Why HH nurses quit

Willow Moonsidhe · Dec 11, 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?

I am not burnt out I just want a home life that is not consumed with patient care from 8 am to 9 or 10 pm for 5 days a week. I work those hours with no lunch I do not stop or take a break in hopes I can finish by 5 pm and it never happens. I never hear I am doing a good job only what things I forgot to do. Nurses are being treated like hamburger flippers and scolded constantly for things they should not be. We do a critical job and should be treated with respect. It is rush rush rush and you have to calm your nerves when you reach a patient's home so they don't pick up on how stressed you are. The real reason we are there is forgotten which is to care for patients. We are paper pushers and slave dogs. If it were not for my actual patients I would brush up my resume and seek a cushy job. My manager Friday had me drive to the office twice which killed 2 hours to do something that was her job in the policy book and she was sitting at her desk reading the internet and eating. I still had to see 7 patients and drive 110 miles with no lunch. That is what makes nurses mad.

I am off my soap box. I know I do a valid job no matter what upper management does with their time and my patients love me.

~Willow

desertnurz · Dec 14, 2010

I am not burnt out I just want a home life that is not consumed with patient care from 8 am to 9 or 10 pm for 5 days a week. I work those hours with no lunch I do not stop or take a break in hopes I can finish by 5 pm and it never happens. I never hear I am doing a good job only what things I forgot to do. Nurses are being treated like hamburger flippers and scolded constantly for things they should not be. We do a critical job and should be treated with respect.
~Willow

You cant hold others accountable for the profession you choose to enter. I am with you, I hear you,and it is unfortunate that our profession does not command the respect you mention. We all work hard every single day, and this is what we choose to do. Nothing is really different discipline to discipline, and I've worked in a few arenas by now.

But you need to realize that you DO make a difference in every life you touch. You need to go home and feel happy inside for the awesome work you do everyday because you know you did, not because some manager pats you on the back every day. Even if they did, you'd get to the point that you'd think they were "Faking it".

I am sad you feel the way you do.....I know you are appreciated either by many people. The patients, your co-workers, your friends and family. No level of appreciation will ever be enough for the type of work nurses do everyday.

Good luck to you! :yeah:

RN1263 · Dec 15, 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 am completely against "pay per visit", "fee based" compensation for nurses. below i copy and pasted an article regarding this practice being banned in oregon.....

****************************************************************************************

lindros honored for nursing achievement at ana national event

ana press release:

washington, dc - billy lindros, a registered nurse case manager for hospice at sacred heart home care services in eugene, or, received a national award for nursing excellence from the american nurses association (ana), the largest nursing organization in the u.s., at its biennial house of delegates meeting in washington, dc june 16-19, 2010.

lindros, rn, of eugene, garnered the ana shirley titus award, which recognizes contributions to the ana economic and general welfare program for nurses.

lindros was a driving force behind the oregon legislature's adoption of a law that bans the practice of pay-per-visit compensation for home health and hospice nurses, which went into effect this year. the oregon nurses association (ona) opposed pay-per-visit provisions because, in effect, they place pressure on home health care nurses to maintain a daily quota of patient visits and arbitrarily allocate a specific, pre-determined charge per patient visit. many nurses report pay-per-visit results in curtailed services to the patient. lindros testified in support of the measure.

"we were motivated by two strongly held beliefs - that nurses are professionals and that our patients are people, not components on an assembly line," lindros said in accepting the award. "during our testimony, senators and representatives told us of the impact that nurses had on them and their families. seeing this bill move through the legislature and become a law was a great experience."

ana is honoring 20 nurses for their dedication to the profession and contributions toward improving nursing and health care during the meeting of its governing and policy-setting body.

"nurses form the backbone of our health care system, yet that often goes unrecognized," said ana president rebecca m. patton, msn, rn, cnor. "today, we recognize a select group of nurses who epitomize the best of the profession through their commitment to clinical practice, teaching, research and advocacy on behalf of patients and nurse colleagues."

lindros worked as a registered nurse case manager for home health at sacred heart home care services from 1993-2004. he previously also worked as a staff nurse in the intensive and critical care units at sacred heart medical center for about 12 years.

lindros has been a member of ona's cabinet on economic and general welfare since 2004.

**************************************************************************************************

i'm paid hourly and before that salary, but never "pay per visit". personally, i think it is a scheme to avoid over-time pay among the other things mentioned in the article.

Willow Moonsidhe · Dec 16, 2010

It is irritating when a patient you have bent over backwards for calls the office for a ridiculous reason. I had this happen yesterday. ~Willow

caliotter3 · Dec 16, 2010

What is worse is when the staffing coordinator from the agency pumps the patient or patient's family to get them to complain about any individual nurse. Clients are usually capable of finding their own need to complain, silly or not.

smartnrse · Jan 6, 2011

I too know exactly why home care nurses quit. The only reason I stay is because I can remember when I worked for a wonderful agency, even though it is a terrible place to work now. There is no respect for your time or your paycheck. Unfortunately I did management and for a year and a half I had to fight to do what was fair for the nurse and the patient. After someone has been in management a year, its not that they don't remember what it was like- they just don't care. Upper management is always on you about numbers and field staff always has something going on, it was a constant struggle. Where I work they have decided it is just too much work to try to cover visits or arrange visits so that the nurse is not drowning. If you assign someone to do 3 admissions, 1 resumption and a visit, are you really doing what is best for the patient? I know it's not what is best for the nurse. I went back into the field because it was best for me and my family and I promised myself I would not be a complainer but it is so hard when the scheduler and the mcps-oh, don't forget the branch director- really just want what is easiest for them instead of what is best for the patient. Complaints are made about oasis accuracy, but if it is your 4th oasis of the day how accurate can you be? The real kicker is we were told they were going to try to do call a little differently to try to make it better and wanted suggestions. The nurses wanted to sign on a calendar days they requested no call and rotate out accordingly - but that was too much work for the mcp. So now our call is set in STONE, meaning until they have to change it to suit them. It's sad that such a small request couldn't be done, we have many nurses who only see their children every other weekend. They shouldn't have to work those weekends. The real kicker this week was when one of the mcps asked a swamped nurse to do a visit on a patient that was not his and told him if he couldn't work it in he could see it that night because he was on call. It is really sad- I do so love home care but I really hate the place I work now. I have thought about transferring to one of the smaller offices but my current area is right around where I live. I miss the home care company I worked for 5 years ago- when we truly did care about the patient.

RN1263 · Jan 7, 2011

Upper management is always on you about numbers and field staff always has something going on, it was a constant struggle.

Yes, I agree. I feel that are DON didn't practice (when she was in the field) what she now expects and preaches to the nurses, which angers me, but I'm realizing that she's getting some or all of it from management above her. For example, we are on computer, BUT with an admission you have to fill out and have the patient sign 9 papers, as well as fill out 5 additional papers for the office, THEN you have all the work to do still on the computer- Meds, DX, Oasis, SN note, POC, etc. It has been impossible to finish in the home, but now that's what they want. I'll be in the home forever.....I have yet to be able to do it. And I feel powerless, because no patient is going to want me in the home that long. As a matter of fact, when I got to the 2 1/2 hour mark with a patient the other day, they said "can you leave now, I'm tired and need a nap"...So, I left. :rolleyes:

annaedRN, RN · Jan 7, 2011

I do alot of my visit charting in the home, but I do believe if my agency required me to do it ALL in the home, especially the SOC - I'd have to look around for something else. Thankfully, there is no requirement at all except we need it done in a timely manner :) Those SOC are often too long even without the charting aspect!!!

Willow Moonsidhe · Jan 7, 2011

This would definitely change the playing field if home health agencies had to pay by the hour like they use to. You would not be required to see 7 patients and drive 100 miles a day. They would know you would be on overtime and cut the load to about 5 patients a day. Just yesterday I had work 12 hours on call the day before and had 6 patients assigned. At 3 pm they added number 7. I finished out with a 12 hour day. I drove 125 miles did 6 regular visits and an Oasis visit. This week so far I have worked 3 12 hour shifts and 1 ten hour one. I will be paid for 40 hours and one call day. It is nuts.

http://www.leg.state.or.us/ors/652.html

652.260 Payment to nurses providing home health or hospice services; rules. (1) A home health agency providing home health services may not compensate a nurse providing home health services for the agency on a per-visit basis.
(2) A hospice program providing hospice services may not compensate a nurse providing hospice services for the program on a per-visit basis.
(3)(a) The Bureau of Labor and Industries shall enforce compliance with the provisions of this section.
(b) In accordance with the provisions of ORS chapter 183, the Commissioner of the Bureau of Labor and Industries may adopt rules to carry out the provisions of this section. [2009 c.141 2]

~Willow

Willow Moonsidhe · Jan 8, 2011

I have decided I am going to write to the government officials in my state and see if they are aware of how we are paid and the long hours we put in without enough compensation. Maybe the laws in our state can change also. This week by Thursday I had already worked 41 hours. It started snowing and the roads got slick. My car slid sideways so I called my boss to let her know I was headed home. She said I could put 1.5 hours on my time card for today and use 6.5 of PAL time (vacation time) for the rest of the day. Now I am suppose to be on salary and it works for them when my shift goes over several hours and I get paid for only 8 hours but when it is short well that becomes my vacation time used up. I was floored.

~Willow

Willow Moonsidhe · Jan 8, 2011

I do alot of my visit charting in the home, but I do believe if my agency required me to do it ALL in the home, especially the SOC - I'd have to look around for something else. Thankfully, there is no requirement at all except we need it done in a timely manner :) Those SOC are often too long even without the charting aspect!!!

It is kind of hard to chart, change a wound vac, a PICC line dressing and do an assessment all at the same time. And I don't know if any of the rest of you notice it but if you bury yourself into a computer screen the old people look as though you don't really care. They have no concept of the amount of paper work you have to do. They need to be the center of the visit focus while you are there.

I was disabled for a number of years and I made an ER visit one night for bright red GI bleeding. While I was sitting there trying to tell the nurse what was happening to me she had her face buried into a computer screen. It feels rude when you are trying to talk about something so important to you.

No offense meant to you all trying to do it but I am giving you another perspective to think about. If we all take time and drafted a letter to our Senators and Congressmen; I bet we could get some response. Home health nurses to do a really good job should not do more that 5, 6 at the most visits a day and come home and be able to turn work off.

~Willow

RN1263 · Jan 8, 2011

I don't know if any of the rest of you notice it but if you bury yourself into a computer screen the old people look as though you don't really care. They have no concept of the amount of paper work you have to do. They need to be the center of the visit focus while you are there.

I'm paid hourly and yeah that aspect is great, except if you don't play by their rules at every turn, they b*tch, moan, whine constantly- They fired a nurse last week. They want all charting for a regular visit done in the home and now want most, if not all, SOC charting done in the home. So far, I can't do an entire SOC in the home. I totally agree that you must spend the visit with your face in the computer and it stinks. From now on I'm going to tell patients when I make their SOC appointment that it will take 2-3 hours, if they cancel or refuse the visit, perhaps management will re-evaluate this new policy. It isn't fair for patients not to be informed up front. The other day I had to give the patient a lunch break, because I was there 3 hours for a SOC.