What is Home Health REALLY Like?

[Bugaloo]

I have been pondering something for a while now and would really like some answers from seasoned Home Health nurses..any thoughts, good or bad, are welcome.

About 2 years ago, after almost 7 years in LTC, Tele, Pulmonary and Med-Surg, I felt that I needed a change. I took a job with a local Home health agency not assciated with a hospital. I was considered an RN Case Manager, meaning that I was responsible for all care with my patient load, excluding baths/showers, which I assigned to a CNA. My base salary was $48,000 a year (salaried), which was a lot more than I was making in the hospital.

For about 8 months, I loved it, then the case load became unbearable. We covered about 7 counties, so at times, our patients were as far as 2 hours from the office. I saw between 6-8 patients a day, and drove between 60-200 miles a day. I bought a new vehicle and in 2 1/2 months, put 10,000 miles on it! I was on call about every 7 weeks, for one week at a time, including a Sat. and Sun. So, there were times that you worked 12 days in a row without a day off. Also, our on-call Sat. and Sun. were usually 12 hour days by the time you saw every one. We were required to do SOC, RECERTS, ROC on the weekends as well. I was paid extra for on call times. Mileage was .34 a mile. If my salary pay was based on 40 hours a week, I made approx. $25 an hour, but because at one point, I had a case load of 25 patients, some being seen every day, my hours started creeping up to 50-60 hours a week-more if I was on call.

Although I loved the autonomy of my job, I began to feel very stressed and I NEVER had "down" time. I was always either finishing paperwork or on the phone. When I brought it to my supervisor's attention, she acted as if I couldn't "hack it" and was complaining. BTW, we went through 3 supervisors while I was there. The field nurses stayed, but the office staff changed CONSTANTLY.

I lasted 16 months before I threw in the towel. The day after I put in my 2 week notice, my supervisor put in her notice, meaning that they would be looking for a 4th supervisor to take her place!

Where my expectations too high or is this really what Home Health is all about?

[TazziRN, RN]

The 7 counties thing is a bit much. Both the agencies here in this county (1 privately owned, the other is VNA) only cover this county. The mileage payback for me is 0.41. As case manager I see anywhere from 1 to 6 pts a day depending on the census. we take turns being on call, which is a week at a time, and that includes weekends. We have one nurse who only works weekends and she does all the opens and resumes. The nurse who is on call during the week works Saturday and sees all the established pts that need to be seen on weekends, like IV stuff.

[Bala Shark]

I am not a manager..I see two patients a day only...I have a lot of down time..The job is not stressful..I am new..I been in home health for about 2 weeks..

But I have to deal with pateints who are ventilator dependent and have a trach..That can be streeful because that is life support and when the ventilator fails, then I would have to take emergency action..

[chris_at_lucas_RN, RN]

I've been working hospice about a year.

In May I took a traveler position with a national hospice company.

I was supposed to be assigned between my home and their office, which was a pretty good bit away and further than I would have accepted had this not been the arrangement.

Of course, once I was in there.....

After four days, I rented a car. I made a profit on my mileage which was about 200 miles a day--my biggest miles day I drove 350 miles!

Because I had (thank you God!) pushed to get my time and miles paid from and to my house, there were 80 miles (and an hour and a half) each day that I got reimbursed for. If they had stuck to their agreement about location and assignments, it would not have made any difference to them. For me, it made up for the frustration of driving all over creation!

I never took call because I was a traveler.

After 8 weeks, though, of 55 and 60 hour weeks, I was worn out with a capital OUT!!! The manager that ran the morning report began to chew on me a bit each morning--and the situation would always turn out to be not as she reported, but what are ya gonna do. The straw for me was, after all my trying to keep their costs down where I was concerned (they would not assign me closer to home, so that was out of my hands), and being assigned to, for example, do an admit "on my way home" that was 20 miles out of the way and after a long day anyway, I got a little chewing from this manager about my overtime.

Huh?

My contract had expired two weeks before, I had asked for a renewal in writing, but they declined (on the national level, not just at this center) and wanted me to go PRN. Two weeks into that, the manager (btw, I had been warned by several of their own nurses at the beginning of my stint, but she was very decent to me and I didn't believe it until she took aim....) got after me about my overtime.

I just looked at her. There was no point in trying to reason, and I don't make a habit of arguing with my superiors.

But I did call my recruiter--I'd talked with her about this person in the past, that's when she admitted she knew it would be a hard assignment! She knew there were big problems there with management! I guess you don't tell your traveler that.....

So, I asked her how much notice I had to give (this was Monday morning), and she said none. I said, not even the end of the day? Not even the end of the day. She told me exactly what to say and to whom, and I did.

I took my paperwork home, finished it that afternoon, trotted it in the next morning--didn't charge them for the week (10 hours) which in retrospect gypped the agency of a few cents, but what the hey, I made a bundle in 8 weeks and I know they did even better.

I guess my point is that I am learning that even if you are paid well, if the compensation doesn't at least equal your sense of what you put in to it, and each of us has to value that our own way, then you will not be happy.

My last hospice job was as DON/PCC of two centers. It was trouble from day one. The organization was a small one but with a long history of failure and bad rep, primarily centered on the CEO (found out later he is a felon!). I made less--and didn't submit some of my expenses, which falls on me--there than at other jobs, but I felt like I was doing something good. I pulled together a team that had been fractured and was in pain. We got ourselves organized and people started talking to each other and smiling more. We had laughter. We had some tears when we lost a very young patient. I left there only when the same felonious CEO started punishing my people because he was mad at me (he actually held their checks until it was too late to get them credited that day, knowing full well that more than half of them were expecting to get them early in the day to cover rent checks and the like!).

Again, my point is, you stay and stay happy where you feel that what you get out of a job/position/whatever at least equals, and hopefully exceeds, what you give to it.

Chris

[caliotter3]

How I would approach it is to not accept that type of job again. I do not do intermittent visits. I only do shift work. I work one or more cases for one or more agencies and my shifts are normally 8 hours long. My schedule is set up to be semi-permanent and life is nice. All of this doing 7 or 8 visits all over Killarney County and an extra visit in County Cork on the way home and then take on-call that very same night does not cut it for me. I don't get paid mileage, my salary is straight per hours worked. I take overtime if I want to. I will take a last minute (within reason) call, only for a case that I've worked on before and have an agreement with my scheduling people about my schedule and how they can get in contact with me. This way, I minimize my stress. And many RNs (I'm an LVN) in the agencies that I've worked for have done similar agreements. Just because you are an RN does not mean that you can't do shift care rather than intermittent this and intermittent that, and get walked all over because you are on salary rather than hourly. Just a thought. Maybe a different approach could make it more bearable for you too. Good luck. (BTW, at one of my agencies, the original Nurse Supervisor went from Nurse Supervisor to doing shift work because she wanted to, so it can be done.)