Why are RN's not drawn to HH? Only LPN's?

Long Term Care Columnist / Guide · Mar 29, 2006

I tried to get into home health a couple of years ago, but they didn't want anyone who didn't have HH experience and a BSN!! :madface: Now, I don't know exactly how you're supposed to get any experience if no one will hire you, and as for the BSN, 90% of the nurses in this area graduated from the local community college just like I did. The agency still has ads in the paper every Sunday. They still want experience and a BSN. Go figure. :uhoh3:

DutchgirlRN, ASN, RN · Mar 29, 2006

I tried to get into home health a couple of years ago, but they didn't want anyone who didn't have HH experience and a BSN!! Now, I don't know exactly how you're supposed to get any experience if no one will hire you, and as for the BSN, 90% of the nurses in this area graduated from the local community college just like I did. The agency still has ads in the paper every Sunday. They still want experience and a BSN. Go figure.

You could get a job in HH in Nashville in a minute! ASN's are the only RN's we have including the DON. I'm sorry you had that experience because you are a people person and you would have enjoyed HH.

DutchgirlRN, ASN, RN · Mar 29, 2006

$100.00 sounds good, but just like what Suzanne said, it's more like $30/hour because my job does not end after assessing the patient, I still have to complete tons of paper work. Now when they say paper work......what paper work are we talking about here?

With an admission the paperwork takes me about an hour give or take 15 minutes either way. That one hour of paperwork I do at home sitting in front of the TV or sitting out in the yard enjoying the weather so it doesn't seem like work to me. So say 2 hours for an admission. I don't make $50/hr at the hosp. I love HH. I think it's nursings best kept secret. I'd go for it.

Home Health Columnist / Guide · Mar 29, 2006

Our admit paperwork is 15 pages long = 3 pages consents required by Medicare/Medicaid. 35 % MC, 40% MC Managed Care, 20% MA +MA HMO, 5 %other. We so same paperwork on everyone over age 21, non maternity.

If they have a lot of Medicare business, one admit = minimum of 45 min to 75 min paperwork. That does not include follow-up phone calls that may be needed. At 100/admit, they are paying you for paperwork time, millage and cell phone. My admits averaged 1 1/2 hrs in pts home; extensive wd care or > 10 meds = 2hrs.

Paperwork = 60 min

Visit = 90 min

Travel =30 min

Total time spent one admit = 3hrs

$100.00 / 3hrs = $33.33 hr.

Salaries are Philly area averages I've seen

Our Urban/Suburban agency has either FT salaried staff w benefits: health, mileage and $20/monthly cell phone,laptop computer, we provide text beeper

Productivity expected: 30 visits/week; bonus if go above that.

(FT salary: mid- hi 50's.).

or per visit (takes 15 min if not being recerted ---add 30 min for recert paperwork) + mileage + prorated cellphone, laptop if working weekly.

(Per-visit: $42.00 admit;$38.00 revisit)

So admit this way may be $13.50 hr if 3 hours. However if I can see two patients in an hour, rate increases to $76.00 for hour. So that what evens out salary.

Now on laptops, admit visit averages 45 min, revisit 10 minutes for paperwork if you are computer savvy. Non savvy nurses have spent 3 hours entering ONE admission till they get the hang of things. Reduced productivity during this time, of course!

IMHO, Six months is not enough time as RN to be a homecare admit nurse. OK to do followup visits for wound care, diabetic teaching, CP assessments. Don't want to see you get burned.

Long Term Care Columnist / Guide · Mar 29, 2006

You could get a job in HH in Nashville in a minute! ASN's are the only RN's we have including the DON. I'm sorry you had that experience because you are a people person and you would have enjoyed HH.

Thank you. I think you're right, I would've loved home health and/or hospice. But I guess their loss is my assisted-living community's gain........I have a job that's as close to perfect as a job can be, I love it, and according to all the feedback I've gotten from staff and residents, I'm doing quite well at it.

Of course, I don't suppose there's anything more desireable to a headhunter than someone who's already employed: since starting this position in mid-February, I've lost count of the number of offers I've received. In fact, one of the head nurses from the hospice agency in the county where I work now tried to lure me away just last week.........ironic, no? :lol2:

renerian, BSN, RN · Mar 29, 2006

Jennifer glad your paid well. That position I worked for capped mileage at 50 per month, no cell phone reimbursement, no office time pay, on call pay of woopie 100 per week and gee a 7 county coverage area. Put on no less that 150 miles per day. I usually put on about 25,000 to 30,000 miles per year on my car doing home health/no geographic defined area for where the nurses work is stinkey. Wear your cars and car warranties out fast.

renerian

CseMgr1, ASN, RN · Mar 29, 2006

I tried to get into home health a couple of years ago, but they didn't want anyone who didn't have HH experience and a BSN!! Now, I don't know exactly how you're supposed to get any experience if no one will hire you, and as for the BSN, 90% of the nurses in this area graduated from the local community college just like I did. The agency still has ads in the paper every Sunday. They still want experience and a BSN. Go figure.

This doesn't make any sense. :confused: 99.9% of the nurses that I precepted as a former supervisor in HH didn't have any previous experience, and having a BSN wasn't even a variable. What WAS required, however, was an active nursing license, previous med-surg experience, a clean background

check and a demonstrated ability to think on their feet. No offense to those of you out there who do have a BSN, but I think those employers who want only BSN-educated nurses are cheating themselves...as well as their

patients, for being a good nurse involves much more than just a title.

DutchgirlRN, ASN, RN · Mar 29, 2006

IMHO, Six months is not enough time as RN to be a homecare admit nurse. OK to do followup visits for wound care, diabetic teaching, CP assessments. Don't want to see you get burned.

I think six months is fine. I've been a nurse for 30 years with med/surg experience. I have done 1,000+ admissions in the hospital and the oasis admissions in HH are far easier.

I was told by HH that because the majority (90%) of our patients are private insurance that the acuity of the patients is very high. The patients by contrast to hospital patients are extremely easy. What I do clinically in one full day in the field is not even equal to what I do in an hour in the hospital setting.

Sitting in the patients home doing an admission is relaxing, a piece of cake if you will. Once you fill out the admit paperwork a couple of times you've got it. The only problem in being a newer RN would be in their assessment skills and that only comes with time no matter what avenue in nursing you take.

Karen, I respect you tremendously and am not trying to be argumenative or disagreeable. Just want to convey MHO.

jenrninmi, MSN, RN · Mar 29, 2006

Jennifer just wondering if you work for a national well-known company or a small local company? Sounds like a good company to work for. I get paid well but would prefer to work for a company who reimburses mileage, pays cell phone and provides a laptop. Sounds like heaven. My only issue with apply with another agency is that I cannot take call because I cannot drive at night because of my eye disease. My DON says rarely do you have to go out on a call at night. Like once or twice a year. How is it with your company? Thanks!

Visiting Nurses Association. I believe they are all over the country. This particular branch, however, is owned by the hospital I used to work for. This company is union too, (the hospital is not). The company I work for has 80% of the homecare cases in the 6 counties we serve. I'm not sure about the on call thing. We have night nurses. I think the on call is for if the night nurse can't take the case, and her back-up can't take the case THEN I would take the case if I was on call.

RNKITTY04 · Mar 30, 2006

I just recently took a job (last Nov) in HH and at first I liked it but for all the reasons that have been stated I no longer work for HH. The driving all over the city is ridiculous, being sent to scarey parts of town, the paperwork is insane, the phone calls form the office staff were taking over my life.

And I swear my paychecks were NEVER right. To get needed supplies from the office was like pulling teeth. Just not worth it to me. The money was not that great. Maybe I got in with a bad company but it definatly soured my taste for HH.

ZASHAGALKA, RN · Mar 30, 2006

1. Not enough pay. I make much more in hospital.

2. Not enough structure. But more than enough accountability.

3. Too many loose ends.

4. You're 'the boss' without getting to be the boss. Sounds too much like middle management

5. 'Stupid Nurse Tricks' - you know, jump through this hoop, then that one. . .

6. Unreliable job. Every small change in medicare reimburs reverberates through HH. The result: if you don't get the ax, somebody you depended upon does. Or YOUR BOSS does, with all the change in regimes that that implies.

My take in the brief time I flirted with it: too much responsibility for not nearly enough pay. I always felt I was walking on a ledge waiting to be pushed. Or that some dittle I didn't put over some i somewhere was gonna bite me, hard.

~faith,

Timothy.

Home Health Columnist / Guide · Mar 30, 2006

Re amount of time need to start in homecare...

a. Having been in homecare 20+ years, have only seen 1 or 2 nurses with 6 months experience stay with a company or even in homecare for more than 3 months.

b. With a new start-up company, many times the director/manager unaware of regs and clinical documentation issues that turn out to bit one in the behind--they are not getting paid. So they're asking you to complete documents you should have done but didn't know about, fix/update missing info weeks-months after care given.

c. Patient complexity and insurance issues: Polypharmacia increasingly issue for my patient population. Average client on 8 meds, many can't pay for them or meds not on insurance formulary. Insurance company gives TWO visits only to teach wound care, does not cover medical supplies. Discharge services are for SN, PT, OT, HHA--- no insurance coverage for homecare services, but admit RN orders anyone and patient sent HUGE bill, unable to pay----RN criticized for this decision.

Admit nurse needs to be aware how to assist client and setup services. New Grad without prior healthcare / homecare experience would be setup to fail in these circumstances. You don't know what you DON"T know often the case here.

That said, I started out in a new mom + pop type agency and learned through the ropes . Must be self starter, inquisitive and have nose of a bloodhound to navigate some travel directions. If you fit the bill, please consider applying. Your in for a wild adventure and ride!