The downside of being a home health nurse
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- Опубликовано: 30 июл 2024
- #nursing #homehealthcare Home health nursing sounds like an easy job but it is no joke. In this video I specify some of the obstacles home health nurses experience on a daily basis.
U spoke str8 facts. When they c a health professional n the hood, esp a nurse...ur good. If u speak when they speak & don't act nervous or uppity, no1 is bothering u. The main thing is 2 get n & get out.
That’s been my experience. I’m usually good in the hood!
I've done home health nursing for 9 years! 8:25 is sooo accurate. I love my lonely elderly patients dearly but when I ask one question and get a 15 minute life story and no answer and about another 35 minutes of assessment and education to go...ahhh.
I about fell out, when you said when you hear OASIS… run! I am retired now but was a Home Health RN 15 years at Kaiser. You are spot on with your points. I saw it as an adventure 😅. I called 911 on people in terrible shape “waiting” on the nurse. One con is working in an area with very restrictive parking like in West Hollywood. So challenging to find a parking place and if you are there too long you get a ticket. I got a few of those. Just another day! 😅LoL
I used to schedule my visits with the longest distance assignment done first. Get out early too. I would work my way back to home . If you get a negative gut feeling about a situation, don’t go back. I had a lady with a creepy sin. After him hanging out during my visits, I told the agency how I felt and never went out. I timed all of my visits. 15 minutes max. It worked for me. I wouldn’t recommend it now however. Be safe nurses and take care of self first.
This is great advice. Thank you for sharing.
Kendra! I've been looking for an RN with good content to follow on RUclips for the past 2 years and just found you. You're awesome! Thank you
OASIS was a nightmare. Non stop documentation. Every time I think about it my mood change. No No. Can’t do it anymore. Done.
Hahahaha I’m in the floor! You took me out with this comment. I’m reliving the trauma right along with you. 🤣🤣🤣🤣
So redundant.
First time watching your channel, and can I just say you crack me up! "Putting shoes on to go fishing" lol you are hilarious.
I've been working as a hospice RN case manager and I love it for all the reasons you mentioned in your previous video. I'm actually from Baltimore, but I now live and work in Northern VA, so no issues with safety in my neighborhoods. I've heard the horror stories about Oasis so I'm grateful that we don't use that EMR. Our routine documentation is 2 pages long and the admissions documentation is only 8 pages. Also, in hospice, we d/c most meds and primarily use comfort meds like morphine, Ativan, etc...
Thank you so much for these videos. I was on the fence about doing home care but this helped me make the decision. ❤ I appreciate you!
You are so welcome!
You are spot on.
I just started with a Home health agency in August. I work at a supportive living & memory care facility so I do not have to travel to homes. Plus side is the facility is 7 mins from my home! You hit the nail on the head with the Oasis documentation and its about to be updated next year 😭 I am not sure how it was when you were in home health but we get paid per visit/time spent per wound. No additional compensation for documentation. Med reconciliation is terrible because the facility usually always has a ton meds active dating back many years. I find myself doing more research for my patients then the actual facility. It can be disheartening at times. I will have to say that Home Health does offer me the flexibility that I need right now with having younger children. It has also made me realize how much I do enjoy teaching. I am trying to decide if I want to pursue a wound certification 1st or look into an MSN program. I am so glad I found your channel!
So glad I came across this particular video about home care. I loved working in home care because of the flexibility I had at times with patients and things I may have had to do for myself. On the other hand, it got to be too much for me because of the case load. Work life balance was non existent. I got tired of having to take my tablet with me to get my patients for the next day, doing follow up charting, calling to make visits etc.. it got to be way to much and the home care agency I was with continued to pile on patients. I remember having to go to a very difficult patient and I cried in the car because I knew it was going to be a long difficult visit. I don’t miss home care at all.
I completely understand! Homecare can be so rewarding but it’s a lot. Patients have so many issues at home and they look to their nurses for help. It’s too much.
17:06 yes documentation! After 9 years, mostly doing admissions with a few years of case managing...the paperwork has grown and gotten worse. Its like a 12 hour shift with the paperwork, I have less time after work now than I did when I first started. Even though I'm home unusually by 3-430pm most days I don't finish my paperwork until 9pm or sometimes the next morning. I'm thinking of applying to a 12 hr night shift doing med Surg...I need a change and although not an ideal shift with 3 kids atleast I won't be bringing home any work. I feel with homecare now there is much less of a work and home life balance..it's weighed down by work and I can't do anything on the days I work because I have to document. I have one foot out the door.
I love your videos and content, and most of all your personality! You are very refreshing and validating. ❤️❤️ Definitely binge watching you the past few days.
If you like home health, don't leave! we need to fight against unpaid responsibilities. The current situation is corrupt politics, not financial necessity. home health could be such a valuable resource if overhauled, but instead we spend our time documenting and our actual visit goal becomes: get VS, make nice, get signature. It is criminal
Thank you so much. I remembered being near tears when I first started HH. I eventually went back to the bedside where I’m at right now.
I am a home Health Case Manager. Just stumbled on your RUclips. I exactly know what you are talking about. Long pages and pages but very flexible with my time. Worked hospital Cardiac and Home Health anytime
Everything you say is true . Esp about documentation! It about drove me over the edge! Thank you for your accurate assessments ! Bless you !
The documentation had me anxious, unable to get good quality sleep along with other horrible feelings. I love home health but the documentation don’t love me.
Home Health was my 'baby' for most of my many years in nursing. All you express about it is true. Even when one expresses concerns about the pitfalls, we do get the 'odd eye' and become branded as troublemakers. Keep telling it all, Nurse Kendra. What you are saying, is absolute truth!
Thank you so much for your words of encouragement. I have so many thoughts on nursing and how nurses are treated, this is def my outlet.
Great information thank you ❤
Everything you said and Omg the mandatory meetings and having to work around them when on the field 😫 I could be documenting and finishing on time but those dam meetings ..
This was very insightful into the world of home health nursing, I am making the transition out of the ICU and into home health so thank you this video was immensely helpful.
You’re so welcome. Reach out if you’d like any more info on home health and how to be successful.
Yes, home health nurses must have excellent knowledge and experience to be successful, I hate when they hire new nurses or with limited to no experience or nurses with limited assessment skills
This is exactly home health 101! I totally agree with all your points! I love this and you! You have been such a light. Thank you!!!
Those 1000 medications is soooo trueee. They pull it out of nowhere. Fridge, under the sink, cabinets, sock drawers. I’m telling you bro!!! Lol and also, the hood is my favorite thing. They’re the nicest people and they also hit u up with a little, “hey nurse, I got a headache… please take care of me” or the elevator “patients” lol those are the funny ones. 😅
Yes!!!! They’re my fav population when doing homecare. So appreciative and yet still so underserved. Thank you for watching, I appreciate the love ❤️❤️❤️🙏🏾
I see you have a channel! Very nice! I just subbed and I’ll catch up on your content 😘
@@KendraRN thank you. I haven’t done any videos in a long time. But I appreciate it. I recently just applied to the ED and I am so nervous starting this career change and stumbled upon your channel. Loving all the nursing content so far. Home health is not doing so well right now and that OASIS is a death sentence lol
Great relevant content-Subbed
i love the comment from the "guys on the corner". People will watch your back. And people in "those neighbourhoods" need nurses! Very important service.
You are so right, if I only knew. Considering going back to the hospital.
Girrrlll what??? Is it that bad???🫣🫣🫣😳
I am considering picking up some PRN work but Home Health is or would be new to me . . . This was very helpful !!
It’s not bad prn, full time is another story, lol
Im in San Diego with 30+ years mostly in critical care. I love teaching and so I thought HH would be right for me. And 7 weeks later so far so good. We take pictures of their med list and add anything else there taking QA in India reconciles the meds for us, they just started doing this. Saves at least 15-25 minutes. Your right about the documentation, ive always been a defensive charter, but i was told by one of our PT manager that im charting too much. He has given me great tips. Yep we use Oasis. It's OOC! I am up to doing one SOC a day and 5-6 f/u visits a day. When I come home I have to chart anywhere from 2 (hardly ever) - 6 and in the beginning 8 hours of charting the things I used to like to do like lifting weights and going to church and midweek bible studies have gone by the wayside. I am sacrificing alot rn but I want to strive to see an average of 7 patients a day. I can also see the value in using an IPAD for wound photos. We dont do wound vacs or any iv's for antibiotics. My default pay is just over 2K a week. Do you think the Ipad will help? Its bigger than the iphone of course and the pix are going to all ready be on it so I think a win/win there. Oh, so pay, once i get wings which is kind of happening now they go by points they expect you to do 30 points a week and anything over and above that is paid by like for me a SOC will be an extra 200$ and F/U's around 150$ if i remember right. so every thing above 30 points is paid by the type of visit with SOC's the most. So i figure an extra 5 visits a week will net me about and extra 5-750$ a week. but in reality thats almost inclluding driving 12 hours a day 5 days a week. In icu I would make 6-7 K every 2 weeks if i worked that much, cuz down here a lot of hospitals pay DT for anything over 36 hours a week. I will say this for some reason after Covid the hospitals are really micromanaging our care in the icu. It used to be so nice and anonymous (kind of) now it seems someone or something is always breathing down your neck. And Modules galore. but i got paid for that. HH you do not get paid for charting thats the suckiets part. The flexibility is great, but I would like to do rx, iv, ventilator stuff and wound vacs cuz all that stuff is right up my alley.
I am happy it’s working out for you. I liked it but the SOC and Oasis did me in. I also found myself getting caught up in social issues. It was too much for me. Thank you for sharing.
Home health will always be a winner with me.. make your own hours, no time clock. I was only doing SOCs for 150/each, Loved those days. Had a work car even. Dont know why I ever left. Main downfall for me was going to the bathroom.. I found myself holding it all the time
I’ve considered going back based on the reasons you mentioned but that darn Oasis 🤦🏾♀️🤦🏾♀️🤦🏾♀️
@@KendraRN girl you ain’t ever lied. But they downsized from 33 to about 22. I know exactly what you meant though when they keep texting you about charts or whatever but I would be with a patient and they just try to sweat me for small stuff and would text me in that annoying tiger text app. You can’t turn it down either. It’s so annoying. I can never go back to the politics of the hospital but listening to your stories make me think about it big time. I seen 7 patients yesterday and 5 were wounds, 2 of them were your speciality wound vacs..
@@KendraRN omg that damn Oasis is the main reason I won’t go back lbvs. I love my geriatric patients and the flexibility. But I refuse to have anymore yellow stick notes telling me to “ correct “ something. That whole documentation system needs updating and simplified.
I’m from Brooklyn.
I ain’t scurd.😂
I’m not going to lie, I’ve been to some places where I was like 👀👀👀
That’s really interesting because when I had home health during my pregnancies(had hyperemesis gravadium). On my good days I went out. I didn’t know I was supposed to be home only. I was also very up and about the house when I was able to. I loved my home health nurses though and I learned sooo much from them.
Thanks for discussing the downside sis! I guess I’m gonna stay in the ICU. I hear you on those medication reconciliation 😫. I really want a break from the ICU. Any recommendations. PCU/ Medsurg?
Sometimes med surg and PCU can be a nice break from the ICU expectations (rounding, drips, travels) but I won’t make a permanent switch. Try home health but stay prn at the hospital, that’s my recommendation.!
@@KendraRN hmm. Great advice. Thanks What’s a great home health agency in the DMV area? We worked together at H in 2020. And I really enjoyed working with you. You are a great nurse! And believe me when I tell you. You were the one that made me started traveling. Thanks and keep it up 🎉🎊👍🏾
After experiencing burnout with Florida's 39 legal patient ratios. OASIS charting had me drop off their box of supplies before lunch. Thank you for the opportunity and good bye 🫂😅
I did pediatric home care.Gained my respect of the family.If you have thick skin you will be fine.I always double check meds and oxygen.Always update your agency via text and document.
Cool I didn't know that you were in Baltimore. That's my home town
Currently?!
Thx, Wanting to get into HHNursing, any suggestions?
I am an admission nurse and let me tell you, I document my butt my off. If my patients have 30+ meds, I will document and all will be completed at their home not mine, I want to relax lol. If they need supplies, I will not only place it in the POC but will order so that the case manager can have access and to see what supplies need to be ordered, especially wound care supplies . I even get the MD to provide an order for DME equipment (Walker, cane, bedside commode, shower chair). Also, if they need additional disciplines such as PT/OT/ST/MSW I’m ordering that too. My biggest pet peeve is leaving a mess for another nurse to clean up (hospitals).
The oasis can be very tricky but once you get the logistic of it, it’s smooth sailing and trust me if a quality personnel wants to change my answers, be my guest and thank you. Lol
Documentation is tedious but having a background as a medical reviewer for CMS, I know how to make sure that the visits maintain to be a medical necessity including the skill and if the patient meets homebound criteria I & II because if not the home health claim is either getting denied or receive a partial payment.
I learned that after my first year of charting all night long. Finally started doing everything in the home even ordering supplies made it so much easier to have a work life balance that way.
@@lthomas3623 absolutely! I don’t see how a few of my peers work at home. I cannot do it. Once, you get a system that works for you then your life will be much easier.
I have some questions for you. Can I email you?
Hey I went to this patient house it was 20 below zero in Chicago the Windy City I called before coming and they couldn’t hear the door 🚪 but in the ruff Neighor the people are actually helpful and look out for you
I do not like Homecare in the winter months! I can’t stand waiting at the door when it’s cold out.
Do you at least get to type that documentation? You're not handwriting it are you? I was a paralegal forever and I have a pretty good typing speed. Where does the information with which you propagate the forms come from? Notes?
Please don't discourage people from working in home health care.
PLEASE!
The paradigm in my city is "aging in place"
I think that's the best thing for most people.
There's a huge need for Home Health Aids and visiting nurses.
Many of the HHA I've met,
MUCH prefer caring for one patient in their home,
rather than working in a nursing home where they have 10 minutes per patient.
That's 10 minutes to wash, dress and make the patient tidy.
Where as in a single home,
The HHA can take their time and care for 1 patient over many hours.
My goal isn’t to discourage. I’m sharing my lived experience. Also the increased amount of documentation is what’s discouraging nurses from staying in home health. That’s a regulation/government issue.
Im a cna, currently in a snf and i want out! My HHA class starts at the end of the month. Any tips? Hoping to do this for the time being while i try to get into nursing school.
I'm a CNA too and worked in both! Honestly home health is the best! I would say get your experience and stay in school as a hha CNA
And you definitely hit all the points on not home health eligible
Hey Girl, will you, please, do a vid on what supplements and vitamins you take ? This would be greatly appreciated for those of us who are looking to live a new and much greater life! 🌈
Hahahah I’ll upload one this coming week. I def want to share what I take daily.
Yayyy! Thanks 😊
I love love home health however I am starting to feel that I have no work life balance. Weekend is the worst. You can already be done with your admissions and at home charting then you get assigned a PRN visit. Have you experienced this? I would love your feedback on this
Yes!!!! 🤦🏾♀️🤦🏾♀️🤦🏾♀️ I have PTSD from homecare. Lol, I’ll do another video on home health.
@@KendraRN please do lol I loved you videos. So accurate
The worst thing for me was that Oasis 22 pages.. U said Run.. lmao.. FACTS the deadlines are ridiculous
Oasis is a beast. I’ve never experienced anything like it.
@@KendraRN We use Kinnser for charting so it formats it pretty good for us. I’m like a zombie when I’m filling them out 😳
Please can you help me with any agency that recruit nurses from Ghana for home health care
I’m not sure what agency that is my dear.
Hey how can I get in touch with you I would like to interview, ask a few ?s of you journey!! As a nurse!! Peace to you!!
Hi, DM me on IG, it’s in my bio. @kengen_rn
my mom did it all for 40 yrs...they did not mess with her !! lol
You forgot the terrible pay per visit structure most agencies use. It’s cool if your prn but full time pay per visit and your pt cancels or isn’t home 🤯
I sure did, lol. It’s a rat race in home health.
Nooooo, I'm making the switch from icu to home health! 😩😩😩 They provide a car and a gas card, so I have to do it. 🤑
That is not a bad deal! Are you staying prn in the ICU?
14:50 - If nurses are "doing too much" by doing the stuff CMS dictates, what's the point of home health? We are about to be smacked with an 8% pay cut in 2023 because we're not doing our job of modifying pt behavior; our focus is instead to smudge metrics. To your concern w med recon: Often, the only pt benefit of SOC is med reconciliation & priming education. Plently of med lists havn't been looked at for years and need review. Nitro is expired, K is missing, the GNC supplement is harmful, they can't find PRNs etc. Slacking off on this is criminal, like, man slaughter criminal. I can't blame clinicians because we are underpaid and negligence is incentivized when the per diem pay rate says you start losing money the moment we knock on a pt's door.
It makes me dispair that clinicians see all these problems and know that they impact care but we treat these impediments as an act of god. They brag about their clever techniques to compensate, say they are just passing through till they get a real job, or sigh in resignation to negligence & 2AM documentation. You say you need to fraudulently admit patients in order to get paid for your work, we just don't do our job because it is uncompensated and we need to act criminally for a $150 that is due to us while making our boss $400 they don"t deserve on the back of OUR license. You all know the problems & our resulting negligence. What i take issue with is the perspective i see taken by my peers. Instead of insisting to be enabled to accomplish our responsibilities balanced with our quality of life, people just quit, we bow to QA falsifying documentation for $ that never hits out bank accounts, we work insane hours documenting and correcting clinically irrelevant crap focusing on performance metrics we can't control and we put so much energy into learning how to play the system that the advancment of our applied science of nursing falls by the wayside. The worst thing is the nurses who LIKE the current per deim set up because they can make a bunch of money. These people are commiting premeditated murder for IDK, $150k, $200k? And then I'm told by management I am bad at my job and hold these criminals up as example, praising their ability to see 10 pts a day! I cover visits for nuses all the time where the pt can't recall a SN conversation about ANYTHING on their POC.
Home health is failing. Clinicians don't even understand why because we are educated by a management who's goals are corrupt. Medicare is making cuts and the problems will escalate until we lose all value and get put out of our misery. 90% of the problem is we need hourly pay and non-exempt status. California has case law finding us non-exempt yet even a letter from my lawyer would not get my agency to respect labor law If you think hourly will net you smaller pay checks, you are part of the problem. We are suffering low wages, compromised integrity, lost family time, complicity in man dlaughter, and unpaid job responsibilities and the only purpose these sacrafices serve is to maximise our agencies profits until the day they render HH so impotent that medicare disbands the industry and you are left unemployed with a resume that says "joke."
You made so many valid points. You need to do a video explaining it all because you gave such an excellent breakdown. You’re amazing and thank you for this insight.
@@KendraRN I've been on one. I have written this essay about every other year for the last 12 years. This time I was Reading an article about the new payment scheme. I wrote a comment that turned into a letter to my representatives... Eschoo is actually my congress woman and she is head of some important medicare committee. But lets face it, we are no longer represented - she will legislate by what is profitable for the health care donors.
The full essay is currently 4.5 pages of basic text, and sort of edited for reading by management at CMS. Until last week I didn't know about medicare structure or CMS and am still very ignorant. They have a section of their website that says 'we are open to creative input from the public and clinicians' but there does not seem to be any way to actually give input. If anyone has knowledge of medicare system and who/how to contact regarding nursing practice policy input would be appreciated!
As for video... I prefer to remain a bit low key at the moment. Union busting is a real thing and several of the top ten spenders in this industry are medical companies (Labcorp, Quest). I have a pretty unique voice so it would need to be done with synthesizer. I've gotten my company blacklisted by the VA because I initiated an investigation by contacting politicians who outed me. I have little faith in petitions as they seem ineffective and I suspect they serve only to diffuse and ignore public anger BUT, maybe a petition of professionals to CMS mgmt would have some pull?
Do you think new grass could do home health?
I’ve been in home health for over 10 yrs. It is important to get basic understanding of disease states (chronic and acute) before home health since you often have to make independent decisions. I suggest med/ surg or a couple yrs of hospital experience if possible first. Hope this helps!
I won’t recommend it. You’re alone in the field, you have to draw from experience.
Yea medication management seems like the worst pain in the butt. Especially because it's the most prone to errors/insufficient information, patient harm and risk for lawsuit. No thank you on HH.
Don’t agree with it being discriminatory. If you don’t feel safe, you don’t feel safe. If you didn’t feel safe in hospital you wouldn’t take the assignment.
There’s a lot I say about this, but I’m not going to type it all out.
Have you heard of home health nurses having a difficult time with buying a home because of getting paid per visit even though they are full time?
I haven’t but I can see how that can cause a problem. They want to see consistency in pay.
What happens when you walk in a cluttered house
That’s a common thing. I just try not to bring a lot of stuff in there.
Common sense unfortunately is NOT a common thing these days.