Published Dec 14, 2002
I work in a county agency in a rural area. The nurses may travel 50-100 miles per day. Average caseload is expected to be 20 - 25 with 4-5 visits being made a day. The agency tells us that other agencies are making 25 caseload a norm with 5 visits per day. Well then I'd like to ask you who are doing this....when do you get your paperwork done? For any start of care the paperwork can take up to 2 hours to complete. I guess because we are rural the mileage thing is the issue.
renerian, BSN, RN
I just left home health after 11 years. We had to do 5 to 6 and put on well over 100 miles per day. Was hard.
An agency I was going to do traveling with in Santa Barbara had case managers doing 2 visits per day, in office doing all paperwork, dr. calls and they had full time visit staff doing 8 to 10 visits per day. The full time visit staff did no OASIS.
i do 5-7 visits per day...patti, i am apparently not far south of you. PM me if you want to chat more...
sphinx, BSN, RN
We average 22-33 on a caseload. We see 5-6 patients a day, "productivity" supposed to be 5 point something. Been known of course to see 7, throw in phone visits, of course calls to MD, insurance companies, etc. Average 40-100 miles a day, for me anyway, as I do half a county for OB. Others at our agency I'm not sure. My day is always: phone calls in am, rush to do BID visits, see the rest, fit in phone calls and other case management, home by 4:30 or 5, start on paperwork, eat, back to paperwork, and depending how bad things were that day have been known to be doing paperwork up till 9-10pm. It's been tough lately, as we changed charting softwear in October. It's been a major hassle, nothing but glitches. I'm pretty computer savvy, so that's not the problem. I do as much paperwork in the home as possible without it seeming as if my attention is more on the computer than on my patient. But it is so detailed, and the softwear is so bloated and bogs the computer down, everything is so slow. It makes everything 10x slower. I was so excited to start it, and it's been a thorn in our collective sides since we started up in it.
However, a change is in store for me. I got fed up and turned in my resignation. In all seriuosness. My boss has offerred me a break from the field, a possible job in office. If it is available, I may take her up on it, as all in all, we have an excellent agency which really does go to bat for their emplyees. Things are tough now. In our community they are tough everywhere. But at least our management tries. They listen, and don't just blow us off. In my case, my manager realizes I am sufferring from depression, and have come off a bad year mentally and physically, and that I need something to ease up, or else I will fall. And she is willing to work with me. How can I beat that?
Anyway, I went off track there....apologies.
Our caseloads are in the upper 20s, generally, and we are expected to see around 7 patients a day. On days I do more than 30 miles I can take one patient off and see 6 for productivity.
Some days I see 5, but those are high mileage days when I'm doing mostly labs and have to carry those back to the lab between visits.
We do case management, but don't have to call insurance companies, we have a UR dept who does our approvals. We have to call or fax labs and contact families, doctors, and a hotline for the hospital liaisons when one of our patients goes inpatient and on hold. The majority of our charting is done in the PALM, with any luck most of it during the visits, except for admits and recerts (just takes too long most of the time to do 485 and OASIS in the PALM during the visit). They are weaning off a lot of the extra paperwork, but we still have to do a paper care plan for the HCAs and interdepartment communication for their orders, as well as discharge papers.
I do quite a bit of charting and cleanup at home, signing 485s and sending emails, updating the POC and med lists for changes I write in a little spiral notebook I keep in my waist bag with my beeper and PALM.
If it weren't for carrying stuff in the car and making a lot of calls on the road, I'd never get anything done. I start and end at the office, but it's always so busy there I don't find it very productive, mostly doing faxes and resupplying my bag.
So my question now is when you're doing paperwork until 9pm or charting at home....are you being paid for this time worked?
And when you say 5-6 patients a day are these numbers weighted...meaning a new Start of Care 1 = 2.1 patients because of time involved?
No we were not paid for the time spent charting at home when the office is closed. Would like to hear if others were not. I donated many hours per week without pay.
Some companies you are paid per visit some salaried, some hourly.
Our manager encourages us to document how long you document on each patient. We get paid for all the work we put in. I was on call last weekend and had two starts each day. I've only been in hh 3 mos, so all that took about 12 hours each day & I got paid for it! Our productivity is 4.5 and 50-100 miles a day is the usual for me. Man, I have 3 starts tomorrow!! Yippee.
Elf that is great you got paid for all your time. That is why I left home health. I put in between 60 to 70 hours per week and was only paid about 35. The rest was donated time so to speak.
Judy, RN BSN
It is awful to read that nurses are not being paid for documentation time. This is illegal. Stop doing it. If your agency will not pay you for the time, I would recommend reporting them to the Federal Labor Relations Board as well as your State Labor Relations Board and start looking for a new job STAT! I work for a hospital based agency with a labor contract and typically put in a 10 hour day due to charting demands, however I am paid for my time. However, I have worked for agencies that have given staff a hard time about overtime and fought these battles with them. This is a tough one, but definitely worth fighting for.
Most times, we too, don't get paid for all our time documenting if it goes too late at home. When we started the new software, we were authorized to put in all the hours we worked. On days when we have a ton of visits, maybe a staff meeting or education, then we can put in extra as long as we let our boss know. But otherwise we just put in for 8 hours. It used to be ok, it worked out in the end, cuz some days were short, and if I put in 8 for both short and long days, it all evened out in the end. But now we are short staffed, all the days are long, and most weeks, I put in for only a fraction of overtime. Is this illegal? Yes. Do I know it? yes. Do they I know it? I'm sure they do. Is it an official written policy? No. It's just spread by word of mouth, implied, etc. But thank God, this weekend is my last on call, today was my last seeing my own patients. I have tomorrow off. Monday I start an in office job. Leave at 4, will put in 8 hours, no paperwork at home, no overtime I don't get paid for, time with my family, etc. This is gonna be a huge life saver for me. The stress has been TOO MUCH lately.
I work for reno county home health we have 2 full time RN"s ,6 HHA's I have 10 Skilled clients now and 40 Older adult ( bathing assist, wellness monitoring, homemaking that I supervise the HHA q month. I have 1 bid dressing, 1 daily , 3 qod,2 diabetic foot care,3 weekly med set up, I work 8-5 drive a county car.. or if one is not avail I drive mine at .36 / mile. I try to see 6 clients a day. Oh I also do DNA blood draws for corrections each tues from 2-4:30
I LOVE MY JOB !!!
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