Would you consider my job full time or part time?

In My Humble Opinion
1

I’m a Home Health RN (Registered Nurse, not Royal Navy). I get paid per patient visit. Patient visits are one hour to an hour and a half.

I have “my” patients, meaning there is a roster of people I see on an ongoing basis. Legally, these are not “my” patients, but the company’s. If I leave, I don’t keep my patients (in fact I’ve signed some strongly worded anti-competition clauses forbidding it.) Sometimes if another nurse can’t see her patients, I will see them, at the same visit rate.

When they get a new patient referred to the office, the manager calls me and asks if I want it. Depending on my case load and the location, I may say yes, I may say no. So I largely control how many patient visits I do a week. I also control my actual schedule - while people need to be seen “this week”, I use nursing judgement and my own preference to decide when to visit them.

If there’s a special project the office needs help with, like training a new hire or doing chart audits, they pay me by the hour for that at 2/5 of my patient visit rate per hour. That’s usually under 5 hours a month.

I have specific forms I have to use, specific time periods (ie. “within 24 hours” or “on the 30th day of the certification period”) when things have to be filed and people have to be called.

I do not get paid for time spent driving, doing paperwork, calling doctors or physical therapists or that sort of thing. I do not get paid for gas or wear and tear on my vehicle. I do appear to be eligible to take standard mileage rates off on my income taxes.

They take taxes and social security out of my checks. I get no “benefits”.

I generally do 20 patient visits (so 20-25 hours) per week, and spend another 20-40 hours doing unpaid stuff like driving and paperwork. (But let’s be honest here…I could probably cut that by 15% if I didn’t browse the SDMB while doing paperwork!)

Am I part time or full time?

Bonus question: Am I best classified as an independent contractor or an employee?

(Why yes, I’m kind of wondering how Obamacare may affect me. I’m pretty sure my employer is exempt based on our small size (<50 employees), but I’m curious…if we were bigger, would I get health insurance?)

2

Is the “patient visit rate” 2/5 of what you are paid, or 2/5 of what they charge the patient, and you’re paid some fraction of that?

If the rate is 2/5 of what you are paid, then I’d assume that that rate is higher to account for the additional time for paperwork and driving and whatever. Presumably, you can’t skip the paperwork, and just do the patient visits. So you’d be full-time, based on how much time you spend working.

3

OK, forget the crypto-algebra. Y’all know my bowel habits, you might as well know my pay: the patient visit rate they pay me is $50 for an hour visit, $60 for an hour-and-a-half visit. The hourly rate if they want me to do something at the office that they’re willing to pay me for is $20/hour.

The company is paid by Medicare, and I have no idea how much. I know that if I see the same patient 5 or more times in 9 weeks, they get some lump sum for the “certification period”, while if I only see them 4 times in 9 weeks, they get paid per visit.

4

If you’re paid hourly and you’re not guaranteed 40 hours a week in writing, you’re part time, even if you work 60 hours a week.

5

Full-time to me means 30+ hours per week, regardless of whether you’re the most servile wage-slave or working entirely for yourself. Whether you’re an employee or a contractor depends mostly on whether your employer withholds the SS and other taxes, or whether you pay them yourself.

6

Part time, independent contractor.

7

You’re part-time and your employer could make a convincing argument that you’re an independent contractor, although if they’re paying their half of Social Security, they may not be trying to do that. Regardless, your employer is indeed a heartless bastard.

I hope you also know you’re also doing God’s work. If not for the Home Health RN we got for my father-in-law after he was released from the hospital in mid-July, I’d have dropped dead of stress and overwork by now.

8

:smiley: He’s really not, that’s just me being snarky and offering the obligatory silly poll option.

But I am trying to sort this out in my head, because there’s scuttlebutt that they may be changing the visit rates soon - up for the longer visits and down for the shorter - but the shorter visits outnumber the longer 17 to 1. The longer visit is only for the Start-of-Care. Even if I spend a longer time with someone at a subsequent visit, I still get paid the shorter visit (“Skilled Nursing Visit”) rate.

I’m keeping closer track of all the unpaid time I spend doing supporting work so I know what to counter with to keep things fair. If my effective hourly rate (not how they figure my check, but my net/number of total hours I spend on job stuff) goes lower, I’m outta there. I don’t much care how they figure my pay. I know what’s average hourly for non-specialized home health RNs in my city, and it’s just about what I make most weeks (somewhere between $20-25/hour). That $50 “for an hour long visit” looks *very *generous only until you figure it out actually averaged over total working time.

hugs I’m glad you’re getting help.

I love this work, I really do. I didn’t think I would, I took it only because the labor market a year ago was horrible, and I couldn’t find anything else. But it’s the kind of medicine I dreamed of - holistic care, professional autonomy, really getting to know my patients and their families, hands on nursing, lots of real patient education, spending time with them instead of passing meds and charting and passing meds and charting… Sure, I could make more working in a hospital. But then I’d have to work in a hospital! :smiley:

9

Just in case new RNs looking for pay information google this (hey, I googled before I started, too!) let me be a little clearer about how my employer does pay. This is not universal; some home health companies do salary, or salary plus per visit. But this is how one company in Chicago in 2012 does it:

Start of Care = $60. Minimum hour and half with patient, 2 additional hours of paperwork and phone calls (on average, sometimes it’s more, especially if you have to beg for medical records from multiple sources). Done once to initiate a 9 week certification period. (I consider this, in isolation, vastly underpaid. But ya gotta do it if you want new patients. Start of Cares are universally loathed by home health RNs!)

Recertification = $55. If they still need skilled nursing or physical/occupational therapy when their certification period is up, we do a recertification, not a new Start of Care. Minimum one hour with patient, an additional hour and a half of paperwork and phone calls. Done once to start the new 9 week certification period. Most patients get recertified once.

Skilled Nursing Visit = $50. Minimum 1 hour with patient, paperwork and phone time really varies a lot depending on what’s going on with the person medically. If they’re stable and boring, I sometimes finish the paperwork sitting there with them. If they need medications reconciled, care coordination with the therapist, doctor alerted about something, etc. then it can be another hour of time, usually split into 5-10 minute bits and pieces as we play phone tag with each other. Usually done weekly or twice a week.

Driving time/gas/wear and tear/mileage: unpaid. All this plus paperwork and phone time is considered “built in to the visit rates”.

10

Basically, you are fee-for-service, or at least that’s how it worked when I was fee-for-service doing mental health home visits. The good thing was that I could set my own schedule.

The bad thing was everything else. :slight_smile:

You’re working full-time but being paid part-time, if you look at hours worked including paperwork, ancillary phone calls, etc.

Are you paid as a contractor? If you are, be very careful to stay on top of your taxes. The first year I did fee-for-service, I estimated the self-employment taxes incorrectly (plus, I was living more paycheck-to-paycheck, and it always seemed “easier” to put off the quarterly tax payment in order to be able to afford rent and gas and food…)and had to file for an extension/payment plan with the IRS come April 15th because I couldn’t pay my taxes all at once.

ETA: You can claim mileage on your taxes, though. ARe you keeping a log?

11

It seems you know due to the size that Obamacare won’t apply to you but I don’t think it would even if your company employed hundreds. Even if you are an employee and receive a W2, you don’t work enough hours to qualify.
I don’t think your employer is a heartless cheapskate as you were hired on as PT. It doesn’t seem like they have a position for you that you would care for one person on a full time basis so it isn’t quite the same as major employers cutting people’s hour to get in under the PT clause. Are you looking for a full time job and can’t find one or is this the type of work you prefer?

12

Since your rate is significantly more than when you do office work, I content that rate does include your paperwork and vehicle expenses. It just isn’t split up that way. Perhaps you should ask your employer about the time spent doing the necessary paperwork.

13

I wouldn’t call it either. I would call it PRN, which has it’s own rules and regulations within the US health system.

14

Have you asked an accountant what (s)he and the IRS would consider you? That’s really what matters, correct?

15

They take out taxes, thank goodness. 'Cause, yeah, I’d be in the same boat as you if they didn’t.

Yes ma’am!

No, I don’t think he is, either. Although I had to keep reminding myself that as I was stuck in rush hour holiday traffic today for 2 hours for what should have been a 20 minute drive. :wink: Not his fault, of course.

This is what I prefer for the moment.

Not at this point. It really doesn’t matter except as a matter of curiosity. My taxes are based on the dollars I make, not whether I’m full or part time. We’re not big enough for Obamacare to matter, whether I’m full or part time. The only time it tends to come up is when filling out surveys, when I feel like I’m lying no matter which one I pick. But it came up in conversation last night - someone asked me if I work at home nursing full time or part time, and I realized that it’s a more complicated answer than he probably expected.

16

Well, you may be an independant contractor in this case, but you are full time. 40+ hours = full time still, right?

17

I’d call it part-time. Because to me, full time comes with benefits, (and a promise that there will be 40 hours a week of work for you everyweek).

Of course, while I’m in a totally different situation from you, I’m presently working an average of 38 hours a week, and getting part-time benefits which does include health insurance (but I don’t think it’s as good as the plans they offer full timers). (Yes, I work for a big business–one of the sort who might decide it’s worth it to pay a fine rather than increase the number of people they provide health insurance to. And I’ve been warned that I could get cut to less than 30 hours when Obamacare laws really take effect. And I’ve reminded my boss that if my hours get cut, she should expect me to cut my availability as I am more likely to look for an additional job).