Struggling with home health ...

[SaraTayRN]

I am struggling with my new job in skilled home health nursing. My background is critical care (burn unit) and catastrophic home care as a bedside nurse and as a clinical supervisor. I have been at my new job in home health for only a few weeks and I love it. I honestly cannot imagine doing anything else and I am determined to stick with it and really give it a chance.

I am struggling though. The most stressful aspect of the job is that I feel I am not making any money. Today for example I was scheduled three RVs and a SOC. My second RV was not home when I showed, despite calling her ahead of time. My third RV was not home when I called to bump her time, so I sat in my car for over two hours. I did use my time wisely, but charting on an iPad in a car is not ideal. It felt like a huge waste of my time since I chart faster on my computer. Anyways, I finally get to do my third RV and call my SOC to let them know I am on my way. They are meeting with their lawyer and cannot see me, even though I had set the appointment in the morning. My cases are spread far apart and by the time the day was over I had worked almost six hours and only made $110. By the time I pay taxes, the gas to and from start and stop, and my babysitter I will be lucky to break even on the day. I honestly am worried that I cannot afford this job. I was offered another home care position that was salary and I am starting to wonder if I made the wrong decision selecting the PPV position. I feel like I will never be able to make a living. I am up to nine patients, but my check sure doesn't look like it ....

The other aspect that is difficult is the time spent charting and making phone calls. I truly believe I have already made great strides in this though and I do anticipate it will get better. I just do not know if I can afford to dedicate time to a job that is giving me such financial worries. What if the pay never gets better and the charting time only slightly improves? Is PPV, especially one with a large coverage area, just a rip off? Would salary have been better?

[caliotter3]

I found that I had to leave the visit nursing to others when I could not keep gas in my car to make only one visit so far away. I thought I was being helpful, but it turned on me. I stick with extended care. I know that I will get X pay for an X hour shift and that is fine with me.

[Libby1987]

The fact that without prior home health experience you are on your own in the field doing SOC visits at PPV just a few weeks in is a red flag.

At my company you would have a dedicated preceptor for another 9 weeks and would be paid by the hour with a reasonable productivity expectation at the end of your orientation period.

The year long learning curve is challenging enough, what you're doing is unreasonable.

[Kaisu]

The fact that without prior home health experience you are on your own in the field doing SOC visits at PPV just a few weeks in is a red flag.

At my company you would have a dedicated preceptor for another 9 weeks and would be paid by the hour with a reasonable productivity expectation at the end of your orientation period.

The year long learning curve is challenging enough, what you're doing is unreasonable.

THIS..

My agency starts every one on an hourly basis and the rate is better than I was paid on Med/Surg. I've been working for two months and I would make more on a PPV but I'm happy with my pay and loving not feeling pressured to complete X number of visits. I like taking all the time I want with my patients and my productivity numbers make everybody happy.

Find a better agency.

[pedsnurseIJAG]

I recognize everything you said. I worked PPV for about 15 mos. I was also a new nurse and was trying to work faster and to become more efficient, but that didn't work out very well. The many phone calls, the charting, the driving, the patients who weren't home make it hard to make a decent living and working decent hours. I barely had time for myself. The incessant begs from my supervisors to take more patients and to drive further made it very stressful at times. But I did love the work most of the time. I liked working independently and helping my patients. I usually stayed too long because I wanted to give great patient care ...which made my work day even longer. So yes, there must be better ways to do this and better agencies to work for. Not sure how to find them.

[OldDude]

My wife, Sweet Petunia, is a HH Physical Therapist...pushing 20 years. She loves HH (I tried it and hated it). I've witnessed the HH salaries and benefits get whittled away, slice by slice, over the years until "someone" came up with PPV; the ultimate cheapskating ploy by HH employers. Her company was recently purchased by a national organization. Sweet Petunia is employed full time, with benefits (if that's what you call them) but her salary is based on PPV and "calculated" mileage versus actual mileage. She has an "hourly" rate but that is based only to calculate PTO. If she is at meetings or other non-visit activities she is paid an "administrative" hourly rate which is 2/3 of her hourly rate. She has worn out about 8 cars in the past 20 years...the last one we replaced had 124,000 miles on it in 2 years. One day last week she drove 248 miles and had 3 visits..."calculated" miles - 199, actual hours - 10.32. This isn't an isolated day for her. Plus the hours of documentation. She is "required" to see 6.1 patients per day, regardless of mileage. She has been informed "that's the way it is" for her productivity requirement and she'll "just have to figure it out." Yesterday she figured it out..."I quit," tendered her two week notice.

So, all this to say, be careful when accepting PPV jobs. PPV employees get taken advantage of, you take all the risk, your employer takes none. You don't cost them anything if your not making the donuts. Best of luck to you.