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Why HH nurses quit

Home Health   (44,125 Views 116 Comments)
by Willow Moonsidhe Willow Moonsidhe (New Member) New Member

Willow Moonsidhe has 25 years experience and works as a RN in Home Health.

5,644 Visitors; 238 Posts

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I have decided the biggest reason home health nurses quit is no time off. You work non stop all day 8 am to 5 pm then get home and still have 2 to 3 hours of charting. It is nuts.

Blessings

~Golanv

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AnnemRN has 22 years experience.

6,556 Visitors; 286 Posts

Yes, and adding all night call to that does make you think about quitting too.

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232 Likes; 3 Followers; 95,210 Visitors; 36,400 Posts

I left a fill-in case today because of the way the family treated me. No amount of money seemed worth eight hour shifts of constant insults in another language and someone shoving me aside to do my job, then complaining that I wasn't doing my job.

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Willow Moonsidhe has 25 years experience and works as a RN in Home Health.

5,644 Visitors; 238 Posts

I totally understand. I am so brain dead I can't even figure a cert period correctly. I think home health nurses should unionize and refused to do more than is a normal days work. At some point the abuse to nurses has to end.

~Willow

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AnnemRN has 22 years experience.

6,556 Visitors; 286 Posts

I completely agree, unions are very much needed in home health.

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6,543 Visitors; 476 Posts

I literally can not do "case management" and visits, because it's like doing the job of three people. I tried it once and lost my mind! The company I'm at now does case managing from the office and all the RN's in the field just follow up on the issues we see during our visits and notify the office case managers if we need to. All the nurses share visits, so you're not stuck seeing the same patients all the time. We have weekly case conferences so we all know the big problems of current patients. I have yet to hear of another home care that operates this way, but they've never been able to implement field case managing for their nurses- probably because everyone would quit.....

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Luv2care0907 has 10 years experience.

2,969 Visitors; 154 Posts

I left a fill-in case today because of the way the family treated me. No amount of money seemed worth eight hour shifts of constant insults in another language and someone shoving me aside to do my job, then complaining that I wasn't doing my job.

I truly believe that someone or some who in the hospital setting sets a negative expectation to families concerning us as hh nurses as though we are the refuge of nursing. I think that's why PCGs have that attitude. For that reason, establishing myself is one of my top priorities on a new case. It isn't easy when these people have had bad experiences.

I would pick hh nursing over hospital nursing any day of the week. I do shift work so the end-of-the-day paperwork has never happened to me.

I think the above reception and attitude is why there are few hh nurses. Even agencies have this attitude. I want to see that change and I believe it can change. Me thinks it's getting ready to change. So watch out, hospital nurses - a paradigm shift is coming!

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232 Likes; 3 Followers; 95,210 Visitors; 36,400 Posts

I think the above reception and attitude is why there are few hh nurses. Even agencies have this attitude.

The clients would exhibit far less of this negative attitude toward hh nurses if the agencies refused to encourage it. I have only experienced one Director of Patient Care Services who would stick up for her nurses.

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KateRN1 has 20 years experience and works as a Home Health.

1 Like; 13,839 Visitors; 1,191 Posts

I think many home care nurses quit because they don't understand the nature of home care. They think that it will be an easy job and no one is looking over their shoulders. I think that home care draws a lot of "loner" -type nurses who balk at authority and don't always have the personality to maintain relationships. When they discover that home care is heavily regulated and relies on massive volumes of documentation and that they are required to meet a certain productivity standard, they move on to another agency where they think it might be easier or they stay PRN to avoid requirements. I've seen quite a few hired without so much as a reference check. As long as they have a warm body, a license, and pass the background screen, they're in.

I also think that many agencies don't treat field staff well. They do not get a thorough orientation and are often surprised by standards they weren't told they had to meet. I think many agencies have unrealistic expectations of what field staff can do in a day. I have seen managers in the office get upset that clinicians are home by 3 while the manager is stuck in the office until 5 (or later), only to forget those days of doing paperwork and returning calls after hours. I have also had managers with the attitude of "I own you until 5 pm" but the reality of it is that there are really no set hours for home care. Some days may finish at 3, some may finish at 7, but it all evens out in the wash.

And hospitals often do a poor job of discharge planning with the attitude that "home care will take care of it." Discharge planners without experience with home care give patients unreasonable expectations of what homecare can/will do which disappoints the patients. Patients and families also have the idea that Medicare will cover everything they need, only to find that there are huge gaps in the coverage.

There is no one reason that nurses leave home care. Those that understand the nature of the beast and love it do well. Those who don't understand it and want it to flex around them will be perpetually disappointed. If you want regular hours with a job that doesn't follow you home, home care is not for you.

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Willow Moonsidhe has 25 years experience and works as a RN in Home Health.

5,644 Visitors; 238 Posts

I think many home care nurses quit because they don't understand the nature of home care. They think that it will be an easy job and no one is looking over their shoulders. I think that home care draws a lot of "loner" -type nurses who balk at authority and don't always have the personality to maintain relationships. When they discover that home care is heavily regulated and relies on massive volumes of documentation and that they are required to meet a certain productivity standard, they move on to another agency where they think it might be easier or they stay PRN to avoid requirements. I've seen quite a few hired without so much as a reference check. As long as they have a warm body, a license, and pass the background screen, they're in.

This I find as an insult.:mad: I have worked Trauma, ICU, L&D and as a supervisor. I think it takes a smart nurse with a lot on the ball to do case management of a large patient load. Your assessment skills have to be very good. You are alone and there is no one backing you up.

I also think that many agencies don't treat field staff well. They do not get a thorough orientation and are often surprised by standards they weren't told they had to meet. I think many agencies have unrealistic expectations of what field staff can do in a day. I have seen managers in the office get upset that clinicians are home by 3 while the manager is stuck in the office until 5 (or later), only to forget those days of doing paperwork and returning calls after hours. I have also had managers with the attitude of "I own you until 5 pm" but the reality of it is that there are really no set hours for home care. Some days may finish at 3, some may finish at 7, but it all evens out in the wash.

It does not always even out in the wash. Being over booked means long hours charting at home. I think it takes a smart scheduler able to look at acuity levels, driving times, skills that have to be done in the home etc. Not enough attention is payed to these things.

And hospitals often do a poor job of discharge planning with the attitude that "home care will take care of it." Discharge planners without experience with home care give patients unreasonable expectations of what homecare can/will do which disappoints the patients. Patients and families also have the idea that Medicare will cover everything they need, only to find that there are huge gaps in the coverage.
This is sometimes true. We actually had a hospital telling patients that the MRSA patients had were getting was coming from home health. These were patients discharged from the hospital for Vanco after a surgery. Pretty sad actually.

There is no one reason that nurses leave home care. Those that understand the nature of the beast and love it do well. Those who don't understand it and want it to flex around them will be perpetually disappointed. If you want regular hours with a job that doesn't follow you home, home care is not for you.
Beast it is most of the time. Mostly because of companies trying to find ways to make more money. Lets see if we can get all the nurses to do one more visit a day for the same pay. Maybe use computers and BING for gas mileage actually decreasing what we pay out in mileage by not accounting for detours, getting lost, finding the right house etc.

Greed is the engine that fuels health care anymore. No what is right or wrong. The biggest problem is fair hours and a fair wage.

~Willow

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AnnemRN has 22 years experience.

6,556 Visitors; 286 Posts

I don't agree that home health attracts loner type nurses with authority issues. It took a lot of adjustment for me to finally get used to being alone most of the time. Previously, I had worked very busy hospital floors that literally made my head spin with all the activity going on at once. I actually missed the hectic pace, but when I tried to go back to the hospital they wanted me to take a pay cut that I couldn't afford so, I stuck it out in homecare.

Unfortunately, I have seen many very good nurses who were not given the time to fully orient to home health which in the end led to their failure. I've also seen many supervisors on a superiority trip create a very hostile work environment for the nurses they didn't like.

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hawkfdc has 9 years experience and works as a Home Health Soldier.

4,234 Visitors; 157 Posts

I have been doing home health now for 6 months and I love it. YEs, when I had 18 patients the case management felt overwhelming but I have a good support system, and my learning curve has been long as far as Medicare regulations go but the one thing I know is that the harder I work, the more I get paid. Unlike in the hospital when the harder I work-hey thats just great, I kept them alive 'til 645. Its a matter of figuring out how to work smarter, not just harder.

And yes I am one of those with a problem with authority and constant oversight. Thats what drew me to Home Health.

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