WWYD?

[KateRN1]

I've been working for a small HHA, poorly run, no proper equipment or real supplies, not paid mileage or an hourly rate for office time. No orientation to speak of. Sounds terrible, right? In some ways, yes. But I have incredible autonomy, can manage my patients as they need to be managed without interference, am completely on my own for teaching (which I love, so is good for me), and can make my schedule however it suits me (and my patients, of course). The per visit pay rate is best in the area, but census is down and no benefits.

Recently, I've been offered a full time position as a field nurse with a new HHA moving to town. They have excellent orientation, aggressive marketing staff that will pull up the census quickly, and several long-term staff members in their home office (out of state). When I originally interviewed, I was very excited about the possibility of getting in on the ground floor, but that was over two months ago and I'm still waiting to hear from them about visit rates, etc. (I know that it won't be what I'm making now, more likely around half the rate after hearing what they've discussed.) I had another interview with the owners last week and was at first denied the position, then offered it a few hours later. Issues with this company are that they are micromanaged to the nth degree with not much flexibility. They expect (demand?) a productivity of 7 visits a day, and I don't know how that can be done in an eight-hour workday. There is no wiggle room for scheduling, it's all done by schedulers and case managers in the office. They say I would get a printout each morning of which patients to see (and presumably in what order), that supplies would be packaged up and ready to take with me (no "shopping" the supply closet), and that teaching materials would be provided.

I intially said yes to the offer from new HHA, but am still waiting for them to announce visit rates (which may well be a sticking point). No info yet regarding when to start. No info at all, actually. Lack of communication is a big issue for me. At least at the agency I'm at now, I can call my supervisor anytime and get the info that I need, whatever it is. I've been having nightmares every night since I pseudo-accepted the new position and am now wondering what I should do. Is full-time and benefits worth the loss of my autonomy and flexibility? Is it worth killing myself with an expected productivity of seven visits a day? Or would I be better off trying to find another PRN position to supplement my original employer and forget about health insurance until healthcare reform pushes its ugly head through the door (not holding my breath!)? Help me think "out loud." What would you do and why?

[classykaren]

I would stay were you are at. and try to find another PRN position to supplement.

[Southern Fried RN]

I'm not in HH but I took a job once for the health insurance benefits (child with multiple medical issues, working in the sister adult facility= good benefits at the peds clinic). It was the worst job I have ever had because the management of that particular ICU was so nit-picky and micromanaging. My husband is in HH and he loves it because of the autonomy. I enjoy independence in practice and have considered HH because of that and the flexibility. Anyways, my point is that you may end up hating the new job and being miserable may not be worth the trade-off.

I know several nurses who do PRN for several places and just buy a health insurance policy from BCBS. It works out for them because they don't have a chronic medical condition. It's a hard decision because healthcare can get expensive but then you have to be happy in your work environment too. Good luck making a decision.

[paradiseboundRN]

I was in a similar position. I ended up at the micro-managed agency because the other one did not have enough patients to keep me busy (or make a decent income). What I found out is that home care is harder to micro-manage than the managers think. They told me at my interview and at orientation, ALL THEIR RULES. I was annoyed at first but once I was out of orientation and on my own, I found that the rules are more lax than anticipated. The key is trust. Once they trust that you are going to see the patients, do the documentation and not raid the supply cabinet, they let go of the micro-managing a bit. I did compromise too. I found out which of their rules are NOT flexible and I follow them to a tee. I feel the other rules are left up to interpretation. Also, I watched the other nurses and how they conduct themselves and keep their autonomy. I have even questioned a nurse to two (very casually) about rules that sounded a little harsh. Usually their answer is "Don't worry about that, as long as you do this...." I have been at this agency for 4 months now and so far that are happy with me. Good Luck!

[caliotter3]

Based on what you said in your post I would stay with the present job and look for another job to supplement. Demanding 7 visits in an 8 hour day is asking for too much in my opinion. I am certain that you are getting great productivity with what you have to work with and your way of doing things now. I wouldn't want to add nitpicking to a near impossible workload. Where in the 8 hours, is time budgeted to get to and from all these clients? I just wouldn't want this kind of a situation.

[KateRN1]

Thanks, everyone, for helping me to think out loud. Caliotter, you hit the nail on the head (like you so often do with my questions). She called me last night from the new place and gave me their quotes for pay. I don't want to give actual numbers in public, but what they're offering is considerably less than what I'm getting now. Like almost half. Hubby and I ran the numbers last night and it comes out to this: I can make almost the same pay for 4 visits with my current agency without mileage, would have to do at least 6 visits (considering 1 SOC and rest are straight visits) with mileage to make same $. At my current agency, that allows me to be home in time to put my toddler down for a nap if I start out early enough (which is always at my discretion). I would have more time with family in the evenings, and would be able to claim $0.505 per mile on my taxes at the end of the year instead of accepting the mileage reimbursement of much less than that from the new place.

I asked about productivity and here's the answer I got. They figure an average visit is about 45 minutes. They don't ever want it to be less than 30. Fine, I agree. But most of my visits are right at an hour. And what about the days when you have to take some extra time? And even if they plot everything out so that they're close together, you're still looking at almost two hours of driving a day. There's almost no way to go between homes in less than 15 minutes and I do factor in my driving to/from office if I'm required to be there daily (which I would be). My current agency, I have a fax at home and use it regularly. I rarely have to be in the office, but do like to go for face time.

As much as I'd like to have health insurance, the idea of being gone from 0730 to 1830 every single day is horrifying. I missed so much of my daughter's early childhood between work and school (she's 16 this year) and I don't want to miss so much of my son's (almost 2 1/2). I'm really leaning on staying put, helping to build up census, putting my best self forward, and aiming for a more solid position there. I think I'm gonna go with the moonlighting idea, pick up some supervisory visits for another agency, maybe apply for adjunct faculty position at one of the local career colleges.

[paradiseboundRN]

I'm glad that you were able to think this through but FYI.. most agencies , at least in Michigan (that are paying benefits) expect productivity of 5-6 per day. So 7 per day is not that far off. I'm usually done with pts by 2pm and then spend a couple of hrs at home documenting. It can be done!

[rainbow62]

Back in the old days of home care you had to do 7, but could not say no unless you had 9. Fortunately it was a small place and it was easily managed and that was before computers so I could sit at ball games and chart.