Why HH nurses quit

Specialties Home Health

Published

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

Specializes in Home health was tops, 2nd was L&D.

Would you be willing to share what part of TN or PM your background? Most of my HH is in FL and that is where I found the blantant disregard.

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Specializes in Home Health.
The State Labor person called me with multiple questions. After I had answered them he told me that he feels they are breaking two federal rules. That is where he wants me to send further information. I hope it finally gets to the place it needs to be. This weeks grand total was worked 66.5 hours and paid for 40. lol

~Willow

Willow, you go girl! Keep us posted. I called our Labor Board in the past about issues and they told me that since Home Health did things differently, they didn't get involved!

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PS At this point I am filling out applications for other types of RN jobs. I am just too tired all the time.

~Willow

I don't blame you. If I worked that many hours without pay I would leave HH also. As I've said before I'm paid hourly, but they pressure us to maintain "productivity" time, therefore some nurses are not charging them for all hours worked. The faster you work the better productivity time you have and they don't b*tch a fit.

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Specializes in ER, L&D, ICU, LTC, HH.
I'm paid hourly, but they pressure us to maintain "productivity" time, therefore some nurses are not charging them for all hours worked. The faster you work the better productivity time you have and they don't b*tch a fit.

How did we let nursing care get to be productivity like a dang factory worker? What happened to "real" quality compassionate care? It makes me sick. I use to work for a University Medical Center Home Health years ago and we did 5 visits a day. Now they expect 7, 8. 9, 10 visits a day. And all that care is reduced to how much they can steal from medicare by adding additional disciplines the patient may not even need. They lie by saying the impossible can be done in 8 hours, they steal from medicare and they cheat the nurses. God Bless the American Greed Machine. You gotta love it. If it were not for the patients I would leave nursing in the dust all together. We need to pray for our poor patients. They only get five visits in 60 days and it is get in and get out and get that money.

~Willow

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Specializes in Home Health.
How did we let nursing care get to be productivity like a dang factory worker? What happened to "real" quality compassionate care? It makes me sick. I use to work for a University Medical Center Home Health years ago and we did 5 visits a day. Now they expect 7, 8. 9, 10 visits a day. And all that care is reduced to how much they can steal from medicare by adding additional disciplines the patient may not even need. They lie by saying the impossible can be done in 8 hours, they steal from medicare and they cheat the nurses. God Bless the American Greed Machine. You gotta love it. If it were not for the patients I would leave nursing in the dust all together. We need to pray for our poor patients. They only get five visits in 60 days and it is get in and get out and get that money.

~Willow

ChaChing! You nailed it! I once interviewed for a company that said they gave a bonus to the nurse if they could get 5 visits done in the first week! I never went to work for them - I guess they thought I was stupid. You are so right about the other disciplines, that's where the $$ is and that is what has Gentiva, Amedysis and others in trouble. 10 visits a day! That is ridiculous. My butt is dragging by the 6th or 7th. Once had a patient tell me the nurse who was seeing her before me never touched her. I told the nurse what the patient said and asked if she knew the patient was a retired LPN, that nurse got out of home health real quick, but she was the darling of the home health agency, the managers couldn't brag enough about her.

When I retire, I am gonna burn my license!

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Specializes in Home health was tops, 2nd was L&D.

My father once had home health in FL. they came to do SOC, nurse never toughed him, opened her computer, tyepd a few things then left in less tahn 10 mins. My mother asked if she was coming back she said no she only did admits. My mother called me. I called the NM and let her know the nurse was right they WERE not coming back ever!! Fired them on the spot, next agency only slightly better.

Me if I do not go back.. it will because of the patients that feel entitled to treat nurse like **** . Been doing this long enough I remember when patients and family blessed the HH nurses and aides, Now they abuse them.. No all but way more than 50% now....that is why I will quit.

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Document as much as you can while in the home. When you can't finish the documentation in the home, take two minutes to fill it out in the car when you leave or drive around the block if it's a paranoid patient. OASIS assessments can't always (usually) be finished in the home, so make sure that you have gathered all the information you need before you leave. I used to have an example of "how to do an OASIS assessment in 30 minutes," I'll see if I can find it. Be sure that you understand the requirements of Medicare documentation so that you're not frequently called back to change something. Now we have to put G-codes on the notes as well, so be sure you understand what category your visit falls into.

Were you able to find "how to do an OASIS assessment in 30 minutes"? Im dying to see what it says! That would be so helpful to many home health nurses, new or seasoned. Any time that can be carved out of the documentation would allow more time to be spent teaching and helping our patients. You are so right that the nurses try to take on things that are not their job. Nurses should not feel like they need to take on another disciplines responsibility just because the patient is confused about what the RN does versus what the PT/HHA/MSW does etc. If I had a dollar for every time I heard; the other nurse does _____, the other home health agency did ______, or the nurse at the hospital did _____. Some nurses feel pressured to do extra stuff that they are not there to do. This is a huge disservice to the patient, the nurses must focus on their goals!!!

Also, just as a suggestion to some of the home health nurses that work their butts off and are not compensated. I used to do the same thing but every since I started working PRN with more than one agency things have gotten SO MUCH better for me. I pick and choose where I want to work, what patients I want, what days I want.... it's great. Plus, you get paid more per visit than a full time nurse because you don't get benefits. SO, you end up working less for the same amount of money. When you are less stressed your paperwork/documentation is better, your patient care is better, your home life is better, etc. If you really need health insurance, buy it independently. If you dont make enough money, see if there is something you can cut from your budget. If you have to drive really far to a patient, call the office in advance and ask for additional money for travel time. Even $15 or $20 extra bucks can make a big difference if you have to do it over and over.

Home health nursing is one of the best kept secrets in the industry, but you have to know how to make it work for you!! If one agency is giving you crap, quit! I guess this really applies to those who live in bigger cities or can drive to a nearby big city to work. I live near Tampa, FL and there are a TON of home health agencies. I have worked for 7 of them, some for less than a week. I keep going until I find one that works for me. You cannot be lazy and succeed in home health care, but this is a great industry if you need flexibility or dont want to work full time hours. Just my 2 cents :)

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Specializes in Home health was tops, 2nd was L&D.
Were you able to find "how to do an OASIS assessment in 30 minutes"? Im dying to see what it says! That would be so helpful to many home health nurses, new or seasoned. Any time that can be carved out of the documentation would allow more time to be spent teaching and helping our patients. You are so right that the nurses try to take on things that are not their job. Nurses should not feel like they need to take on another disciplines responsibility just because the patient is confused about what the RN does versus what the PT/HHA/MSW does etc. If I had a dollar for every time I heard; the other nurse does _____, the other home health agency did ______, or the nurse at the hospital did _____. Some nurses feel pressured to do extra stuff that they are not there to do. This is a huge disservice to the patient, the nurses must focus on their goals!!!

Also, just as a suggestion to some of the home health nurses that work their butts off and are not compensated. I used to do the same thing but every since I started working PRN with more than one agency things have gotten SO MUCH better for me. I pick and choose where I want to work, what patients I want, what days I want.... it's great. Plus, you get paid more per visit than a full time nurse because you don't get benefits. SO, you end up working less for the same amount of money. When you are less stressed your paperwork/documentation is better, your patient care is better, your home life is better, etc. If you really need health insurance, buy it independently. If you dont make enough money, see if there is something you can cut from your budget. If you have to drive really far to a patient, call the office in advance and ask for additional money for travel time. Even $15 or $20 extra bucks can make a big difference if you have to do it over and over.

Home health nursing is one of the best kept secrets in the industry, but you have to know how to make it work for you!! If one agency is giving you crap, quit! I guess this really applies to those who live in bigger cities or can drive to a nearby big city to work. I live near Tampa, FL and there are a TON of home health agencies. I have worked for 7 of them, some for less than a week. I keep going until I find one that works for me. You cannot be lazy and succeed in home health care, but this is a great industry if you need flexibility or dont want to work full time hours. Just my 2 cents :)

How did you work for 7 agencies and not be classified as the horrid "Job hopper"? I am not being smart, I am serious..how do you do that on resume. You can PM me if you want privacy. MY Oasis has assessment and care plans and all built into it by company.. A straight Medicare Oasis I can do in 30 mins. Every time I try PRN, I get worked too much, then cut back, they get mad, then before you know it they have "no visits" Seems they need fulltime just do not want to pay benefits so they do the PRN thing here. Frustrates me!

I can handle all the paperwork, no problem, I am so disappointed in the changes in patients attitude in last 3-5 yrs. And sometimes the Road Warrior gets to me. Majority of 20 yrs I have done HH so I have seen lots of changes. Been out the majority of last year with family illnesses and just interviewing to see about going back to work. Last agency will not hire me even though I am re-hireable(worked notice etc) because NM does not think I had right to quit just because father was dying and wanted to do so at home. So I have had one good interview with LifeCare at Home for prn and another interview for primary care clinic. It is for city workers/families, they have 3 yr+ contract, new to town but is 35 miles away.. HH is local with possibility of pts in 3 counties. Of course no offers yet so probably will not even get offer. In 3 months I have applied to no less than 100 jobs, got 2 interviews until this week. Both of current interviews came from posted resume not application.

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Specializes in Home Health.
Were you able to find "how to do an OASIS assessment in 30 minutes"? Im dying to see what it says! That would be so helpful to many home health nurses, new or seasoned. Any time that can be carved out of the documentation would allow more time to be spent teaching and helping our patients. You are so right that the nurses try to take on things that are not their job. Nurses should not feel like they need to take on another disciplines responsibility just because the patient is confused about what the RN does versus what the PT/HHA/MSW does etc. If I had a dollar for every time I heard; the other nurse does _____, the other home health agency did ______, or the nurse at the hospital did _____. Some nurses feel pressured to do extra stuff that they are not there to do. This is a huge disservice to the patient, the nurses must focus on their goals!!!

Also, just as a suggestion to some of the home health nurses that work their butts off and are not compensated. I used to do the same thing but every since I started working PRN with more than one agency things have gotten SO MUCH better for me. I pick and choose where I want to work, what patients I want, what days I want.... it's great. Plus, you get paid more per visit than a full time nurse because you don't get benefits. SO, you end up working less for the same amount of money. When you are less stressed your paperwork/documentation is better, your patient care is better, your home life is better, etc. If you really need health insurance, buy it independently. If you dont make enough money, see if there is something you can cut from your budget. If you have to drive really far to a patient, call the office in advance and ask for additional money for travel time. Even $15 or $20 extra bucks can make a big difference if you have to do it over and over.

Home health nursing is one of the best kept secrets in the industry, but you have to know how to make it work for you!! If one agency is giving you crap, quit! I guess this really applies to those who live in bigger cities or can drive to a nearby big city to work. I live near Tampa, FL and there are a TON of home health agencies. I have worked for 7 of them, some for less than a week. I keep going until I find one that works for me. You cannot be lazy and succeed in home health care, but this is a great industry if you need flexibility or dont want to work full time hours. Just my 2 cents :)

What are you including in the OASIS Assessment in 30 minutes? For an admit, my total time, visit and paperwork is approx 2 - 2.5 hrs and I have been doing them for 9 years. The 'Oasis assessment in 30 minutes' reminds me of the nurse who saw, but did not touch the patient - not sure how she came up with b/p's, hr's, temps, pulses, etc. Maybe my assessments are too detailed, I do a head to toe assessment and questions are asked about every body system for history of disease. Can't wait to retire!

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Specializes in Home health was tops, 2nd was L&D.
What are you including in the OASIS Assessment in 30 minutes? For an admit, my total time, visit and paperwork is approx 2 - 2.5 hrs and I have been doing them for 9 years. The 'Oasis assessment in 30 minutes' reminds me of the nurse who saw, but did not touch the patient - not sure how she came up with b/p's, hr's, temps, pulses, etc. Maybe my assessments are too detailed, I do a head to toe assessment and questions are asked about every body system for history of disease. Can't wait to retire!

When I speak of Oasis in 30 mins that is Oasis questions only...not your head to toe, your assessment, your vitals, your teaching....I am speaking the specific Oasis question as created for Medicare, not the rest of the admission that your agency needs. Yes from start to finish including creating 485, I can do most in 2-2.5 hrs. Did a cut and dry one once in 1.5hr.. Now I do not know about other posters.. they may mean something different. Proper way to do Oasis is to have pt actually demonstrate ADL's so you can rate correctly.. But how many nurses do that. I do have them do things while I am assessing other things.. It is like a fine tuned routine with me.

If any nurse says she can do an SOC in 30 mins she is lying. Most agencies blend their Oasis in with SOC assessment paperwork but they do not have to..there are some where Oasis stands along and assessment is another set of papers......Think about when you were taught Oasis or updates..assessments never were involved in that teaching, just MOO type questions.

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How did we let nursing care get to be productivity like a dang factory worker? What happened to "real" quality compassionate care? It makes me sick. I use to work for a University Medical Center Home Health years ago and we did 5 visits a day. Now they expect 7, 8. 9, 10 visits a day. And all that care is reduced to how much they can steal from medicare by adding additional disciplines the patient may not even need. They lie by saying the impossible can be done in 8 hours, they steal from medicare and they cheat the nurses. God Bless the American Greed Machine. You gotta love it. If it were not for the patients I would leave nursing in the dust all together. We need to pray for our poor patients. They only get five visits in 60 days and it is get in and get out and get that money.

~Willow

My company is using the "national average" reported for productivity in HH which is 1.55/day, who actually reports this, I don't know? They take are points (SN visit=1, SOC=3, D/C=1.5) total for the day and divide this into are hours worked to create the productivity for that day (and yes this includes our drive time). And you are right it's like a factory worker getting in trouble for not producing "x" amount of parts, in "x" hours worked. They don't care about the patient, as long as they're getting money and no complaints, then they're happy. Oh, and that your Oasis shows improvement in outcomes.... real or imagined. It's pathetic.

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Specializes in Home health was tops, 2nd was L&D.
My company is using the "national average" reported for productivity in HH which is 1.55/day, who actually reports this, I don't know? They take are points (SN visit=1, SOC=3, D/C=1.5) total for the day and divide this into are hours worked to create the productivity for that day (and yes this includes our drive time). And you are right it's like a factory worker getting in trouble for not producing "x" amount of parts, in "x" hours worked. They don't care about the patient, as long as they're getting money and no complaints, then they're happy. Oh, and that your Oasis shows improvement in outcomes.... real or imagined. It's pathetic.

Yes my old company used that same exact scale..according to them that meant a SOC was 1.55 x 3 equals the amt of time you should be able to finish the whole thing...When you work that out it sounds feasible,, but somehow in a regular day it just never really came out that way.. Oasis throw everything off.. Now straight intermittent visits were not any problem.

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