Visiting Nurse Service of New York

desta · Jan 4, 2009

hi sammi, i've been at VNS in manhattan for 4 years - just got our updated rates for this year - i'm not sure the exact starting salary - but, it should be upper 60s, with the educational & experiential differential should be 70K +/-. hope that helps....

Sammi15 · Feb 8, 2009

hi sammi, i've been at VNS in manhattan for 4 years - just got our updated rates for this year - i'm not sure the exact starting salary - but, it should be upper 60s, with the educational & experiential differential should be 70K +/-. hope that helps....

Thank you desta for your reply!

I'm seriously considering trying out home care nursing after 9 months (med-surg) in the hospital. The stress of bedside nursing is killing me. I would like to try per diem first and see how I like it. If you don't mind me asking, how many patients do you usually see per day? Do you have a lot of paperwork afterward? And how do you like working for VNSNY? I hear they're one of the best company to work for!

Thank you in advance!

desta · Feb 10, 2009

hi sammi...

so, i have just left vns, about a month ago, and am starting a new job. but my info should still be pretty current!!

i would say the average caseload is 5-7 patients/daily. i have heard of nurses being pushed to see up to 8-10, but that was never my experience. the paperwork is all done on a laptop computer that you carry with you. once you learn your way around the computer system, it's pretty straightforward to do a note. the length of time varies according to how much you do during the visit. avg time - maybe 20-30 mins? longer when you're new, but you'll definitely get faster!!

i had a great experience at vns b/c i had a really good manager and a good team. we had a lot of great teamwork, support, and i really respected my manager and colleagues. i think people's experiences vary a lot though. i've met people on other teams who were just as happy, and also have met people that weren't as happy. i'm sure you'd get a sense while interviewing of whether your new supervisor would be someone you'd want to have supervising you!! the patient population vns serves is very sick and very needy. i found that i had to play so many different roles - nurse, social worker, surrogate family member, case manager.... etc etc etc. when you are doing per diem work, you might be more in and out, with very specific goals (like wound care, an insulin prefill, etc) for each visit, but as a staff nurse/coordinator of care you are really involved with every aspect of your patients' lives.

the union and benefits are very good. pay is pretty good too, about equivalent to what i'm making in my new hospital position.

hope that helps... good luck w/ your transition, and let me know if i can give you any other info.

~desta

Bklyn_RN · Feb 10, 2009

Re Desta. It puzzles me why you would leave if things were so great. Also you did not elaborate on your reason for leaving. I have done homecare myself and found it very demanding. Recerts were a killer, also some housing projects were very dangerous even with an escort. And even with a laptop you still have other paperwork that can not be done on a laptop. I can go on but I do not want to scare novice nurses.

desta · Feb 12, 2009

bklyn - i agree w/ you that homecare isn't easy, by any means, and i didn't mean to give the impression that it was!! it's a distinct area of practice that requires specialized skills and knowledge, and is much less controlled than a clinical setting. you have so much responsibility because you are the only one there. and you are right that safety can be an issue when we are on our own out there. but... based on the original post, it sounds like sammi is planning to test the waters a bit before making the switch, so i think she would be going in w/ her eyes open. and i do think that, although it has its own pitfalls and stressors, homecare also offers some things like flexibility, an opportunity to interact with patients in a different and often meaningful way, and the chance to have a more autonomous practice than bedside nursing.

as for the paperwork - personally i didn't think recerts (assessments that have to be done every 9 weeks to reevaluate the patient's need for continued services) were much different from a regular visit note - i always documented a full assessment for every visit anyway, so it was just a few extra questions about functional status. but you are right, there are some other paper forms, which i wasn't really thinking about (admission forms, a few forms for medicare/medicaid, and for home health aide placement/continuation). it also depends on whether you are in longterm (much heavier paperwork load) or acute care... i'm not sure what the hospice or mch paperworkload is like. but in the hospital, you have to document everything too.... but... it's just a different workflow, and figuring out what works for you in terms of when/where you get it done. one other time burden that's coming to mind - in homecare, you also spend a lot of coordination time on the phone - calling doctors, social workers, the pharmacy, therapists, ordering supplies and placing services, or getting in touch with family members/caregivers who don't live with the patient. so that can add up too.

as for why i left - i did have a positive experience and felt i was treated well as an employee, but after 4 years i felt i'd learned what i could, and needed a new setting to expand my skills and get some fresh energy. i chose to leave not because it was unbearable, but because my learning curve had flattened out and there were other things i wanted to learn/experience in nursing. it was just time for a change, plain and simple.

i will say that the main thing that became a real negative for me over time was feeling isolated from other clinicians - although i loved the independence (the positive flip side!), part of my decision to move on was being ready for a change to an environment where i can learn from watching others practice and have more direct and immediate collaboration, rather than having the bulk of my contact with physicians and other nurses be by phone. but.. if someone is sick of the floor, maybe that person would also like a break from co-workers!!! it's just so much about the individual's personality and whether community/homecare agrees with her or not, as well as the timing - what's perfect at one time in your life/practice may not work at all at some other point.

sammi, one more thing - i don't know if you're aware but there is a new-grad program at vns through which you get extra support & guidance for the first year. i think they take nurses (with both associates and bachelors degrees) who have up to a year's hospital experience. that might be a possibility for you as well. http://www.vnsny.org/careers/positions-by-specialty/home-health-nursing-internships/

Bklyn_RN · Feb 12, 2009

Desta, you are right on! I can absolutely relate to your reasons for leaving. Its many of the same reasons I left medsurg.

I apologise if I made it appear that it was suspect the fact that you left. It was not my intention.

Your detailed and honest response was refreshing. :yeah:

BigBoy75 · Feb 17, 2009

I'm a new Grad and don't have any experience in Med Surge. I can't find a job in a Hospital. However I heard that VNS hire new grads. Do you think I'll be okay if I were to get a job there without any experience

nyforlove · Feb 20, 2009

Desta,

Thanks for your detailed and eloquent summary of life as a VNS RN. I would consider the career, but am concerned why it seems that almost ALL assignments are to relatively dangerous areas, housing projects, etc. Is VNS something that only the gov't pays for when needed by economically-poor patients???--why no mix of patients like in a hospital, e.g., private pay, public pay, self-pay? I care about my patients, but as RNs, we must protect ourselves first in order to help patients, and I can't justify entering drug- and gun-ridden neighborhoods daily--I'm not a police officer. Thanks again for your post. AllNurses.com is a great resource because of its committed members :) :yeah:

bklyn - i agree w/ you that homecare isn't easy, by any means, and i didn't mean to give the impression that it was!! it's a distinct area of practice that requires specialized skills and knowledge, and is much less controlled than a clinical setting. you have so much responsibility because you are the only one there. and you are right that safety can be an issue when we are on our own out there. but... based on the original post, it sounds like sammi is planning to test the waters a bit before making the switch, so i think she would be going in w/ her eyes open. and i do think that, although it has its own pitfalls and stressors, homecare also offers some things like flexibility, an opportunity to interact with patients in a different and often meaningful way, and the chance to have a more autonomous practice than bedside nursing.
as for the paperwork - personally i didn't think recerts (assessments that have to be done every 9 weeks to reevaluate the patient's need for continued services) were much different from a regular visit note - i always documented a full assessment for every visit anyway, so it was just a few extra questions about functional status. but you are right, there are some other paper forms, which i wasn't really thinking about (admission forms, a few forms for medicare/medicaid, and for home health aide placement/continuation). it also depends on whether you are in longterm (much heavier paperwork load) or acute care... i'm not sure what the hospice or mch paperworkload is like. but in the hospital, you have to document everything too.... but... it's just a different workflow, and figuring out what works for you in terms of when/where you get it done. one other time burden that's coming to mind - in homecare, you also spend a lot of coordination time on the phone - calling doctors, social workers, the pharmacy, therapists, ordering supplies and placing services, or getting in touch with family members/caregivers who don't live with the patient. so that can add up too.
as for why i left - i did have a positive experience and felt i was treated well as an employee, but after 4 years i felt i'd learned what i could, and needed a new setting to expand my skills and get some fresh energy. i chose to leave not because it was unbearable, but because my learning curve had flattened out and there were other things i wanted to learn/experience in nursing. it was just time for a change, plain and simple.
i will say that the main thing that became a real negative for me over time was feeling isolated from other clinicians - although i loved the independence (the positive flip side!), part of my decision to move on was being ready for a change to an environment where i can learn from watching others practice and have more direct and immediate collaboration, rather than having the bulk of my contact with physicians and other nurses be by phone. but.. if someone is sick of the floor, maybe that person would also like a break from co-workers!!! it's just so much about the individual's personality and whether community/homecare agrees with her or not, as well as the timing - what's perfect at one time in your life/practice may not work at all at some other point.
sammi, one more thing - i don't know if you're aware but there is a new-grad program at vns through which you get extra support & guidance for the first year. i think they take nurses (with both associates and bachelors degrees) who have up to a year's hospital experience. that might be a possibility for you as well. http://www.vnsny.org/careers/positions-by-specialty/home-health-nursing-internships/

Bklyn_RN · Feb 20, 2009

Nyforlove

Your point is well taken. You are an RN not a police officer.

Mabey it will put your mind at ease to know that you are provided a personal escort to go into areas where you might feel unsafe.

Also the reason that there are a lot of patients in unsafe areas, basically has to do with density. There are more people per square mile in those areas than in a nice suburban-like area with houses.

Also the "good" zip codes are usually taken and new nurses are usually assigned to what remains, the undesireable areas.

But you will never know if homecare is for you untill you try it.

SueNYC · Feb 21, 2009

nyforlove---

Though I have never worked for VNS , my sister in law did for the last 4 years with the peds population and has recently left, not because she didnt like it but due to a move. Back to your post, it depends on what area you are assigned to. Her area had a mix of both nice neighborhoods as well as projects. And though she always used an escort when she felt the area was unsafe, the only time she felt she was directly in harms way was in a well to do home in an affluential home where a teen pulled a knife on his mother and sister during a visit.

thedit · Feb 22, 2009

I'm sure this question depends on what area of homehealth you're dealing with, but I'm wondering if you get to practice a lot of skills doing homehealth, i.e. IV insertion, PICC care, ostomy care, etc.? Thanks!