Working all the time in HH

chenoaspirit, ASN, RN · Dec 4, 2009

Well, my doc put me on steroids and valium, of all things, for my neck/shoulder/arm pain. A low dose of valium, but still... My boss took pity on me and allowed me off work for 4 days. It took forever to get my charts in order for the prn nurse to cover for me, but i am soooo thankful to be off. I cant tell you how many weeks it has been since i actually had a whole day off, let alone 4 days in a row!!!! I have some paperwork to do, but im not touching it until monday. I am layed up on the couch with my heating pad and pain meds.

lamazeteacher · Dec 4, 2009

Chenospirit:

Let this experience be enough to let you set more clear boundaries when you go back to work!

You need to let your boss know that you will expect labor laws to be respected, when you go back; and that you will work 40 hours /week, (including paperwork) and avail yourself of breaks and mealtime as the law dictates. It evolved through the sweat of workers whose lives were usurped by unfair labor practises. To ignore that, is to betray all those nurses and other workers whose lives and health could be endangered as was yours. Unrealistic expectations of HH workers has been perpetrated by nurses who thought it was their fault if the demands of their agencies meant they should work longer and harder than they should.

With unemployment as it is today, more nurses would have jobs if others didn't work such long hours in an attempt to do the impossible. Four (recerts, admissions, discharges) - six (regular) visits/day is possible, no more!

We need to be confident in our abilities in order to overcome unfounded criticism about the need to work faster. An example of that type of thing, is a diabetic patient I saw who was blind and wheelchair bound. He lived alone in his house which opened onto a pool that wasn't 3 feet from his sliding glass back door. The nurse who visited him before me, had not reported the pool danger and had given him a pamphlet (he obviously couldn't read) about programs for blind, homebound patients. The nursing care plan didn't state that he was unable to prepare his own meals or shop for food, and needed OT and a nurse's aide for help with ADLs.... :eek:

berube · Dec 4, 2009

when i got a call yesterday about having to change a regular visit into a soc (change in payor source, i understand that, but would one more visit as indigent make that much difference!!!), i responded i have a soc, roc and 7 visits, and you want me to do another soc and d/c (had to discharge him to open him again) on top of all the rest i have to do" the response was ,,,are you ready,,,"it's just paperwork"!!!!!!!!!!!!!! if i didn't hang up the phone, i would of jumped thru it and lord knows what!!!!!!!!!!!!!!!!!!!!! most, not all, but most managers have forgotten what it is like to be in the field. AND have forgotten it really is about the patients!! those are the people that keep me going, i love my patients. i have done HH for 30 yrs and it will never change.

chenoaspirit, ASN, RN · Dec 4, 2009

I know what you all mean. The other day, I had 3 Recerts, 1 SOC, and 1 ROC, plus 3 regular visits. I did the bare minimum while in those homes so I could go on to the next patient. We have 24 hours to turn in our OASIS's. Needless to say, I did NOT get them turned in within the time limit. Over that weekend, all I did was paperwork. Then later to findout that my ROC visit should have been a d/c and re-admit because his first visit after a recert cant be a ROC (I didnt think of it while I was there) because he had gone into the hospital and discharged between my recert and the next visit. OMG, this paperwork is rediculous. I truely feel that there is more paperwork than actual nursing care. And I dread the OASIS C. Im so used to this one.

My neck/shoulder/arm is finally beginning to improve. My doc put me on valium and started me on steroids yesterday. I know stress is what caused it.

Lamazeteacher, you are right that I need to set boundaries, its just so hard. It isnt just me, all of us are overwhelmed, even my boss. She was still in the office at 7 last night correcting codes on lab papers that all the field nurses had turned in with labwork, so we wouldnt have to do it. She is a wonderful boss. Our agency is just growing so fast and we cant keep up. They have just hired a new nurse for float and I hope it eases it some. If not, then I guess my only choice, for my health's sake, I will have to find something else. Your story about the diabetic patient worries me. And sadly, that happens alot. Ive visited patients like that when I was covering for nurses on vacation and found dangers like that. Its scarey. These agencies need to realize that patients should come before money/paperwork and allow us nurses the time we need to provide adequate care. Some days (well, most days) I feel like Im running in and out of homes and not really doing anything to benefit the patient because Im so stressed out about how many I have to see.

Im so glad for this website. Its soooo nice to be able to talk to you guys...people who understand what Im going through, and to know that Im not alone.

chenoaspirit, ASN, RN · Dec 4, 2009

The PRN nurse covering for me today has called me 4 times!!!!!!!!! OMG. OMG, OMG. I hate this!!!!!!!!!!! Ya know, look in the freaking charts. I gave her the entire charts so she would have all the info she needed. I might as well just go to work and do it myself.

berube · Dec 4, 2009

The PRN nurse covering for me today has called me 4 times!!!!!!!!! OMG. OMG, OMG. I hate this!!!!!!!!!!! Ya know, look in the freaking charts. I gave her the entire charts so she would have all the info she needed. I might as well just go to work and do it myself.

we are told we need to make it as easy as we can for the PRN nurses!! i am all for helping my co-workers, but come one-i agree look in the chart, but it is sooooooooooo much easier to call the casemanager, and in our office, the managers say--oh call so and so (casemanager) and she will tell you,,,,LOOK IT UP!!!!!

and our managers are out of the office by 5,,cant remember the last time i was done at 5! and it is all of the nurses that are overwhelmed...well gotta go, working the weekend and need to get a jump start on the paperwork!!!!

lamazeteacher · Dec 5, 2009

we are told we need to make it as easy as we can for the prn nurses!! i am all for helping my co-workers, but come one-i agree look in the chart, but it is sooooooooooo much easier to call the casemanager, and in our office, the managers say--oh call so and so (casemanager) and she will tell you,,,,look it up!!!!! whenever case managers are off, they need to have left the care plan so explicit that someone can go right in and do what is necessary for patients (unless a change in condition happened overnight). with that in place, there should be a rule that staff who aren't there should not be called on their days off. in case someone calls anyway, he/she should not respond to the telephone.
and our managers are out of the office by 5,,cant remember the last time i was done at 5! and it is all of the nurses that are overwhelmed...well gotta go, working the weekend and need to get a jump start on the paperwork!!!!

managers need to stay at the office until all their workers are ready to leave! if other workers are still there, it's obvious that the manager didn't manage so well....... :imbar

berube · Dec 5, 2009

i agree with everything you said!!!! alot of times we don't answer our phones on days off, but they call and call and call!!!! i don't think there is any good answer except to be able to vent here with people that actually do understand.

when i do have a day off, i make a reassignment sheet out for the patients that have to be seen with everything, down to the time they eat lunch and yet still get calls with questions!!!! never ends!!!!!!!!!! retirement around the corner???

tewdles, RN · Dec 5, 2009

i know what you all mean. the other day, i had 3 recerts, 1 soc, and 1 roc, plus 3 regular visits. i did the bare minimum while in those homes so i could go on to the next patient. we have 24 hours to turn in our oasis's. needless to say, i did not get them turned in within the time limit. over that weekend, all i did was paperwork. then later to findout that my roc visit should have been a d/c and re-admit because his first visit after a recert cant be a roc (i didnt think of it while i was there) because he had gone into the hospital and discharged between my recert and the next visit. omg, this paperwork is rediculous. i truely feel that there is more paperwork than actual nursing care. and i dread the oasis c. im so used to this one.
my neck/shoulder/arm is finally beginning to improve. my doc put me on valium and started me on steroids yesterday. i know stress is what caused it.
lamazeteacher, you are right that i need to set boundaries, its just so hard. it isnt just me, all of us are overwhelmed, even my boss. she was still in the office at 7 last night correcting codes on lab papers that all the field nurses had turned in with labwork, so we wouldnt have to do it. she is a wonderful boss. our agency is just growing so fast and we cant keep up. they have just hired a new nurse for float and i hope it eases it some. if not, then i guess my only choice, for my health's sake, i will have to find something else. your story about the diabetic patient worries me. and sadly, that happens alot. ive visited patients like that when i was covering for nurses on vacation and found dangers like that. its scarey. these agencies need to realize that patients should come before money/paperwork and allow us nurses the time we need to provide adequate care. some days (well, most days) i feel like im running in and out of homes and not really doing anything to benefit the patient because im so stressed out about how many i have to see.
im so glad for this website. its soooo nice to be able to talk to you guys...people who understand what im going through, and to know that im not alone.

most certified home care agencies that i am aware of are for-profit endeavors. their first objective is profit. they provide quality care as the profit line will allow. in other words...if quality would suggest that a nurse complete x number of visits per day and profit demands that a nurse complete y number of visits...the nurse will be expected to complete y number of visits. the anticipation and expectation of the employer is that there will be a profit...breaking even is not an option. this basic necessity to generate profit is in direct conflict many times with the nurse assessment, particularly in the cases that have been mentioned here...the nursing assessment that would require that more time and additional steps be taken at that moment, rather than hurrying up through the process so that you can move on to the next oasis visit. as nurses, we cannot enter a home, identify an urgent or important issue and then simply generate a care plan and leave the interventions to the next visit. most of us will try to take action on those problems right then and there and end up doing the paper work later...often unpaid. this is unacceptable but as long as we have nurses who will tolerate it because they love their patients so much it will not end. at my last home care job i started doing all of my documentation in the patient home. really ticked the patients and families off sometimes cuz as we all know, it is not a 15 min process to complete a soc oasis. but my pda and documentation system required a pt signature at the end of my visit, and i was not paid after i left the home...so...i did not leave until the work was done.

KateRN1 · Dec 6, 2009

After a mini-breakdown at work about three weeks ago, my boundaries have been made clear. I am a happy team-player, but the rest of them have to be team players, too. After working 50+ hours the week before, and working all weekend (my on-call), I was looking forward to having a lighter day the following Monday. It didn't happen when I got handed a SOC in addition to my three regular visits. Same thing happened on Tuesday. By Wednesday when it happened again, I was so tired I couldn't see straight, couldn't put my contacts in that morning (or for almost a week after) due to eye strain/fatigue. I came very close to walking out at that moment. I made some phone calls up the chain of command and while no one was the least bit sympathetic, I did end up with the afternoon off. I talked to my director a few days later and it was made clear to me that I was out of line asking for an afternoon off, that I needed to "find my joy" and get with the program. Ummm . . . . hello. I think not. I have a family that I rarely get to see. I'm in the office between 7:30 and 8:00 every day, rarely finish before 5:30 and of course I don't take an hour for lunch, so that's 45-50 hours a week. Apparently it's not enough to justify my salary. Since my little hissy-fit, though, I'm not being scheduled more than 5 visit points per day anymore. At least that's something.

This office (agency?) doesn't appreciate the skills of a case manager, the follow-up with physicians, DME companies, family members, and all the myriad of minutiae that requires a blasted paper trail. If it's not a revenue-generating visit, it doesn't count. I have refused to do the 30-minute-minimum visits and will stay in the home until the documentation is done. My regular visits run an hour if it's a patient that I know, sometimes longer. Apparently my time management isn't up to par since I can't get an assessment, teaching, wound care, and documentation done in 30-45 minutes. I am frustrated beyond belief with this and am biding my time until I can move on to someplace else.

cwood88 · Dec 8, 2009

I agree with everyone here I feel your pain too!!! like 8 soc in 5 days and when I take call every 4th weekend I don't take any time off for it I use it as vacation time so when my fiancee comes home from Iraq I can spend time with him. But I have a question, Are most everyone here salaried or are you guys/girls paid per visit? I am salaried and tired of working like most of you 50+ hours a week:angryfire My patients have even commented on how tired I look wow!! In the last 2 years since my fiancee has been gone I have seen him a total of 4 weeks 2 weeks last year and 2 weeks this year and now they tell me that they have suddenly set a new policy that you can't take more than a weeks vacation at a time and they will allow only 1 2week vacation a year, my response to them was, how would you like it if you didn't get to see your husband or son or fiancee? I look at it this way he is over there fighting for "THEIR" freedom as well as mine and you won't allow me to have off to see him, well they can kiss it where the sun don't shine. :up:

lamazeteacher · Dec 8, 2009

i agree with everyone here i feel your pain too!!! like 8 soc in 5 days and when i take call every 4th weekend i don't take any time off for it i use it as vacation time so when my fiancee comes home from iraq i can spend time with him. but i have a question, are most everyone here salaried or are you guys/girls paid per visit? i am salaried and tired of working like most of you 50+ hours a week:angryfire i was working per diem, sometimes over 65 hours/week when i first started, in 1994.....
my patients have even commented on how tired i look wow!! no kidding, fatigue is a concern for patients, as they know mistakes are made more frequently when one is sleep deprived, and it scares them!
in the last 2 years since my fiancee has been gone, i have seen him a total of 4 weeks 2 weeks last year and 2 weeks this year and now they tell me that they have suddenly set a new policy that you can't take more than a weeks vacation at a time and they will allow only 1 2week vacation a year, it shouldn't include you, as you've worked there longer than the new policy existed, and earned more vacation time than newer employees there (an incentive to retain staff, not required by any law that i've heard about). did they say what made them change their policy? is the agency so small, that there's too few staff to allow what really is the accepted period of time for vacations?
my response to them was, how would you like it if you didn't get to see your husband or son or fiancee? i look at it this way he is over there fighting for "their" freedom as well as mine and you won't allow me to have off to see him, well they can kiss it where the sun don't shine.

i can understand and sympathize with your anger; and i know that employers also feel your pain (since i've worked around military installations many years). however they won't bend rules they think they had to impose, for one employee whose fiance works for our country. it would be better if you would look at other ways to get the time you need - such as using the overtime accumulated, when he's home (unless they'll pay you time and a half after 40 hours in one week have been worked). then they'd be in compliance with labor laws. you could agree to work 5 holidays (if there are that many before he is furloughed), in return for having that "extra" week.

it's terrible that others don't appreciate the sacrifice your "fiance" and you are making. perhaps if you set your wedding date, they'd be more convinced that yours is a permanent relationship. it shouldn't be necessary to do that for credibility, but there are people who have seen engagements come and go. when you work near a military base, families of soldiers get special consideration, usually out of respect for the hardships they endure in their lives. so rather than arguing that your man is saving their lives (a concept that many people stateside doubt), you might go other routes of persuasion.

i wish you the best for your next time with him, and in your future together. :icon_hug: