. I am responsible for all the admissions as well as scheduling for the 2 parttime LPN's that I employ. And you are right I cringe at the thought of an admission because I do most of the SNV also. Home Health is becoming a high stress job and it shouldn't be.