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Discussion

Switching agencies

So, I have been at the agency I am at for about 2 months. When I came in, two clinical supervisors had quit that had been in the office. They had just hired 2 more. One of them has never done home health and has not done patient care for at least 9 years.. The other, I guess she did home health but has no idea how to answer most questions... So, I have been doing case management on my 30+ cases and keeping up with their problems, doing visits, Recert's, Resumptions, start of cares, LPN sup & HHA sup visits... and so on... So, I am new to the home health gig and had no experience really doing the OASIS paperwork. It really isn't that hard to me but I asked from day 1 if somebody could just spend a little time with me to do the paperwork after I started going out on my own. So, here is what happened. Day 1 I went over policies, Day 2 listened to some crazy woman at the office talk about her husband, sex life, etc. Days 3 & 4 went out with a nurse in the field. Then Went out on my own... After about 3 weeks, I asked if somebody could go over my paperwork (SOC) and went in one day but nobody would/could help... Then, I have asked a few more times.. I have just been getting so frustrated... The LPN I work with wants all the visits in her area but won't go to another city in our area.. So, there are days I am just going all over to help my patients... Can't ask her to do anything cuz I am the RN and she is an LPN and there is an issue... Cuz she has more experience than me.. And, she has an issue with lots of things... And, she missed a huge wound on a woman's foot months back (before I even started) and I had to baby the lady until she went to a hospital for 6 weeks of antibiotics... I worry about giving her people with wounds cuz I fear that she doesn't follow my plans of care. For instance, I have a woman with chronic venous insufficiency that I have been seeing for a while. I asked her to go and see her last week one day.. I have been cleaning the wound on her bottom of her leg with soap & water and putting silvadene on it and leaving it open to air. I called the woman Friday to see how she was and she said the other nurse was there Wednesday. But, she said that she put a bandage over her wound. I specifically told the LPN a week before that I have been putting silvadene on and leaving it open as that was healing it. It has been looking very good. So, it makes me worry... Just many things..> Nobody to go to... Also, the home health aide that works with me always does communication addendums stating the patients refuse for her to come out... So, basically, I can't get anybody to do anything and nobody backs me up... Any advice???

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    • Experts

    I think you should already know what the advice will be. Once you have a new situation in hand, give two weeks notice, unless, you want to keep your foot in the door, so to speak, because there are limited opportunities. Then perhaps you should cut back to part time until you have enough time with one or two other agencies, so that you can break free without worrying about being able to dredge up 40 hours a week somewhere else. But as far as being able to get cooperation from anyone at this present agency, don't hold your breath. The people in this agency did not get that way over night, and the agency did not develop its problems overnight. I doubt you will be able to turn the entire agency around overnight by yourself. Good luck getting work elsewhere.

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    • Author

    The other agency says I cannot work at both?

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    • Experts

    People work for multiple agencies all the time. That is how they stay employed. Primarily talking about extended care though. Intermittent visits are harder to keep on top of more than one employer. Usually one employer will keep you busy enough for the entire week. I do extended care and am presently signed up with six employers but only one is giving me any kind of work. Two or three agencies can usually keep you busy except for times like these.

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    • Author

    But, home health agencies??

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    • Experts

    Yes, home health agencies.

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    What Caliotter is referring to is extended care, places like Interim who do shift work with stable patients, primarily paid by Medicaid or waiver programs. Not the same gig as Medicare home health.

    Many agencies have a no-compete clause in their full-time contracts stating that you agree not to work PRN for another agency. This prevents loss of their supplies, etc., if don't keep track of which belongs to which agency or have a tendency to "borrow" from one agency's stash to help a patient from the other agency. However, it's been my experience that many nurses continue to work on a PRN basis for another agency or two, especially is they are on a pay-per-visit scale at their full-time job.

    My advice to you, based on your situation, is to begin looking immediately (if not sooner) for another home care agency for a full-time position. Try to find a place that will give you the orientation you need to be successful. You can then change your status to PRN for the current agency or give your notice altogether. I have only ever given notice to one home health agency, all the rest I have stayed on PRN basis, just in case.

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    • Author

    Hmmm... Well, the agency I interviewed at specifically told me that I would not be able to work at both. Initially, I had wanted to do both. Then, I could make sure I had enough work... But, I did decide today that the current agency is going to work with me and I will do that... I am trying to keep my foot in the door at the other agency and we will see what happens. I will just go PRN where I am if this doesn't work out. I just kind of feel like I do need to give it more time. Just not ready to learn a whole new place again, especially since I am new to home health??

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    Sounds like some very serious issues at the current agency... very risky for your license...

    I'd check out Gentiva, if you have an office in your area. The training for someone relatively new to home care is far superior to all other agencies I've worked for. Don't give up on home health, find a successful agency that will invest the time in teaching you to do it the best way. Good luck!

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    • Author

    Well, I am probably going to stay with the feeling I had a few weeks ago. I guess I just thought I really didn't want to start all over again... I do enjoy the job most of the time, just do feel short changed most of the time.

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    I can certainly understand feeling like that! Best of luck, and don't forget that homecare can be a wonderful and rewarding career field. Reach out to your homecare peers for support if you need it. You are making a difference in people's lives! Good luck.

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    • Author

    Then today I had a conversation with the LPN I work with and she said that we have to go out to do a wound dressing change daily on a patient because the family REFUSES to do the dressing. This patient also doesn't go to dr appts (missed last week appt with wound doctor)... also didn't have Cipro filled since 2 weeks ago... she says we cannot discharge and she sees him so what do I do? I have to dc but she sees the patient...

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