Why HH nurses quit

desertnurz · Dec 8, 2010

I totally agree with KATERN1. Her first paragraph nails it right on.......So many people I hire on board do think its "easier" in home care. Medicare Regulations, OASIS questions. "Massive volumes of documentation" doesn't cut it....its worse than that. After about 3 weeks, you can usually weed those "wanting it easier" nurses out. The rest have already quit by then.

I believe Home Care tends to attract people who need great amounts of flexibility for their family or granchildren or those who are almost ready to retire but still want to work (but not really). Add to that who see a false sense of autonomy......

By the way.....Our policy calls for documenting during your visit, not afterwards.....72hrs is given to complete admission paperwork...as it is more detailed.

Add to that poor case management at the hospital level and MDs that want us to go out "just" for blood draws or those complex cases that really should not be discharged, the nursing shortage, overworked RN's, and you've got a brewing pot of failure waiting to happen.

It takes a really organized, well skilled, yet flexible "GO WITH THE FLOW" type of person to survive homecare. Maybe that is not you. Its ok, not everyone is cut out for the job....

Its late and I could probably go on and on....but I'll save that for another day.

Willow Moonsidhe · Dec 9, 2010

I totally agree with KATERN1. Her first paragraph nails it right on.......So many people I hire on board do think its "easier" in home care. Medicare Regulations, OASIS questions. "Massive volumes of documentation" doesn't cut it....its worse than that. After about 3 weeks, you can usually weed those "wanting it easier" nurses out. The rest have already quit by then.

I don't think people think it is easier. Nursing at its best is a hard profession.

I believe Home Care tends to attract people who need great amounts of flexibility for their family or granchildren or those who are almost ready to retire but still want to work (but not really). Add to that who see a false sense of autonomy......

Older nurses are not always nurses who do not want to work.

By the way.....Our policy calls for documenting during your visit, not afterwards.....72hrs is given to complete admission paperwork...as it is more detailed.

Depends on if you want your patients to feel the dang computer is more important than they are. Nothing like watching a little old person try to figure out way the nurse looks more at the computer than them. Kind of hard also to do a PICC line dressing care, wound vac and drawn labs, assess the patient, VS and chart and be out the door in an hour. You must be a manager posting our policy that way. It sounds good in theory but it never works out. Home health nurses always end up charting into the night.

It takes a really organized, well skilled, yet flexible "GO WITH THE FLOW" type of person to survive homecare. Maybe that is not you. Its ok, not everyone is cut out for the job....

Maybe we have all GONE WITH THE FLOW too long and not stood up for equal rights. My brother is an engineer we both graduated at the same time and set out making the same money. He now makes $150,000 and I am about 1/3 of that even though I work a job that deals in life and death go figure!

Insanity is defined by doing the same thing over and over and expecting a different result. Well home health bosses keep expecting nurses to do it all in 8 hours when the work load is impossible to do in 8 hours. Maybe they need to see a shrink.

I did 7 visits today; one an Oasis, drove 125 miles, started at 8 am and finished tonight at 9:30 pm. I will be paid for an 8 hour day. That does not mean I am lazy but over worked.

~Willow

RN1263 · Dec 9, 2010

By the way.....Our policy calls for documenting during your visit, not afterwards.....72hrs is given to complete admission paperwork...as it is more detailed.

Spoken like a true "manager" that has forgotten what it's like in the field...what a shame....you will no longer be able to "relate" well to your nurses. "Policies" are thrown out the window when the nurse has roaches climbing their leg, family screaming at each other, massive amounts of smoke blown in their face, intolerable odors making their eyes water.....should I go on?

The DON where I work spent over a decade doing home health nursing. She has been DON for maybe a year and now expects nurses do perform in a manner that she herself could never do...if she couldn't do it, why are the rules different for her staff......because she's a company/office girl now and can no longer relate to her field staff.

KateRN1 · Dec 9, 2010

I am a manager, but I am also still a field nurse. On top of my regular office duties, I also see patients and until recently continued to case manage in the field as well as in the office. I do not ask any nurse to do anything that I don't do myself. I have done four SOCs in a day and still had the paperwork in the next morning at 8 am without working well into the night. I have driven over 150 miles in a day and covered five counties on my own while case managing 70+ patients. I have made all those phone calls to the doctor asking for orders and waited until they called me back. I have discovered I'm out to draw labs without the proper tubes and kicked myself because I had to drive 75 miles (one way) back to the office to get them. I've had those four-hour admissions that I thought were gonna be the death of me. I've had the non-compliant patients that don't understand why their blood sugar is over 400 and they feel fine. So don't even start with that BS of "you forgot what it's like." No, I most certainly have not.

And you know what? It boils down to this: time management. You have to have your ducks in a row all day, every day. Some days your ducks will break rank and you will have to herd them, but you do what you have to do. You must be organized beyond your wildest dreams. The house and laundry can go to hell before I let my trunk get out of hand. You have to have a really good handle on the paperwork and how to complete it. It is not impossible to finish your visit notes, whether paper or computer, during or immediately after your visit. It is not impossible to finish nearly all of your OASIS assessment during or immediately after your visit. It really isn't. You just have to get in the habit of doing it instead of saving it for the end of the day and complaining that you're losing too much of your free time. The fact is, the documentation is part of your visit and part of what you're getting paid for. If you don't complete the documentation, you haven't completed the visit. You have to take stock of your supplies at least weekly to make sure that you have everything you could possibly need and everything that you know you need (like those tubes!) *before* you set out. You need to sit down the night before and call all your patients with approximate times so that you can anticipate changes and be ready to fill holes where needed. If you know you need to make a certain productivity, it's up to *you* to make sure you get those visits.

Home health can be very overwhelming to those who are new to the specialty and it does take about six months to get over the learning curve. However, much of that depends on you as an individual. The more you want home health care to conform to what you want it to be, the more you are going to be disappointed. It is what it is and until you can accept that, you will not be happy. I've watched it go from a fee-for-service where we got reimbursed for every little bandaid to rules and regulations that made almost no one homebound to PPS to OASIS-C and now the freakin' face-to-face rule threatens to make me bald within the next 30 days. The one thing that you must accept is that it will continually change and it's up to *YOU* to make sure you know what those changes are.

If you are committed to home care and want to be a good home care nurse, learn all that you can about the industry. Learn what OASIS-C really is and what the process measures are. Learn about how your agency scores on Home Health Compare. Learn what your HHCAPS score is. Learn how competitive bidding is affecting our DME providers. Join your specialty nursing organizations. Participate! Don't be a passive participant in your career, be active!

I am not a perfect home care nurse, not a perfect manager (far from it), but I care deeply about patients and their home care and I care deeply about this industry.

[\soapbox]

annaedRN, RN · Dec 10, 2010

Kate - as always I respect and agree with your input! I am EXTREMELY organized and have everything done each day as well. The only thing I have to say is if I ever had to do 4 SOC in a day....it would take me way into the night!!!! Overall, I do believe that it is getting harder to meet productivity because patient acuity continues to rise...individual patient visits are seeming to require more time. I think with increasing requirements on nurses, staff retention and new HH nurses will continue to suffer. I love what I do, I am good at what I do....but somedays.......

RN1263 · Dec 10, 2010

I have done four SOCs in a day and still had the paperwork in the next morning at 8 am without working well into the night. I have driven over 150 miles in a day and covered five counties on my own while case managing 70+ patients.

Do you think that is "reasonable" to expect for one nurse to have to do? I want work to be part of my life, not BE my life.

So don't even start with that BS of "you forgot what it's like." No, I most certainly have not.

Maybe YOU have not, but believe me others have.... I just hate when nurse managers say the policy this or that in the home, because we don't work in a controlled work environment. Just yesterday, I was doing an Oasis in the home while being swarmed by cockroaches, then the patient said "I'm tired can you leave?".... the office policy went out the window, because I could not complete the oasis in the home.

The house and laundry can go to hell before I let my trunk get out of hand.

Again, I want work to be PART of my life, not BE my life... I've been doing home care for 3 yrs, so I know we have days when we have to suck it up, work late, ect.... I get it....but when those days become the norm there is something wrong with the company, maybe they need to hire more nurses.

desertnurz · Dec 10, 2010

To WILLOW and RN1236: I am sure no one is strapping you down to your job, sounds like you are burnt out.....why don't you refreshen your resumes and leave the industry you both so much seem to like to complain about. Or maybe work part-time? Vacation time perhaps?

KARENRN thanx I could not have summed it up better.....

Believe what you want...but some nurses do pursue an interest in Home Health because they do "think" it's easier. I am not agreeing with them it is really hard work, but there are those who think is is easier.....those who don't know.

Willow Moonsidhe · Dec 10, 2010

Yes Mercury is in Retrograde! LMAO

Hugs

~Willow

Willow Moonsidhe · Dec 10, 2010

this will be interesting to see how it comes out:

class action lawsuit in ny against major employer - homecare nurses sue gentiva

~willow

RN1263 · Dec 10, 2010

To WILLOW and RN1236: I am sure no one is strapping you down to your job, sounds like you are burnt out.....why don't you refreshen your resumes and leave the industry you both so much seem to like to complain about. Or maybe work part-time? Vacation time perhaps?

HHmmm, see your own quote below, sounds like you were doing more complaining regarding the actual "industry", then I. As a matter of fact, you referred to it as a "brewing pot of failure" waiting to happen!

Add to that poor case management at the hospital level and MDs that want us to go out "just" for blood draws or those complex cases that really should not be discharged, the nursing shortage, overworked RN's, and you've got a brewing pot of failure waiting to happen.

However, "I" was stating that some policies/rules set by managers should not be so black and white, because the nurse doesn't have a controlled work environment...that was the point I was trying to make. And sometimes managers just pile on the work to their existing employees, day after day after day, instead of hiring more nurses. That's what burns the nurse out! And in "my" experience, sometimes management does forget what it's like in the field or it seems as if they have.... If none of this applies to you, then great, good job!

By the way, I'm doing fine thank you- not burnt out, I don't let it get to that point. Actually, just got a raise and promoted to admissions nurse for the agency. So, I do not need a vacation, but thanks for asking.

KateRN1 · Dec 11, 2010

this will be interesting to see how it comes out:
class action lawsuit in ny against major employer - homecare nurses sue gentiva
~willow

i agree, it will be interesting to see how it turns out. i have been against pay-per-visit since its inception as i feel it treats professional nurses as piecemeal workers. if you want professional results, pay in a professional manner. i'm pleased that our agency pays full-time nurses a straight salary with a productivity requirement (plus bonus if they go beyond their required "units"). i could not work for an agency that did not treat their employees as professionals.

i wonder if the newer home health nurses here have a good understanding of the role of the clinical manager in home care? it varies from agency-to-agency of course, but many of the responsbilities are industry-wide. just for giggles, here's a typical day for me:

*get up at 0530 for exercise and caffeine (turkish tea for me).

*check blackberry for any email or text messages that came in during the night.

*respond to above, as needed.

*0700 take daughter to school, answering calls/texts some days during the drive.

*0730-0745 arrive at office, make tea for me, coffee for rest of staff if it isn't already made.

*0800-0830 prepare for morning meeting, which means having an accurate census without expired episodes artificially inflating it, call nurses who did socs, rocs, and recerts from the day before if they haven't called in a report, make sure that pts who have been discharged are marked inactive.

*0830-0900 morning meeting with clinical managers, schedulers, don, and administrator to review all the numbers, go over planned socs, anything unstaffed, problems, incidents, complaints, etc.

*0900-1300 review oasis assessments for completion and consistency, call nurses about corrections (how can your blind patient be independent with all adls and drawing up her own insulin?), things they left blank, lack of documentation, etc. take phone calls from therapists, nurses, aides with questions, concerns, complaints, issues. take phone calls from dme providers, patients, physician's offices, marketers with questions, concerns, complaints, issues. listen to administrator complain that we aren't putting out raps fast enough. review the previous day's oasis assessments that have gone through the review program and make corrections, document changes, corrections. type 485s, edit for consistency (your teaching interventions are for a-fib but your goals are for the patient to be knowledgeable about htn?). call nurses and therapists to try to get socs, rocs, and visits staffed. order dme, chase down dme providers, look up icd-9 codes for lab work, fax documentation requests to the lab when nurses don't fill out the lab form completely. pull supplies for nurses who are in a hurry and need to breeze through to pick them up. send order requests to physicians for therapy evals and consults.

*1300-1330 bolt down whatever leftovers i managed to snag from last night's dinner as i review paperwork that doesn't need me to do actual corrections, sometimes catch up on the local news site, sometimes work on oasis training modules. try not to answer phone with my mouth full although sometimes that's hard.

*1330-1800 continue with more of the same from before lunch. cover for others who are out to lunch by taking phone calls. answer the back line if it rings after 1700 because everyone knows i'm generally there until 1800 and they can come by if they need something. tuesdays are late nights, though, and i generally don't get out until close to 1900 as i'm getting ready for case conference on wednesday mornings 0900-1000.

*1800-2100 generally home by 1830 and hope my hubby had the sense to put some dinner on the table. answer text messages, phone calls, emails that trickle in with questions. look up patient demographics and text, email, or fax information for nurses who didn't get the info from the schedulers and need to call the next day's patients. answer calls from marketers wanting to know if patients were started. sometimes take supplies home for nurses who can't make it to the office before i leave but can swing by my house or meet me somewhere. (i'm looking at the bag of wound care supplies sitting on my kitchen counter at the moment.)

*2100 generally shower and go to bed, turn off phone if i'm not on call. if i'm on call, expect to answer the phone at least once during the night for something trivial like "when is my nurse coming tomorrow?" how am i supposed to know at 2am?

on most weekends, i also see a couple of patients, sometimes straight visits, sometimes socs or rocs or ivs. up until last month, i was also regularly seeing a patient and case managing him, but that case ended and i haven't picked up a new one. maybe after the first of the year. i also answer calls, texts, and emails from nurses and other staff who have questions, concerns, or complaints. most of the time it's something simple like a phone number and address for a patient, sometimes they need a 485 emailed or need the latest wound care instructions. sometimes they need suggestions for care, help completing paperwork, or just want someone to listen to them complain.

do you know what your clinical manager does? if you haven't sat with him/her for a day, i would highly recommend it. you don't realize all that goes on behind the scenes to make home care happen, i know i didn't before i took this position. i had some small idea, but didn't realize all that went with it.

RN1263 · Dec 11, 2010

Do you know what your clinical manager does? If you haven't sat with him/her for a day, I would highly recommend it. You don't realize all that goes on behind the scenes to make home care happen, I know I didn't before I took this position. I had some small idea, but didn't realize all that went with it.

Do I think you're over-worked....YES. Would I want your job?...NO. Would I take a job that consumed my life and stressed me out daily... Not anymore, been there done that... no thanks.

Now, I do know our managers work hard and deal with a lot. Maybe I have not put the shoe on the other foot often enough to see their point of view "clearly" .... but I'll try.