5 top things

JessLPN2RNASN · Mar 8, 2012

I have been doing home health for 6 months and feel like a retard. I have been a nurse for almost 9 years and I think my company is taking advantage of me being an "experienced nurse". I had two days of orientation (no skilled anything, just OASIS teaching) and then took on my own patient load. The office I am at is 50 miles from where I oriented, and I am the only RN. I have tried to learn on my own and don't recommend it. Make sure you get GOOD orientation. My friend works HH for another company and has been doing it for years. She got two weeks with new company and just spent a month orienting a nurse. Don't let them throw you to the wolves. They will tell you your name is all over charts you've never seen just because you are the RN and thus expected to case manage. Overall, HH is WAY better than hospital nursing, and I do like the office I am in because I truly feel supported there. It is very small and the administrator there has been fighting for me with the parent office for better orientation. That won't save your license if it comes down to state reviews gone bad... I started on this site looking for advice about HH and planned on asking for basics, like general qualifications, better definitions of skilled needs, and how to turn down a pt who doesn't qualify. I really want to succeed in HH and enjoy the work, so I hope I didn't bum anyone out or turn a great career into a terror for anyone. Just wanted to vent a little and ask for help as well.

MommaNurse26, LPN · Feb 23, 2013

1. Time management is key.

If you are seeing 5 patients tomorrow - mapquest all their address to find the shortest routes - then once ordered call them with a time frame.

For ex. I will call pt one and say I will be there between 8 and 9. Then I will call pt 2 and say I will be there between 900 and 1000 and so on.

When you meet your patient for the first time - take a few extra minutes to explain how hh works.

Explain that the time frame you give is tentative and there may be days that you or the CNA may run late due to traffic or emergencies with patients. The more you communicate with them the more accepting they are of scheduling issues and the less demanding they are.

2. Organization is a priority!

Patient binder organized by last name - each pt will have face sheet, any DNR paperwork, then of course any history or orders that I want to keep with me.

File folder with all blank forms - verbal orders, nursing notes, med profiles, death packets, fall reports, infection reports, you name it - its in this file folder!

Car stock

I have a bin of foley supplies - from 10 Fr to 18 Fr, insertion trays, spare parts (lube, sterile gloves, iodine swabs, in case I contaminate something or need an extra I don't need to open a new tray) and urinals... I also keep fleets and lube in here too.

ADL supplies - shampoos, deodorant, barrier cream, drink thickeners, body wash, combs, anti fungal powder etc all in a 1 foot long by 6 inch wide tub from the dollar store

Wound care supplies - drsgs and sterile gauze in a gallon bag, wound sprays and NS in a gallon bag, gauze 4x4 non sterile in zip lock, other wound care supplies in a bag

Lab supplies in small tub - needles (im, vacu, tb etc) , vacutainers, tourniquets, tube tops with a cheat sheet, alcohol, lab bags, lab req forms, band aides, gauze 2x2, paper tape, hand warmers (from dollar store), urine cups, clean catch wipes, wound cultures, list of lab locations and hours, gloves

3. Lysol, shoe covers, gowns, chux and "back up totes"

You will eventually go into a house that is not up to your personal standard. It will be unsanitary, may smell of human/animal urine/feces, you may see cockroaches crawling everywhere in broad daylight and the house just might qualify to be on hoarders -------> and you will be afraid.

When I have these pts I have a plan of action:

I put on shoe covers and gown before entering house (but at minimum shoe covers), in my car is 'MY BACK UP Totes" which is just a fancy way of saying plastic grocery bags - I transfer my NECESSARY supplies to this bag along with Lysol wipes, alcohol preps and 2 chuxs (first chux is for you to set your bag on in the home - 2nd chux is used for you to either sit on in home OR for you to set your clean supplies on or paperwork)

4. Be prepared to enjoy the immense freedom that comes with the job.

You will have a lot of control over your schedule - when you leave in the morning, how long you stay with a patient, how often you stop and get coffee, when you go home, etc is all up to you. You are your own boss on the road and it makes "work" feel less like work. This is a great thing BUT DONT let that freedom take you down the lazy path. I know nurses that spend 15-20 minutes with EACH patient EVERY DAY so they can catch their 3pm massage or go home and take a nap. This is not cool and your aides, LPNS and RNs will know that you cut corners/are lazy and will not have respect for you. More importantly your patients and or their families will also know that you are not spending enough time with them to truly address issues. Now that is not to say that every single visit needs to be an hour - all I am saying is dont take advantage of your patients.

5. Best advice I can give that I myself still work on learning - is start researching Medicare laws.

KNOW YOUR LAWS AND REGS! Know when you are required to do a visit, know what to chart to medicare standards, Know the ins and outs of medicare in your field and you will become an asset to upper management. You will also be better prepared to be a clinical coordinator or DON should you head down that path later on.

paradiseboundRN · Feb 24, 2013

1. Do not expect to be proficient in Home care for at least a year. Home health is a specialty. There are many things you need to learn that are exclusive to Home health so your prior nursing experience doesn't help. And its a big adjustment if you have never worked out in the community before. You have to get used to working out of your car, learning your territory, finding the labs, etc. Trust me and give yourself a year.

2. Buy the book Home Care Standards and Documentation by Tina Marelli. This will teach you all the home care lingo; OASIS, 485, CPC, cert periods, ROC, etc plus Medicare regulations.

3. Time management and organization will keep you from sinking in paperwork. If you are full-time, make sure you are actually putting in your full 8 hours or you'll be doing paperwork all weekend.

4. Buy a GPS. Getting lost wastes time and gas.

5. Be prepared for anything when you do a SOC (Start of Care). The CPC (Continuing Plan of Care) rarely gives the right picture of the patient. The CPC may list the diagnosis as pneumonia and when you see the patient, you find out they also have a Stage IV decub, lung cancer, and uncontrolled diabetes. On the flip side, the rehab center may write about a big nasty wound, and when you do the SOC, its healed.