Easy job??

[TiddlDwink]

i just have to vent a bit here...

i read a lot of allnurses posts, and i see a recurrent theme regarding home health nursing. sometimes it's regarding nurses who couldn't "cut it" in hospital nursing, and are advised to "try home health", or sometimes it's about ed nurses or critical care nurses who need "something less stressful" ... any number of situations. but the more i see it, the more agitated i get.

now, i've been around the proverbial nursing block a time or two. i'm entering my 46th year as an rn. i've done just about every kind of nursing there is, from critical care to nursing home; from med/surg to psych; from teaching to the army... and i tell you that home health nursing is the one job that pretty much incorporates every nursing specialty that exists.

consider this: you see/care for every illness, injury and disease state imaginable. your job involves all ages, from newborns to centarians. you need every nursing skill from fingersticks to infusions to catheters to ports to pacemakers to wound care to staple removal to venipuncture to patient education to g-tubes to tpn.

you are going into people's homes: some fine with housekeepers, but many filthy, roach-infested, stopped-up plumbing, tiny spaces and animals everywhere. nowhere to sit. nowhere to put down your blood pressure or wound care equipment. nowhere to actually wash your hands. a whole new nursing paradigm.

your documentation means the difference in payment and retention of the patient, or non-payment and loss of the patient.

but most important, excellent assessment skills are essential! you are alone. if you can't find a vein, there is not a cadre of other nurses to try. it's just you. you must be able to detect gi bleeds, impending heart and circulation problems, and you absolutely must recognize an emergency. you must recognize patient neglect.

and this just scrapes the surface. to tell a relatively inexperienced nurse that home health might be a "piece of nursing cake" is ludicrous. just my humble opinion, and thanks for letting me vent!

[Double-Helix, BSN, RN]

I understand your frustration, but I disagree a bit with your perception of the attitude toward home health.

I've read a lot of threads on here as well, and I have seen home health suggested to nurses who are burned out in the hospital setting. While home care is, of course, stressful in it's own ways, there are also some definite differences between acute care that might make it less stressful to hospital nurses. (You aren't managing multiple patients at one time. In general, your patients are not likely to crash at any moment.)

However, I have not seen home health frequently suggested as an avenue for inexperienced nurses. (If that is suggested, it's quickly corrected by another poster.) On the contrary, I have seen new nurses cautioned against pursuing a home health position because they lack the necessary assessment and clinical skills that you described.

I think the attitude you described might be held by some people who are unaware of what home health really entails. Rest assured though, that the majority of posters here do understand that home health is a very difficult job, and we bless you for being willing to do it.

[Vespertinas]

Yeah, I just read that suggestion on the 'suspension' thread 5 minutes ago. It was made by a nursing student

[Esme12, ASN, BSN, RN]

I hear what you are saying...when I go and read all their posts I realize they have never done home health. One of my more difficult jobs was caring for a 10 year old grade 4 myelomeningocele with 34 VP shunt revisions on a vent at home.

Not for the faint at heart.

[SHGR, MSN, RN, CNS]

Home health...you're on the patient's turf, not your own (as you are in hospital or other health care setting), and yes you do have other patients. You just have to drive across town to tend to them, so every thing you have to do, you have to do right then before you leave. You have to anticipate all possible events; you can't just run to the supply room. Home care was one of the hardest jobs I ever had.

[PMFB-RN, RN]

Weird. I always was under the impression that home health nurses had to be the best cause they work alone and unsupported. I never heard that it was easy or suitable for hospital wash outs.

[Vespertinas]

I hear what you are saying...when I go and read all their posts I realize they have never done home health. One of my more difficult jobs was caring for a 10 year old grade 4 myelomeningocele with 34 VP shunt revisions on a vent at home.

Not for the faint at heart.

What the...? I didn't even know grown children still would have that! Then again, I know nothing about children.

[tyloo]

I agree with you TiddlDwink! I have never done home health but that is one clinical rotation that I remember vividly when I went to my nursing school (ten years ago).

When I was a student nurse, I remember the nurse I followed had excellent assessment skills. I was at awe watching her. She was great with teaching the patients and to teaching me. I knew from watching her that she knew a lot and I was not even close to having a sprinkle of that knowledge nor the skills to back it up.

Another sticky point- I did not want to go to anyone's house by myself unattended. When I am at work and you get those patient or families that may be weird or difficult, you bet your bottom dollar that this nurse is happy she is in the comfort of a hospital. I am in my world, but when they get discharge you have to enter their world- not for me! Kudos for anyone that can do that!

I think nurses make an exception that home health is easy because like anything, they haven't done it. I remember enjoying the fresh baked goods that some of the patients prepared. I remember enjoying the one-on-one encounters with patients. However I think nurses may forget that those really sick patients that are in the hospital- get to go home sometimes and still be really sick. I'd imagine it is a different type of acuity.

I just think there is no special magical path in nursing that is easier or less stressful. Maybe nurses will like their duties better or coworkers better. Maybe they will like the type of care or specialization better. However you are still an RN whether it be a nursing home, home health, or doctor's office. The responsibility and stress is still present- just packaged differently.

[pinkfluffybunny]

I would like to add that dealing with difficult family members can be amplified being on their own turf. Trying to get people to be medically compliant when caring for your pt. and knowing that all the good you do can be undone in the three days you are off. Knowing no matter how many times you educate the family the next time you walk in the door it will be a hot mess. There are times when it weighs on your soul, this sense of futility. Yet you walk in the next day and do it all over again. Being in their home, growing to care for someone and be a part of their life can be much harder than rotating pts through a floor. No one should take this job lightly.

[AnonRNC]

You know...in the mid-1990s (at least in this region), hospital nursing jobs were out of reach to new grads. A residency was something physicians did if they wanted to specialize. At that time, it was VERY common for new RNs to do 1-3 years of home health before getting hired for a hospital job.

Now, mind you, I consider there to be two "types" of home health: the pop in assess/wound care/put out fires/dash to the next client kind of home health OR the come for an 8 hour shift to manage vent/dialysis/tube feeds/suctioning/meds and so on kind. During the time period I speak of, it was the 8-hour shift nursing that new grads did in the home.

Of course "back then" home care patients might have been more stable than they are now, as we continue (over the past few decades) to discharge patients "sicker and quicker."

So, not disagreeing with the OP, but offering some insight into where this idea might have come from.

[ruthalittle]

TiddlDwink, as an RN in home care you not only have to have strong clinical skills, the patience of a saint, great communication skills, but also be able to deal with completing a MOUNTAIN of paperwork AND have it completed & turned in within 24 hours for start of care, resumption of care. Your job doesn't end there! How nice would it be if MD's would call you back before 10 or 11 PM in some cases? I once had an MD leave a message on my phone at 1 AM! "Hello, this is Dr so & so, returning your call" click.

I am an LPN in home care, and sometimes it gets overwhelming for me, & I have a fraction of the paperwork that you do. I am in awe of some of the RN's I work with. I have no idea how they manage to complete all of the paperwork, & still have time to care for their pt's!

AnonRNC, I mostly agree with your comment, but I want to say something on wound care. Wound care in a home setting can be so much more challenging than in other settings. Filthy surroundings, diabetic wounds, venous or arterial ulcers, non compliant pt's and family members. I once went on vacation for 1 week and returned to find that my pt with a lower extremety ulcer and lymphedema hadn't had her dressing changed the entire time I was gone. The order was for 3 times weekly.

I know that you didn't say this, but I remember when I was a treatment nurse @ SNF, one of the nurse managers told the skin care coordinater that his job was easy, "anyone can slap a band aid on". I don't want to say I think I've seen it all (don't want to jynx myself!) but I've seen nurses apply enzymatic debrideing agents to dry gangrene, cross hatch intact dry eschar on heels, apply compression to arterial ulcers, all without orders. There is so much more to wound care than just changing the dressing.

Even with all of that said, I have to say that I love home care. Not because it's "easy", but because the rewards of helping someone to remain in their home instead of a hospital or rehab stay are so great. Also, for me, not having someone micro manage my every minute is a huge plus.

[wish_me_luck, BSN, RN]

Vespertinas, it was made by me. There are pros and cons to home health. What I was referring to was when you are in a patient's home, you are focused on them. You don't have the secretary calling you saying "lab's on the phone for you" or a CNA calling you "patient's IV is beeping", etc. I personally could concentrate better when I did my assessments on my home health days (I had two days of home health and loved it) because I was alone (with the RN for the patient, of course); but I am also a person that for whatever reason does better solo. Plus, I love the autonomy (you do everything in HH; blood draws, assessments, case management). Also, I know for a fact that home health has slight flexibility over Med Surg floors. Both nurses that I went with told me that. Maybe not where you live; but where I live they do have slight flexibility. That allows for more time with the patient to make sure you "cross your T's" and "dot your I's". Plus, I loved the fact the patient was home (they heal much better in their environment rather than a hospital) and you can give better care because you see what you are working with as opposed to giving vague suggestions that may or may not work for the patient (some patient's do not have money or are not able to do what is suggested to them). Also, you become so close to your patients because you often see them over months/years.

That being said, the roughest part is that you are alone. It is all you.

Also, I am really starting to get pretty frustrated. I am not attacking anyone, yet everyday I get attacked. I am tired of "get thicker skin". I don't want thicker skin; "thin skin" or whatever you want to call it is what makes me compassionate, sweet, and caring. That's what nurses need to be; not thick skinned to the point where they have no compassion for anyone (not patients, co-workers, or their fellow nurses) or where lateral violence is a big problem. Every innocent suggestion I make turns into "oh, that was the stupid nursing student". If you don't like the suggestion, don't take it/ignore it. I am trying to help.