I am an RN who went from acute care to HHC in Jan '11 after moving from Tulsa to Phoenix. I needed something less physical after being fused from C2-C6 in 2008. I had no experience so I took what I could get after applying a few places. I had no idea this company was in such a shamble. I was offered 60,000/year, no mileage but 300.00/month for car allowance???, and 10 PTO days a month. I also have insurance.
In the beginning, I took call at 2.50/hour every Monday-Thursday but now I take call for 10.00/night for the same days because they hired a answering service to route the calls. I should have known this job was going to be crazy when my interview lasted 6 minutes! My training included a ride-a-long with an RN to do one SOC. Yep, that's it. The "DON" hated "teaching" anything and basically answered my questions with "...because that's the way it's done". When I say I was on my own after the one visit, I am not kidding. We have been without a DON for 3 months! The company gets away with this by "using the DON" in their other HHC in another city 2 hours away. The new DON is now training at the other facility; I was so excited to learn that finally we would have resources, at least a nurse in the office to help facilitate orders and assist with questions. Well, I am devasted at this point. The new "DON" has absolutely no HH experience and no OASIS experience. He will be at our office 3 days a week but the rest of the time he will be at the other office 2 hours away. How is this supposed to help me? I have absolutely everything on my own and have put in more hours per week that I can admit. I am more comfortable with OASIS but my fear is that, everything I have learned is crap. JCAHO made their second visit in June after their first visit almost shut the company down. Our auditor was a retired person who was get ready to go on vacation and pretty much flew us through-really??? She did say that my charting was "impeccable" :). Our total staff is 2 full-time RN's, a few PRN nurses, one receptionist, one other person who takes calls, audits charts (she's not a nurse), does pay role, talks with the "corporate" office", and some of the accts payable stuff. Our "marketer", the guy who talked his way into becoming Director of our branch, and then resigned after not being able to deliver on his mission, brings nothing other than a few "dumps". My travel is huge. I can drive up to 3 hours a day and my stuff is scattered everywhere because we "take what we can get". There is not even a nurse in the office to answer questions or send an order for us.
I am so burned out. I am a very good nurse. I have good clinical skills, have great repore with my patients, and am professional. I have learned absolutely everything on my own through many, many, many hours. They actually hired an DON who stayed 5 weeks. This girl knew her stuff and had rescued companies facing really bad things with compliance/OASIS/everything. She knew her stuff the right way but after 5 weeks she couldn't take it anymore and went somewhere where she could actually do what she was hired to do. I am the "primary nurse". I do and do an do. How can I case manage clients I am not familiar with? I work Mon-Fri, the other nurse works Thurs-Monday. There is no continuity in my schedule. Case conferences are a joke. The PT, OT, SW never comes, I don't get report, I don't know what their frequencies are unless I call them and the office mgr says "I can't make them come to the meetings". I am expected to see 5 patients per day but many times I will have 4 or 5 visits and a SOC completely in opposite directions because they don't have enough patients.
When I hear nurses talk about their flexabillity, I'm like "really"? I can't even make and keep a doctor's appointment for myself because I'm all over the place. I did get a 5% wage increase a few months back but I'm pretty sure it's just because they were freaking out that I was wanting to leave. I have asked to go to 32 hours a week because I just can't keep up with the paperwork. I have yet to get that request. I have absolutely no life. On the weekends, I am stressed because I need to do paperwork and my family wants me to spend time with them. I am so passed tired, I'm totally exhausted. I have stayed here because literally I can't schedule interviews because I never know where I am going to be. This weekend I am updating my resume and will definitely make the interviews, so I have a few questions:
1. Do most HHC use paper or computer charting?
2. Is everyone required to attend Case Conferences?
3. What's your distant requirements?
4. Are SOC's the same form, no matter which company you work for?
5. How much training should I expect to receive?
6. Should there be an RN in the office to facilitate orders and assist the RN's in the field. If so, what does a nurse
in the office do to help the nurses in the field?
7. Are you required to keep up with what supplies need to be ordered?
8. How does your DON help you?
9. How many people do you see in a day? (Our starts count as 2 visits)
10. How long do you have to complete paperwork?
11. Does a nurse check your charting or just someone in the office?
Please feel free to comment so I can figure out if this pretty much the norm, if HHC is just hard overall. Also, answering any of the questions will give me an idea of what I can expect from other places.
I would have given anything to have orientation, literally, at that point I was desperate and probably would have paid for it:twocents:. I think you have to let them in the field (supervised) and bring them back, hand them all the paperwork and say "have at it". Eagerness is good, but not to the point that you sabotage a great beginning. I knew from day one what I was up against, very scary and frustrating. It literally took me nine months to go "oh ya, now I get it". Thanks to people like you who are willing to be there and provide invaluable instruction, what happened to me won't happen with everyone. This experience has been hard, at times scary, but I want to try another home health and see what a "normal HHC RN/Case Mgr position is like. This time I'm probably going to computerized charting and I'm sure this will come with it's own frustration level. I have worked on so many computer programs but only in acute care, so I'm hoping my previous skill is going to make it easier. Be patient with you new orientee, let her fall but be there to catch her and maybe then she will "tame the ego".
In phoenix as well and burning out on home health!!!!! I don't know how anyone can do this long term. I put in sooo many hours of paperwork not paid for. Doing 30 units or more per week right now, and have no time left to do the paperwork. I sympathize and am happy you got out of a bad company! We get paid 40 per visit, 75 for SOC, Recert, ROC.
I hear you! I am in a very similiar situation working for a smaller agency with branches in other cities in this state. I have worked home health prior to Oasis. It is very different from my previous experience, and my patients are far sicker now.
Hospitals are sending home patients that are still so very ill, and I have been told that the agency gets bad marks every time our patients get readamitted to the ER, so we have to really try very, very hard to keep them home like getting an order for IV diuretics, waiting for delivery of supplies, getting the IV started (hopefully we can start it), and monitoring them all in one visit or two so that they won't go into CHF? Hello? Is this realistic?
I very much worry about being thrown under the bus in many situations. I had an SOC recently who had so many problems that were not on the referral form, and that there were no orders for (just one example of many).
The hospital nurses sometimes are young and inexperienced. They don't always tell the coordinators the full range of problems that the patient has. Leaving out "a few things" like hemodialysis 3x per week, 4 lumens in substernum, pressure sores, no orders for flushing the J tube or the IV lumens, or the wound care. I did know that my patient had a recent transplant (not a kidney!), was on insulin, and that I had to teach the caregiver how to do tube feedings, and did I mention, the colostomy? Of course, the fact that the CG was in terrible pain from a back problem was not mentioned either. The provider for tube feeding equipment was royally upset when they found out about the central lines that might need flushes (patient has no money). We still don't know if dialysis is going to manage them or not. Very scarey!
Then there is the hospitalist issue. Many do not allow access to them for orders, and "call the patient's PCP" is a standard answer from their staff if you can get an answer. Of course, some patients don't have a PCP. Frustrating? You bet! We all just want to take care of our patients and keep them safe, but this is very, very difficult.
And yes, we do work many hours for "free". The hour it takes just to schedule the cases for the next day is a good example. You get most scheduled, and the ones who didn't answer the phone call back to say that there is a problem, and you have to juggle.
Or you find out the next day when you are already in the field.
I am all over the whole county, and spend lots of time traveling. Oncall usually every 3rd week for a week which I hate. Sometimes more often if one of us is on vacation. Maybe a bigger agency, better organized is the answer, and maybe not. Maybe it's just how things are everywhere. I truly don't know but I am fast approaching burn out.
Specializes in Dialysis. OR, cardiac tell, homecare case managem.
All I can tell you is my neurosurgeon said to "GET OUT OF HOMECARE" after I was fused L 3-5. Every week was 60 hours minumum and of course you are not paid what you are worth, I know homecare needs good nurses and there may be some good companies out there but you burn out so fast. Good Luck wherever you go in your career. Nothing is worth your back or your mental health!!!
tulsanurse1
25 Posts
I would have given anything to have orientation, literally, at that point I was desperate and probably would have paid for it:twocents:. I think you have to let them in the field (supervised) and bring them back, hand them all the paperwork and say "have at it". Eagerness is good, but not to the point that you sabotage a great beginning. I knew from day one what I was up against, very scary and frustrating. It literally took me nine months to go "oh ya, now I get it". Thanks to people like you who are willing to be there and provide invaluable instruction, what happened to me won't happen with everyone. This experience has been hard, at times scary, but I want to try another home health and see what a "normal HHC RN/Case Mgr position is like. This time I'm probably going to computerized charting and I'm sure this will come with it's own frustration level. I have worked on so many computer programs but only in acute care, so I'm hoping my previous skill is going to make it easier. Be patient with you new orientee, let her fall but be there to catch her and maybe then she will "tame the ego".