Brand New Nurse in Home Health: Can you really gain experience?

Specialties Home Health

Published

I'm a brand new LPN in NYC. Like most new grads, I am struggling with the frustration of finding places that will interview LPNs without that magical 1-2 years of previous experience. The jobs seem extremely limited and the job hunt has obviously been somewhat discouraging. Two home health care agencies have taken an interest in me and don't even seem to mind that I don't have a year of nursing experience in the workplace. However, I want to ask if you can actually gain viable experience starting off with your first job in home health? I feel 100% clueless about SO many things in nursing, but I am so desperate to start working and cannot afford to stay unemployed.

Specializes in Give me a new assignment each time:).

You know what, guys? I started Home Health as a caregiver with ventilator patients and learned a lot from the nurses and RTs way before I got into nursing school, so that' why I got very comfortable as a new grad LVN. But you have to know what the alarms indicate. It's a machine. You have to read the user's manual to trouble-shoot. Before you start your shift YOU HAVE TO KNOW WHERE THE AMBU BAG IS AND HOW TO USE IT!!! YOU MUST HAVE PULSE OXIMETER TO CHECK O2Sat. YOU MUST MAKE SURE THAT THE ALARMS ARE AUDIBLE. IF THEY ARE SLEEPING AT NIGHT, I INSIST THEY KEEP THE CONTINUOS O2SAT ON. DON'T YOU DARE SLEEP ON THE JOB ON NIGHT SHIFT FOR A VENTILATOR DEPENDENT PATIENT. If patients/family insist on turning off the alarms because the alarms are disturbing their sleep,you better not go there again.

To learn more about specific ventilators, call the vendor. The 1-800 number should be on the machine. They can send you videos/CDROM too. See this link for HT50 ventilator video : http://69.228.124.29/training/HT-50_Part2/index.htm

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Specializes in Home Health; Family Practice Clinic.

I started doing home health with only 3 months experience. AND my experience was in a nursing home, so I wasn't doing much other than passing meds & charting. I found home health to be challenging at first, but so was the SNF I was in. I think starting any new job, even if it's working in retail or something, is difficult. You're new and have questions and don't feel secure, but after a few weeks/months on the job, you'll develop your own way of doing things, and once you start doing those things well, you'll become more confident. (whether it's figuring out a cash register or inserting a foley!)

A couple of things that gave me hope when I first started:

1- in home health, if you don't know how to do something, you're forced into learning...and quick. Like another user said, there's no one down the hall to call and assist you. Of course you can always call other nurses you work with or your supervisor, but being on your own really lights a fire under your a$$ to develop your skills as quickly and efficiently as possible! There's no one else to save you. I saw that as a positive.

AND

2- in most cases, if patients are really, really sick, or experience something acute, they will more than likely seek attention at the hospital, or call 911..or should be advised to do so if they haven't. There's only so much a home health nurse with a stethoscope and thermometer can do for the patient. Sometimes they need diagnostic tests and doctors and obviously can't get that from us. You're not a brand new ER nurse. You'll need to think on your feet and do the best you can do, but you won't necessarily be saving lives everyday doing home health, so hopefully that relieves some weight from your shoulders

Also- important to mention- I don't know what kind of patients you'll have, but I never have any on vents or anything. I do visits that last a half hour to an hour, which means I go there to do assessments, draw blood/get other labwork, do wound care, give SQ/IM injections, etc. Most of my patients are elderly & somewhat independent, but can't leave home too often due to taxing effort, can no longer drive, etc.

Think good thoughts... Good luck! :p

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The "need a paycheck" mind set is one of many reasons we're not a profession.

Bottom line, a new nurse requires learning experiences that are interactive and varied before taking on the very independent role as a home health nurse. When you sign up, you're saying "I can handle this".

In home care, you ARE the backup. That's why the patient is at home because a competent, confident, professional nurse has been provided. The only back up you need is 911. The doctor's expectation is that you would have assessed a situation and handled it. The doctor expects you to call to say this is what I assessed and this is what I did or planning to do! You are the eyes and ears out there!

Please respect your hard-earned licensed. Don't offer it up so easily! And don't get me started on the fraud side of HH that greedy agency owner can pull on the newbies! Home health agency owners love you guys.

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Specializes in Homecare, Pediatrics, Mental Health.

I was hired as a new grad RN at a pediatric home care agency, had never worked in a hospital or in homecare before, and I didn't start working until a year after I graduated. It was a little intimidating at first, but my company trained me very well and by the end of my 3 day in office training, and 7 nights training with my new client I felt very comfortable, and I was confident in my nursing skills and knowledge. I work with primarily all trach and vented clients, who have gt or JT feedings and or meds, as well as some kids who have IV therapy in the home as well, with central lines, ports, and PICCs...using anything from TPN to PCA pumps. It all takes some time to get used to, but that is why you have training, if your agency doesn't provide enough training, then let them know you need more. If you ever don't feel comfortable with accepting a case due to the acuity, then DON'T!

New grads can make great homecare nurses because your mind is fresh, and the agency can mold you into the kind of nurse they need you to be based on your client's. For the first 6 months, I took my pediatric nursing book to work with me everynight and read it to re-fresh and to look up any questions I had.

I have had emergency situations on my shifts, but it is never anything I don't feel prepared to handle. Your state gave you a nursing license for a reason, and if you feel comfortable being on your own then I say it is a wonderful first job! I have loved the 1:1 patient care, the independence and flexibility, and have truly learned a lot. Some of my friends from nursing school and I have talked about what it is like to take care of patients on vents, because a lot of them work in acute settings, and if something goes wrong with the vent on their shift, they call the RT's because they don't know what to do. BUT HOMECARE NURSES DO!

Don't let anyone scare you out of homecare, you do learn a lot, and you are forced to because you're on your own, but it really builds confidence as a nurse, and your school wouldn't have graduated you, and your state wouldn't have given you your license if you were clueless!

Goodluck :)

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So I'm still torn..everything seems to be about half half. If they train you...and the patient isn't in need of acute care..I wonder if that would be ok. I will be honest..I can't take something very acute. I don't have the experience.

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Most extended care is routine care for stable patients. Tell your agency supervisor or the person doing the hiring, that this is what you want to work with and they should accommodate you.

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Most extended care is routine care for stable patients. Tell your agency supervisor or the person doing the hiring, that this is what you want to work with and they should accommodate you.

Ok! BTW, I contacted an agency out here and they say they pay $30 per case..but said most cases usually take only 30 minutes...is that a decent wage? I'm just trying to factor in travel..and how many cases can you possibly receive per day ya know?

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I'd make sure you get a comprehensive orientation, as well as who to contact if you have a question or problem arise when you are out and about. I've found that a reputable agency will provide you with both a good orientation and ongoing support.

Being a well seasoned......or as my colleagues would call me, ancient, home care nurse, I agree with the above quote.....but only to a point. As a new nurse, you will find yourself working autonomously......and with some very sick people. All the "book" learning in the world can't prepare you adequately for what you will encounter in the home. It is not uncommon to be trying to instruct a 90 year old husband in taking care of his 88 year old spouse only to find that he is in worse shape than she is.

The home care nurse must have exceptional assessment skills and observation skills as well as good old fashion common sense. There are those times when one walks into a home and must make a split second decision regarding the patient. There are no colleagues you can call to down the hall to give you an opinion......and trying to reach an MD via telephone could take hours. It may not be the blood pressure....temperature....or those measureable things that tell you something isn't right. It is pure gut instinct.....and the putting together of the assessment that validates your decision.

The nurses that work in an an acute care setting prior to coming to home care will have garnered those skills needed to form a firm foundation to begin their home care experience. Of course you will grow and continue to learn.....we all do.....even this antique nurse.

My role now is focused on the orientation, and mentoring of new nurses to the agency. Those that do well.....and enjoy their experience are those who began with a strong foundation in an acute care setting.

Good luck!

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I'm a newer grad (RN) and I started right away doing home care. I was worried at first because my agency doesn't require experience and I've read a lot about needing experience. Personally, I think having a good agency is key. I was horrified at first.. especially because they give you 2 hours of orientation (at my agency)... annnnndd then you're on your own. I did get a few training classes though. I couldn't believe they would throw me with a patient for 2 hours and expect a brand new grad to be "ok"!! :eek:

At first I oriented with a few patients. I liked that after orientation I talked to the DON and if I didn't like a case or didn't feel comfortable, I never had to go back. Honestly, I was picky at first, but knowing the patient and my license were at stake.. I felt it was ok to be. I ended up finding an amazing patient that I see everyday and love it! Anytime I have issues, we have a DON that we call (and I've taken full advantage of that!). And of course if its serious, we call 911. I've learned so much already. Even though I am with the same patient, I learn something new everyday ;)

So to answer your question being a new graduate as well.. YES, you can gain experience. I think finding the right patient(s) for your experience/comfort level and speaking up are key! I couldn't imagine doing anything other than home care! Good luck..:heartbeat

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