Calling all HH Nurses, roll call - page 31

Hi, as a newly appointed moderator, I want to live this forum up a bit. I just resigned my position as a HH supervisor, to go back to the field. I have been a nurse 20 years, 17 in critical care,... Read More

  1. by   GYPSY1349
    Quote from bsrn0523
    hi everyone! i have been in home health on and off for 10 years now, nine of those as a lpn. previously, i worked in both a hospital and ltc, but i have always had a soft spot for home health. now as a rn, i do two private duty peds high tech shifts a week, plus several wound care visits. i expect to begin iv therapy within the next month. hh has been wonderful in that it has given me the flexibility to be with my family while at the same time getting to spend quality time with my patients. i truly feel blessed :d
    [font="comic sans ms"]thanks for your positive post! i also feel blessed to be able to work in home health, and cannot imagine doing anything else. it truly is a blessing to be able to care for our patients on our own time table, taking the time we need to make an impact in their lives. keep up the good work!
  2. by   lamazeteacher
    I worked in L&D, taught prenatal classes and was in charge of a 52 bed Maternity Home in the '60s in L.A. The latter was my foray into the community, and for the next 2-3 decades, while waiting for an administrative type of job, I signed on "per diem" with about 7 Home Health agencies (5 at one time, in L.A.).

    Doing the paperwork for each agency was a challenge....... finally I created my own. At first I visited Maternity "early discharge" patients who went home within 24 hours of birth, did assessments on moms and babes, taught infant feeding, (became a lactation consultant), nutrition, early infant development, s/s to report to MDs, etc. It concerned me greatly that more and more newborns by the 1990s became jaundiced by day 3, and I did heel sticks for testing; and some docs wanted the moms to stop breast feeding.

    Once 24 hour discharges for NVDs became the norm, and hospital Nurses mumbled myriad instructions to exhausted parents at discharge, Home Health visits for them came to a grinding halt, unless there was concern about complications or security.

    So I began seeing adult and geriatric patients, doing wound care, diabetic teaching, med management, etc. I enjoyed that, but not having years of med/surg hospital experience was a hindrance. The paper work became overwhelming (especially the repetitious OASIS - do you think someone could get reasonable, nurse friendly software for that?).

    So I took a job at the "Regional Center" and did monthly home visits for developmentally disabled children, at their homes or facilities where they were cared for in small groups.

    That lead to work at schools' special classes when a "student" required Nursing care. One such girl was comatose, blind and deaf, required frequent suctioning and GT feeding, and I couldn't help but wonder if she wouldn't have been more comfortable (being left behind) at home, without the sense of not being where she was most comfortable, hurried into her wheelchair to go there, etc.

    The development of better and better dressings for wounds, and the advent of specially certified "wound Nurses" is a great asset now. However, doctors need to become aware of those services so they refer their patients to Home Health agencies, rather than submit them to painful, sometimes lengthy excursions to clinics and offices for that care. I 'm helping with the home care of a good friend/close neighbor who had ankle surgery, is on antibiotics (round 3) and has a weeping wound that won't close. I suggested that she call the lofty MD's office at the University clinic where she's seen (every 2 weeks!), and ask for a Home Health wound specialist, so she won't have to pay exorbitantly for dressings that are inappropriate (I love the 2-3 2X2 gauze sponges they send home with her each visit). However, as a licensed professional acting voluntarily, I can't do more than she's been told to do (how I'd love to irrigate the ever expanding site, get some silver dressings, etc.)

    Well, thanks for opening this thread. As isolated as Home Health Nurses are, it's great to hear from others.
  3. by   greenlotus
    Thanks to all for the great info and insights into the world of HH nursing. I am considering jumping off the cliff of over twenty years of psych nursing into HH. These days in psych, we get plenty of basic med-surg, IVs wounds, G-tubes, diabetics etc., but I wonder if I really could learn fast enough to do a competent job being so long out of school and no recent experience on a med-surg unit. I love the idea of the autonomy and being in the community, but wonder if my resourcefulness will be enough. Any opinions or HH nurses who came from psych?
  4. by   lamazeteacher
    Quote from greenlotus
    Thanks to all for the great info and insights into the world of HH nursing. I am considering jumping off the cliff of over twenty years of psych nursing into HH. These days in psych, we get plenty of basic med-surg, IVs wounds, G-tubes, diabetics etc., but I wonder if I really could learn fast enough to do a competent job being so long out of school and no recent experience on a med-surg unit. I love the idea of the autonomy and being in the community, but wonder if my resourcefulness will be enough. Any opinions or HH nurses who came from psych?
    Hmmmmm, I've always thought the world in general is a psych unit, and your experience in that field can only be an asset in home care, as there are plenty of "unhinged" patients and family members you'll meet. I know you may have been joking, or half serious in the first sentence of your post, but please look at it seriously............. like why you're "jumping off", instead of augmenting your career...........

    The worst part of HH is the paperwork, and in time that gets easier and faster. If only we used computers, with nurse friendly, pertinent software it would be better, but I'm always looking ahead.

    Best wishes!:heartbeat
  5. by   gelia
    Hi greenlotus
    It can be frightening when you leave an area and jump into one like HH. I would hate to think about leaving HH after the 22 years I've spent here. We've had several psych nurses come to our agency and they do wonderfully. We have two with us now. They have brought their specialty with them and they are very welcome. We have several psych patients for whom they care. Come join the fun.
  6. by   eileenis1
    Hi,

    I'm an RN w/15 yrs of experience. we moved from the midwest to Louisiana almost a yr ago. I had to take a 20 % pay cut to work anywhere and am working home health. I feel burnt out already. I am driving a 50 mi radious and am doing 26 or more recerts/admissions a mo. I love the home health except for the filthy environments. The patients are wonderful and I like management and staff. I am still trying to get to know the outlying areas to be more efficient w/my road trips. I added an online map to Mapquest an GPS. Do you think my caseload is too large? What kind of tips can you offer?

    Thanks,

    Eileen
  7. by   lamazeteacher
    Quote from eileenis1
    Hi,

    I'm an RN w/15 yrs of experience. we moved from the midwest to Louisiana almost a yr ago. I had to take a 20 % pay cut to work anywhere and am working home health. I feel burnt out already. I am driving a 50 mi radious and am doing 26 or more recerts/admissions a mo. I love the home health except for the filthy environments. The patients are wonderful and I like management and staff. I am still trying to get to know the outlying areas to be more efficient w/my road trips. I added an online map to Mapquest an GPS. Do you think my caseload is too large? What kind of tips can you offer?

    Thanks,

    Eileen
    Dear Eileen (and all HH nurses swamped by the needless repetitious paperwork our government requires of us):

    It seems to me that 26 of the most paperwork oriented cases, appears to have nurses doing all the admissions. P.T. s can do them, but some agencies don't allow that. Try to find out if there is uneven assigning going on, and then get the ear of your preceptor (you do have one, don't you?).

    When new personnel come on the scene, it's a great opportunity for those in high positions in the agency, to hear a fresh voice reflect what others keep saying is superfluous. Yet it's hard to start off as a complainer, and get anywhere (other than out the door). You've had some time now, to show your worth, so you can now voice your concerns, gradually.

    First of all, there is software for completing those forms, that automatically fills in repeated questions' answers.......... how about Medicare providing that with their forms? It would certainly stop errors caused by boredom (like the wrong date, address, name).

    It would be lovely also if the symptomatic information we provide, along with the medications ordered, automatically brought up the ICD-9s.........; and medication categories and side effects could be there, too which would save hours of time. Since books provide the information no one can retain in its entirety, let the forms do that!

    As far as filthy environments are concerned, that can be called patients' inappropriate placement. If they're in dangerous circumstances (as well as healthcare visitors), Adult Protective Services may be required. If you're working anywhere near the flood locations, molds can harm you and the patient! There are diaster funds still available to rid buildings of that. Maybe a word to Oprah, too.....?

    Best wishes. You can contribute positively to your and others' lives in a way others may not have tried. Go For It!!!!
  8. by   anna565
    Hello,

    I just decided to accept a job as a HH RN with the VNA. All I have thought of since nursing school has been community health, it is my goal and my passion. I spent the first year of my career on a busy med-surg pediatric floor at a teaching hospital. Although afraid to leave the world of acute care so quickly, I feel like I need to seize this opportunity to enter HH. Thank you all for the posts and threads, they helped me land the job and decide to take it! I look forward to coming here again once I start, but until then I'll be checking those articles mentioned for HH rns in a previous thread. Any advice or tips to a newbie would be welcome. Thanks!

    ps: out of curiosity, what is the average case load you all have? Mine will be 20-25 patients with 5 visits per day. Is this standard? I read in a hospice thread that more than 12 is alot, but maybe that is b/c of the high acuity of hospice pt's???
  9. by   annaedRN
    Welcome to HH Anna! You'll love it. You're right - there are numerous post on how to prepare for HH and what to expect, so look around then ask us a bunch of questions as they come up!

    20-25 patients with 5 visits per day. Is this standard?
    That is pretty average for my VNA. There are times where the census is higher and sometimes lower. I see anywhere from 4-6 a day ( with admissions counting as 2 visits due to the increase time of visit as well as charting). Seeing 7 is pushing it, but I live in a rural area and sometimes the travel time can add up. Hospice visits take more time - our hospice nurses only see 3-4 patients a day. Good luck to you. Let us know how it goes.
  10. by   vicky1964
    Well I have been doing Home Health for 6 years here in Texas . I will tell you the paper work kills me , comming up with the teachings is hard.I work for a small company as the only feild LVN and I may see 8 - 11 people a day, so if you find out a better way for the paper work let me know , Thanks Vicky
  11. by   lamazeteacher
    Quote from vicky1964
    Well I have been doing Home Health for 6 years here in Texas . I will tell you the paper work kills me , comming up with the teachings is hard.I work for a small company as the only feild LVN and I may see 8 - 11 people a day, so if you find out a better way for the paper work let me know , Thanks Vicky
    Do LVNs in Texas do OASIS forms? They're the worst. There is software to help with them, but the HH agencies I've worked at, say that it's unaffordable.
  12. by   NRSKarenRN
    Quote from lamazeteacher
    Do LVNs in Texas do OASIS forms? They're the worst. There is software to help with them, but the HH agencies I've worked at, say that it's unaffordable.
    Federal Medicare and state medicaid regulations permit only RN's to perform OASIS assessments.
  13. by   tricia0424
    hi! I need advice. For almost 2 months I'm working in a government hospital as an OR Nurse, also my part time job is Home Health. I'm planning to give my work as an OR nurse and just be full time Homehealth nurse. Is that a good decision?? please advice..what are the advantages and disadvantages of working as a full time homehealth?

    Tricia

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