Why HH nurses quit

sweetsugar · Jan 15, 2011

I cannot stress it enough - complain to the state and federal authorities on labor laws. The Gentiva lawsuit is only a starting point on this issue of unpaid overtime. Contact the attorneys for Gentiva--they are also interested in what home health personnel have to say about this issue (I know, I called).

If home health personnel voice their complaints to the proper authorities, there will definitely be a change in the amount of unpaid overtime being forced upon the home health nurse. I actually quit home health because of this very reason. When I calculated my hourly rate based upon the number of hours I worked, my hourly pay was less than what my mother earns at a shoe factory in Pennsylvania. All of my family kept telling me it was absolutely crazy the amount of time I spent working once I was home (e.g., one hour in the morning and then easily two hours at night). With the particular agency I worked for, all of the data entry was done by the RN on all OASIS visits before the transmission was made to corporate. It was a nightmare! I loved home health and the interraction with the patients. It was the corporate crapola that finally got the better of me .

Willow Moonsidhe · Jan 15, 2011

I totally agree and if you say anything it is about your time management. I thought what time management. I have no time left to manage except work. Most days I start at 7 am and end at 8 pm or 9 pm. It is nuts. I am drafting the letters to legislators and representatives in the state. That is just the start. They are no better than thieves the big companies and stealing from us. I am on salary with points until the ice hits then I am suppose to use my pal time for the 2 days I can't drive on the roads but don't count the day after day I put in 10 and 12 hour days. They are in a loop hole that is gonna catch up with them and I hope they get burned.

~Willow

sweetsugar · Jan 15, 2011

It is NOT about time management. I was a legal secretary in Washington, D.C. before I became a nurse. I type well over 100 wpm. I am organized as all get out. In rural areas, the drive to a patient's house--on average is one-half hour. The visit--if lucky--can be made in 40 to 50 minutes. Then, the charting takes--on average 10 to 15 minutes--if you are charting towards Medicare guidelines to substantiate the need for home care. On an average, a visit is made--in its entirety, including charting, in 1.5 hour. Take 1.5 x 6 visits = 9.0 hours. If you have 7 to 8 visits, the time average is 10.5 hours and 12.0 hours, respectively. The only way a nurse can alter the time involved is to cut the amount of time spent with a patient, as well as cutting the quality of his or her charting. Does this affect patient care--you betcha.

tencat · Jan 15, 2011

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

My job is NOT more important than my family, and if I have to make a choice, the paperwork is NOT going to get done in a 'timely' manner. Asking someone to put their job before all else IS unreasonable. There is a balance, and my job allows me to balance well because I do my job and take care of my patients. If someone has 4 admissions in a day plus patient visits, something is not right with the JOB, not the nurse. I will do the best I can for my patients, but I will not sacrifice myself in the process.

Willow Moonsidhe · Jan 16, 2011

If we all banned together wrote the authorities it would stop. I do not understand why nurses can not present a united front. We are smart and know what needs to happen. Other professions work for fair labor practice and we should also.

Speaking of nurses throwing away home life. I know a 63 year old nurse who cries routinely because she spent night after night with home health charting instead of her husband who died with cancer last year. She would give anything for one of those nights back.

~Willow

caliotter3 · Jan 16, 2011

I see continually where three or four nurses on one case can not even agree to be civil to each other, much less get anything constructive done, so I can definitely see how it is that large numbers of nurses can't seem to band together to accomplish anything worthwhile.

Willow Moonsidhe · Jan 17, 2011

i spent my weekend drafting and sending letters. i hope i get a response.

mrs. rn

01/17/2011

the honorable

united states house of representatives

washington, d.c. 20515-4201

dear ,

my name is mrs. . i am a _______ resident and a registered nurse in the state of __________. i have a concern i would like to present to you. i work as a home health nurse. are you aware of how home health nurses are paid in__________? we are basically hired in as salary but we have to see patients to get our points for the week. the average home health agency requires 31 points a week. this changes the salary thing to actually being paid by the visit. most weeks i work 10 to 12 hours a day and i am only paid for 8 hours of that. this week by thursday i had already worked 41 hours. it started snowing and the roads got slick. 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. well long story short the home health agencies are cheating registered nurses out of paying them what they actually should. with the work load we see 6 to 7 patients a day and drive an average of 100 miles a day. this adds up to a 10 or 12 hour day. they say it should be done within 8 hours. this is impossible. i run as fast as i can and then chart when i get home. they say we are supposed to chart in the home. well while i do wound care, change a picc line dressing, assess the patient, review medications and teach the patient, call the doctor for any complications i guess i could chart and not really do my job. i am not that kind of nurse or person. i have been a registered nurse for 25 years. our elderly and sick deserve our full attention. the patients we mainly serve are the elderly on medicare. these companies are milking medicare and cheating nurses. they will not even pay us for our true gas mileage instead they use bing mileage calculated by an internet bing search. routinely my pay for mileage is way lower than what i actually drive.

i would like to see _________ look into these things. it would be prudent to have an investigative committee look into the labor practices of home health agencies in the state. i have worked for three different agencies this year and found they all do the same thing. one nurse in oregon brought this same issue to their senators and congressmen and their law changed. below is how their law reads now.

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]

we are not in the dark ages now and labor laws protect our workers. somehow these companies have found a loop hole to cheat our state's nurses of well-deserved pay. please give this your full attention. i know if it is investigated you will find what i say to be the truth.

attached is an email i received from my boss regarding putting down my time on the time card.

sincerely,

sweetsugar · Jan 18, 2011

Please keep us posted of any response you get. That would be quite an incentive to make other nurses take a stand on this unpaid overtime issue.

Willow Moonsidhe · Feb 11, 2011

I have gotten reply s from the Governor and he has sent my letter on to the Department of Labor and Workforce Development. He said he careful reviewed all I said and it does need to be looked at. I hope all of you that feel the same way I do will also write in about the bogus 40 hour a week work week that takes 60 to 70 hours to complete.

Thanks

~Willow

Isabelle49 · Feb 24, 2011

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]

What you have posted does not sound real. And, it isn't real. I have often found that 'super nurses' cut corners every chance they can. It takes me as long as it takes me to do the job, and I won't shortchange the patient for company profits.

Isabelle49 · Feb 24, 2011

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.

Sounds like your job is your life. Slow down, don't let life pass you by. I gave my all for many years and shortchanged my son, now I grieve for him every day (he was killed at age 22) and feel so sorry that I missed so much time with him because I felt caring for others was so much more important. God, if I could only turn back the clock. From Ray'sMom

Isabelle49 · Feb 24, 2011

I cannot stress it enough - complain to the state and federal authorities on labor laws. The Gentiva lawsuit is only a starting point on this issue of unpaid overtime. Contact the attorneys for Gentiva--they are also interested in what home health personnel have to say about this issue (I know, I called).
If home health personnel voice their complaints to the proper authorities, there will definitely be a change in the amount of unpaid overtime being forced upon the home health nurse. I actually quit home health because of this very reason. When I calculated my hourly rate based upon the number of hours I worked, my hourly pay was less than what my mother earns at a shoe factory in Pennsylvania. All of my family kept telling me it was absolutely crazy the amount of time I spent working once I was home (e.g., one hour in the morning and then easily two hours at night). With the particular agency I worked for, all of the data entry was done by the RN on all OASIS visits before the transmission was made to corporate. It was a nightmare! I loved home health and the interraction with the patients. It was the corporate crapola that finally got the better of me .

I hear you girl! I would probably do better as a cashier at WallyWorld!