To return to home health or to stay put in hospital??

caliotter3 · Apr 22, 2010

There are companies, (or offices of companies), that will treat you better. You might have to look for them. A lot of this depends upon how much competition for workers is in an area. If you have only two hh agencies to choose from, it will be rougher to negotiate your treatment versus having a myriad of agencies available, such as in the metro LA area.

nursester · Apr 25, 2010

Stay at the hospital Home care is not what it use to be...I Get paid per visit and I do sooooo much work on my own time....

JenRN22 · Apr 26, 2010

Thanks for the responses!! There are a lot of home health agencies in my area...The one that I was previously employed with was a big name company which with that being said, I assumed that it would be better benefits and plenty of patients in my "region". I was definately wrong!!

tewdles, RN · Apr 26, 2010

I completely agree that you have to do your homework. In my experience, too many home health agencies are smitten with the money they can make and forget that they also have an obligation to their professional staff for reasonable employment.

I think that the time is coming when HH nurses are going to HAVE to stand up and refuse to work unpaid from home on documentation. IMHO it is illegal and immoral for employers to expect this from hourly professionals.

ProBeeRN, BSN, RN · Apr 26, 2010

I am full time, but our per diem staff has many of the same complaints-- they only get paid per visit, so there's a lot of paperwork left over at the end of the day. They aren't supposed to get any discharges or recerts, but sometimes they try to sneak em past. I'm paid hourly, so I get paid for paperwork time. We are also very strongly unionized at my agency and are very proactive about speaking out in regards to workload before it becomes a huge problem. If you want the per diem flexibility then you have to be very firm on what you will and will not do on your own time, even if it means finding a different agency.

KateRN1 · Apr 27, 2010

Okay, here I am going to be the voice of some dissent. If you are paid on a per-visit basis, the documentation is part of your visit. If you choose to leave the patient's home before your documentation is completed and save it to do at your own home, then you have nothing to complain about. (The exception to this is SOC and sometimes ROC, those are nearly impossible to do in a sitting.)

However, if you are being asked to do non-visit paperwork or additional case management duties that are not captured in a per-visit rate or an hourly billing rate for "other duties," then you do have something to complain about and should expect to be compensated for that time.

berube · Apr 27, 2010

i agree that if you are paid per visit (as i am) the documentation time is "built into" the visit rate,,,,BUT if you have 9 or 10 visits a day, which happens alot where i am as we have no help then my priority is seeing the patients so that i am not out doing visits at 7 or 8 at night, so i spend a few hrs at home doing paperwork,,,seems it is just the nature of the beast....all i really say is , don't go into HH thinking it is "easier" than the hospital of LTC, as it has its own difficulties and burnout.

KateRN1 · Apr 27, 2010

I agree with the burnout. Don't go into any nursing field thinking it's going to be easy. Home health certainly does have its own stressors. As bad as the hospital is, at least you leave your patients at work. In home health, they tend to "follow" you home, at least by phone.

jnette, ASN, EMT-I · Apr 28, 2010

Okay, here I am going to be the voice of some dissent. If you are paid on a per-visit basis, the documentation is part of your visit. If you choose to leave the patient's home before your documentation is completed and save it to do at your own home, then you have nothing to complain about. (The exception to this is SOC and sometimes ROC, those are nearly impossible to do in a sitting.)
However, if you are being asked to do non-visit paperwork or additional case management duties that are not captured in a per-visit rate or an hourly billing rate for "other duties," then you do have something to complain about and should expect to be compensated for that time.

Agree with you on the above, KateRN1 :)

As a matter of fact, our agency recently made this a new requirement... except for SOCs and ROCs, all notes must be completed in the home. The thinking behind this is the fact that the patients are signing off on what you write. Although 99.9% of them will never actually ready your notes, it shows that the notes were complete before asking them to sign off on them. You're not asking them to sign something that's incomplete.

And it really doesn't take much longer... I let them chat while I write away.... nodding my head, looking up and smiling occasionally.. and keep writing. Takes about ten minutes. And it's done while things are still fresh in memory, too! The when you get home.. no more stack of notes yet to be written! :yeah:

tewdles, RN · Apr 29, 2010

Charting in the home is the best practice for both HH and Hospice nurses...however it is NOT always possible.

For instance...I care for a sweet little ol' man who lives by himself...he is deaf and does not read lips. My entire visit is written in a notebook...every word I say to him, every question I ask, every aspect of my visit which is spoken is in that notebook.

Given that he is old and alone, he is covetous of my time when I am in the home...I simply cannot chart there. I spend 45-60 min with him receiving my full attention, then I drive down the street to the McDs and chart in their parking lot.

Another case is a home with a mildly demented mother and 2 adult children with learning disabilities and mental illness...I cannot chart in that home, the process causes the dtr to feel suspicious and agitated (learned the hard way).

There are times when I am called to a home for a prn visit, spend the entire visit actively engaged in treatment and teaching and then get on the road as quickly as possible because another family is expecting me 15 min ago...but those are the outliers that come with the job.

My biggest beef is that some employers have are unrealistic about the time they "allot" for completion of a document in the home...they then proceed to waaay over schedule the nurse who cannot possibly begin to complete the travel, the visits, and the documentation all within an 8 hour shift. The completion of the work then becomes her expense on her time...not cool. There are too many HH who expect that the RN will spend no more than 30 minutes in the home providing nursing care and teaching, some even expect that 30 minutes should cover the documentation time as well...give me a break!

KateRN1 · Apr 29, 2010

Tewdles, I absolutely agree with you about the amount of time alloted for visits. In my head, the allotted visit time has always been 1 hour, to include the assessment, teaching, and documentation.

Just a question, though--when you have those oddballs with whom you can't complete the actual charting in the home, do you "clock out" when you leave the home or when you complete the documentation around the corner at the McD's parking lot? I've also had visits like that, where I couldn't complete the documenation for whatever reason, but I didn't "clock out" until, like you, I completed it somewhere else close by.