Why is there so much turnover in home health? Esp. mgmt

0402 · Jul 27, 2011

My mom does HH (not private duty) and has been there for many, many years. From talking to her and seeing what's around here (I'm in the hospital setting now but have an interest in HH, so I do check out what's available from time to time), I think that it is seen as the future in health care and as a result, many private companies are opening, trying to get in on the market. My mom works for the HH branch of a hospital system. Personally, if I were to get into HH, that is the only way I would do it. It seems like there is so much variation in pay and policies with each individual company, whereas there is consistency within the hospital system.

klone, MSN, RN · Jul 27, 2011

I agree with you that a HH branch of a hospital seems safer and more secure. OTOH, my husband took a risk last year (with my encouragement) and got in with a startup company, and they're positively busting at the seams, and he's very upwardly mobile (helps to be the most senior person working there). While others were jumping ship and going to more established companies, he stuck it out and is now reaping the benefits. Of course, the company that funded the startup of this branch has pretty deep pockets, so they had quite a bit of scratch to work with. He never had to worry about not getting a paycheck.

0402 · Jul 27, 2011

I'm not discounting start-ups and business opportunities in general, just my observations regarding HH. =) I think that the companies are starting because there really is a market for it, and I'm sure that the hospitals can't even meet all of the demand that is out there. There are probably great private companies, as well- things seem to vary by part of the country, too.

honeykrown, MSN, NP · Jul 27, 2011

I did HH (not visiting nursing), the good side is you get a lot of time with your patient and the family members (just one patient). I did it because i was going to school and i was able to read at work.

The management position for HH is very stressful. From what i understand, dealing with the doctors, family and then staff can get very demanding and in HH people tend to call out a lot. if 3 nurses call out from their cases and you cannot have a fill-in then you are left to cover the position or leave the patient without care. Also family members sometimes can be picky. they don't like nurse A but then want you to find a replacement immediately.

nursearoo · Jul 27, 2011

I can tell you 1st hand....I am a PDN homecare nurse and I do supervisory visits also & I work with peds &have been for 4 years....the beginning of this year a job opened up as a clinical manager/ clinical care coordinator....(basically DON pretty much) I was offered the job & took it......and I only stayed in that position for a month ...the reason is because of all the extra you are required to do in addition to the office part......driving out on a minutes notice to do a post hospital visit or issue with the patient/family, dealing with nurses needing reeducation & reprimanding etc... follow up for an issue, handling issues nurses call in regarding the pt &/or family, complaints the family has with a nurse, calling to track down a doctor to clarify orders or sign orders faxed over weeks ago (have a time frame to have signed orders in the office per state regs).......the $$$ sounded great, until you actually are doing the job......I used to drive 75 miles one way to the office, have to drive all over for visits, then drive back home......usually getting home in time to shower & go to bed just to get up & do it all over again the next day.....then throw in not eating right, little sleep, lots & lots of worry & stress...basically thinking about work when not working...so it seemed like I was working 24/7.....and also if a patient got out of the hospital we had 48 hrs to see them for a post hospital visit....it is a regulation.....so imagine making plans with your family for something and then not being able to follow through because you have to go do a visit, then being on call every night from 5pm until 830am ........not fun.....

I think that's why in the position I did it has a high turnover......you think the pay is great, then you actually do the work.....It's too stressful....I went back to PDN and also help the office out by doing supervisory visits each month......still alot of driving, but at least I keep my sanity .....I would never do that job again anywhere for any amount of $$$$$.....

klone, MSN, RN · Jul 27, 2011

Thanks for the insight, Mrs. Reilly! Yes, that sounds familiar - exactly like my husband's job. He's always dealing with work, even at 8pm on a Saturday night. His work cellphone goes with him EVERYWHERE he goes. He had to leave dinner last night to go to a death because the care home called 911 when the woman was found dead, and the coronor would not release the body until my husband came out to approve it.

So basically, it's a high stress job that nobody wants!

netglow, ASN, RN · Jul 27, 2011

I'd be careful though. Lots of private ownership HH and Hospice popping up. They have beautiful websites, remember anyone can get a beautiful website - just hire a design/marketing firm to design it and find a few good marketing writers and you are off to the races. Some really lay it on thick and spend some big money because HH and Hospice are BIG MONEY. It's tough to research these privately owned companies, and some can be really bad news. You can find yourself working for some really ethically challenged folks.

I'd hesitate unless they have some kind of hospital backing, or are a business with some sound history as one poster mentioned about her husband above. If you interview, as for the names of your chain of nursing command as well as those that run the place. Research them, look them up on your state licensing website to see how long they've even been in nursing. Don't assume people are going to do the right thing when they decide to have a healthcare business. I now often look up the not so well known companies on yelp, glassdoor, medicare.gov, any state oversight orgs. I also google them a million different ways. Then I ask around. You just have to do all of it these days and then evaluate it all and decide what you think.

xoemmylouox, ASN, RN · Jul 27, 2011

I think that a lot are popping up too quickly, and the office is then ran poorly. I have worked with two different companies that seemed great in the begining, but I soon learned what they were really like unprofessional, greedy, and willing to throw you under the bus/in an unsafe situation. I know not all companies are that way, but I always say do a lot of research, and if it sounds to good to be true it is.

laughing weasel · Jul 27, 2011

I have worked HH for 5 years tried different companies twice for more money. If you do home health ask if you can speak to some other nurses. It is extremely important to find one that you like and can trust. I love working nights and working with one patient. The problem with hh from management view is because of the demand you have finicky nurses,parents who get picky(these people are going into their homes!) and nurses who lack skills or ability to bond with pt family while remaining proffesional. You are responsible for keeping every one happy with as little overtime as possible . YUUUUUUUKKKKKEEE!!!

netglow, ASN, RN · Jul 27, 2011

You know, I would also add to my post that, "hospital backing" cannot be assumed because they list that hospital on their website. It's sometimes is simply that - just a listing. They can say they've "worked" with a hospital system, but, maybe they sent a sales person there once. It could be that they were so effed up that they basically are unwelcome at that facility, but, they list it on thier website anyway. It's best to actually find out if they are a preferred HH or Hospice directly from the facility casemanagers. You will find out lots this way and it will enlighten you!