Very unexpected job opportunity - need feedback please

[CFitzRN]

I apologize if this is the wrong place to post this - I know they will move it if it is inappropriate here. I just need some feedback on a very unexpected job opportunity that fell into my lap a few days ago.

Background - I graduated with ADN April '08. Started on L&D, 6 weeks' orientation on days, then went to nights (I was hired for nights). Crashed and burned after realizing I could not sleep during the day no matter what I did or how exhausted I was. Forced to leave my dream job. Started working PRN in an Endo unit at a GI practice, post-anesthesia/recovery nurse, still doing that. Also picked up PRN jobs at 2 family practices. As other PRNs know, it is feast or famine. The zero benes work out okay as I am on my husband's through his job. I enjoy doing all jobs, though the fam practices pay little (one pays 16/hr, one 14 - not much). The Endo pays $20.

Saw an acquaintance Thurs night - she is the executive director of a home health agency here in town. It is a nationally owned franchise. She mentioned that she was in serious need of an RN supervisor to do "sup visits" 16 to 20 hours a week and couldn't find anyone because everyone she interviewed wanted full-time. I do NOT want full-time as I need some flexibility for kids appts, etc.

The job pays $23 an hour (more than I made bedside in L&D and obviously more than the other jobs). No benes. The hours are totally flexible - I can work when I want, no weekends or holidays - so long as I get my sup visits in and get the paperwork in. I can work 2 8-hr days a week or any combination of hours/days I choose to, so long as it is 16-20 hours (I can choose how many). The job would entail visiting pt homes and "overseeing" the CNA or Nurse, checking the plan of care and determining if it is being followed, having the CNA or Nurse do one demonstration of care for me (accu check, in & out cath, G-tube feed, etc), speaking with the client about whether they feel they are getting appropriate care, then moving on to the next home. I would have up to 10 pts to visit in one day but the visits average 15-20 mins each. Then back to the office to enter the documentation into a computer, file paperwork, etc. Oh, and .45 cents per mile reimbursement. She kept calling it a "cream puff" job. Does anyone have actual experience with this kind of job? I would do patient visits one of the 2 days, then paperwork in the office the other day. For the 3rd day (half-day) I could visit any pts I didn't get to see the 1st day or finish paperwork.

It would entail very little (almost no) hands-on nursing work or skills. I could (and would) choose to participate in all their in-service training sessions for vent/trach, wound care, G tube, PICC flush, etc. Though I wouldn't be actually using these skills very often if ever. I learned early on that bedside nursing isn't my ultimate goal, so I feel that this could be a great opportunity to learn case management, which I'd like to do full-time eventually, once the kids are older. Am I skipping a necessary step here in not working med-surg first? Or would this be a good move seeing as case management is what I plan to do anyway? Have I mentioned I hate the hospital and would rather never work in one again?

I guess I'd just like to hear what other nurses' thoughts are about something like this, and also, I would love to hear from home health nurses who have experience either doing this, or dealing with RN supervisors in the home health setting.

Thanks so much in advance.

C Fitz

ETA that I love being out "in the field" and enjoy driving a lot, especially when it is only 1 day or 1 and a half days a week.

[CFitzRN, ADN]

OhioRN, thank you so much for your input. And thanks for the link. I know I will have a good amount of responsibility and I'm okay with that. I know it's not going to be a walk in the park with a huge payout of money, but I do think it will be something that will get me a step closer to my ultimate goal.

That poor woman in the story. ARGH. She's spending a ton of her time just commuting. Luckily I don't have to commute at all - okay, 10 mins to 2 of the places I'll work, 15 to the other. But of course I'll be driving all day for one day a week starting soon - maybe one and a half days. It will probably get old soon, but I figure I can do it for a year. That will help my friend and will give me some good experience.

[erroridiot]

10 visits per day! These visits will have to be very close to each other to accomplish that many visits in one day.

You may want to find out the geographic area you are expected to cover in one day.

[DirtyBlackSocks]

Dirty

You aren't a nurse? That is bad but at least you have a job. I worked a couple of shifts as a caregiver for $12 an hour and was happy to get it. But when they cut my pay rate for LVN work, I get angry. I did not spend all that time and money on an education to work for the same wages someone coming out of high school can make. My daughter gets more money than I do and does not have a college diploma. With her shift differentials, she is doing fairly well.

Nope.

I was a Medic in the Army - which is very close to the same work RN's do in the civilian field, but not with the same level of knowledge.

I'm a nursing student right now. I don't work - and support my family on even less than $12 an hour right now because of it. :)

I know Paramedics out here who make less than $12 an hour - which is ridiculous. EMT-B's get minimum wage.

I agree that wages should be higher in the medical field, considering how stressful the work is and the level of education that goes into something like an RN License. But I don't think turning down work out of being stubborn is a good idea either!

[ghillbert, MSN, NP]

How are you going to supervise RNs doing all these things, if you haven't worked more than 6 weeks in a hospital yourself? Just curious as to how one "supervises" and assesses others without acute care experience themself...?

[caliotter3]

Nope.

I was a Medic in the Army - which is very close to the same work RN's do in the civilian field, but not with the same level of knowledge.

I'm a nursing student right now. I don't work - and support my family on even less than $12 an hour right now because of it. :)

I know Paramedics out here who make less than $12 an hour - which is ridiculous. EMT-B's get minimum wage.

I agree that wages should be higher in the medical field, considering how stressful the work is and the level of education that goes into something like an RN License. But I don't think turning down work out of being stubborn is a good idea either!

For years I have noticed that EMTs of all levels get paid low wages compared to nursing and have never been able to comprehend it. I was once certified as an EMT but would not go that route today partly because I think the profession is worth more pay than anyone seems to be willing to pay them.

[CFitzRN, ADN]

How are you going to supervise RNs doing all these things, if you haven't worked more than 6 weeks in a hospital yourself? Just curious as to how one "supervises" and assesses others without acute care experience themself...?

That's a fair question, and one that I asked the exec director. Her response to me was that these nurses or CNAs are all trained to do this work, and the most important thing I can do is to make sure they are doing it. I can't possibly supervise every nursing skill in the 15 mins I am at the site, so I have to get family/patient input as a first-line of communication. I did explain that if the CNAs and nurses are going to be demonstrating one skill each when I go to visit, I need to be trained on that skill before I supervise it. I have done straight caths and wound care and g-tube feedings before, I'm just not what one would call 'proficient' as I have not done them on a regular basis. I know proper procedure though, and sterile field if one is req'd and I would know if it were not being performed correctly. If I were actually doing direct pt care, I would need much more training on each skill. That may sound backward but it's what the director explained to me. She explained that she needed an RN supervisor with impeccable communication skills and documentation skills more than anything. I have those.

[caliotter3]

Don't get hung up on observing the skill for each visit. Start out with things that you know about. And yes, I have seen where the nurse supervisor documented that she checked "handwashing", and for that matter the same skill almost every time. It is just important that you do it. A good one for general purpose checking is "documentation". You can check a lot of different aspects of documentation, to include just verifying that they get the family member signature on the time card! And it does not even have to be done as a formal check, just have them demonstrate or verbalize something to you and you will be able to tell if they are on mark. It will all come with time.

[HouTx, BSN, MSN, EdD]

Home Care is a nursing specialty - very different from acute care or other settings. There are two main areas of increased professional & personal liability exposure that aren't found in other environments.

First of all, there is a question of clinical liability. I don't understand how the OP could adequately supervise anyone without first being competent in this field. With minimal background & only L&D experience, there's a very high likelihood of failure to recognize important aspects of patient care - leading to unsafe patient care & personal/professional liability. I would certainly not recommend that the OP accept this job without adequate training prior to taking on any independent accountability.

Being caught up in operational liability is a big concern also. Home Care is currently under intense scrutiny by the Feds - because there has been so much fraud in the past. The OP should note that anyone involved in documentation of 'supervision' without fulfilling ALL Federally mandated requirements is automatically considered a participant in Fraud if CMS audits reveal that there are any problems with the company. This results in the nurse being individually sanctioned by the Feds... and unable to get a job with any organization that receives CMS reimbursement. That can pretty much put the kibosh on a nursing career.

[CFitzRN, ADN]

Don't get hung up on observing the skill for each visit. Start out with things that you know about. And yes, I have seen where the nurse supervisor documented that she checked "handwashing", and for that matter the same skill almost every time. It is just important that you do it. A good one for general purpose checking is "documentation". You can check a lot of different aspects of documentation, to include just verifying that they get the family member signature on the time card! And it does not even have to be done as a formal check, just have them demonstrate or verbalize something to you and you will be able to tell if they are on mark. It will all come with time.

Good advice - I really appreciate the feedback.

[CFitzRN, ADN]

Tex - thank you - this stuff is good to know. I spoke fairly extensively with the ED and she told me about fraud cases that they are actively watching. Apparently there is one case that she has been personally supervising and has reported this person and the family for whom she works to the social worker on the case and he is supposed to follow up with them. She told me that is the extent of her liability in the case, so long as she has documented her suspicions and brought them to the attention of the social worker involved. She told me that if there are ever incidents where I suspect fraudulent activity, she will personally take over that supervisory responsibility.

[sunrock]

I am fussing over 27.00 in the '

BURBS', the nyc is 36.00, full time is 78,000.00 plus diff. if you can find it.