Home health nurses, I need your help!!

Tweety, BSN, RN · Feb 21, 2008

Hi! We have a forum specifically for home health nurses and I'll move your post there. Take some time though to read the forum and perhaps you'll find some answers there as well. :)

annaedRN, RN · Feb 22, 2008

Home health is an entirely different kind of nursing. I cannot imagine doing anything else. Every day is different, seeing different kinds of people. You may have chronic COPD, newly diagnosed diabetic, venous insufficiency with ulcers, post-op THR, colon resection, mother/newborn, osteomyelitis, etc...thus your care is very different from place to place - teaching, IVs, wound care/wound VACs, insulin injections, lab work, ostomy care, CV checks, etc. Big emphasis on teaching - diet, meds, labs, s/s to report, as well as teaching independence in wound care or IV antibiotics of possible. The big difference is the one-on -one...actually being able to spend the time teaching and listening...even if you have a busy day, you have time to spend some uninterrupted conversation with the patients in THEIR environment. I love the autonomy and independence. The docs really respect us. You become a wound expert of sorts. You don't have to deal with all of the catty office policy and procedure stuff b/c your office is your car for the most part. You get flexibility in your schedule. Of course there is the paperwork - but stay organized and on top of it and you'll be fine. Learn to do some/most of it in the patient's home. Keep a box of supplies innyour vehicle ( basic wound care stuff, catheter supplies, IV supplies, ostomy supplies...) that can save you uneccessary trips back to your office. You aren't cooped up in the office -you get to enjoy the sasons ( good and bad!)

Anyhow, sorry for rambling on...I truly love HH nursing and find it more rewarding than any other area I've been in. If you have any other questions, ask away! Good luck!

caliotter3 · Feb 24, 2008

Just wanted to say that one of the most important factors in how well you adjust to hh is your orientation. When you interview, ask about orientation to the job and orientation to each of your clients. A lot of problems in hh arise out of poor or no orientation. When your agency has an established client, there is no reason why the supervisor or another nurse who is working with this client can not give you a thorough orientation to the client. This way, you know what to expect and can prepare mentally, whether the client is a shift care or intermittent visit client. You should be given a copy of the 485 and the MAR before you see the client. When you review the 485, you can ask questions or can tell them if you do not want to work with this client. Saves you surprises and wasted time. No reason to have to find out certain things the hard way.

akcarmean, LPN · Feb 25, 2008

I am a HH nurse. I work with one pt. instead of doing shift work. I like the fact that I am with the one pt. You get to know them inside and out. You can catch the early signs of an illness etc. sooner b/c you do know the pt. inside and out. I do everything from ROM, baths, all ADL's. meds, contacting dr..

I have to agree with the previous post. Please make sure the orientation is good and you are prepared. Orientation is a HUGE part of HH. The only down side of one pt. instead of shift work is that like right now my pt. has been hospitalized and I am not working therefore no paycheck:o

I have been in HH care for most of my nursing career and I love it.

HOpe this helps some

angie

jays · Feb 25, 2008

I have been a home health nurse for about 2 yrs, so weekend I worked (1 weekend a mo.). sat. consisted of me driving 34 mi. to my first appt. which was a open it takes about 1.5- 2 hrs, then I had 3 revisits that had me busy until around 200. Most of the charting I do in the home for revisits with exception the the narrative note. The open charting takes about another 1hr or more depending on the agencies paperwork. The assessment is called a oasis which is medicares way of know the initial status of the patient, and to follow up on the outcomes of the nursing service. example if the patient has a stage 2 dec. they would like to see it resolved by the end of the care. Often on the following day with visits I am following up on md. calls and labs. etc. the work goes beyond 8hrs sometimes but you can sched. around you life sometimes.

LoriRN03 · Feb 28, 2008

Let me preface this by telling you that I was a paramedic for 15 yrs. After graduating nursing school, I went straight to the hospital with the intention of winding up in ICU. I absolutely HATED working the floor. To me, there was supposed to be more to nursing than running into your pts rooms, making sure they had a pulse and were still breathing, throwing pills down their throats and telling them ' If you need something, just push the button', knowing that because of my pt load, I may not be able to get right back to them. I eventually got to ICU, which the 1:2 ratio wasnt bad, but I had a preceptor that was a witch. I know now why they say that nursing is the only profession that eats their young. I resigned my full time position primairly because of her, but also because the 12 hr shifts were not 12 hr shifts...they were 14ish hrs. I lucked into a position in a home health agency a few months later. Granted, I knew nothing about how home health worked, I think because of my background as a paramedic, I was able to assimilate things easier. I enjoy the autonomy afforded to this arena of nursing. I enjoy getting to know my patients. I never realized just how underserved our elder population was until I got into home health. It is alot of hard work, more paperwork than in the hospital, call weeks, travel time (which I didnt mind because it gave me alone time), and all around responsibility, but the gratitude you get from your patients makes it all worthwhile. Often times, the home health nurse is the only person the pt sees each week. Once the rapport is developed, they welcome you into their home with open arms. During my last semester in nursing school, we did our community health rotation we did ride alongs/shadowing with in hospice, HIV clinics, school nurses, home health, county clinics and occupational/industrial nurses. I specifically remember my day with the home health nurse. Each pt we went to see was not only glad to see "their" nurse, but they were happy to see me as well. It amazed me that perfect strangers would welcome someone new into their homes that easily. OK, enough of the monologue. Bottom line, its a hard job, lots of responsibility, lots of paperwork, lots of time, but in the end, its worth each minute I spend.

wonderbee, BSN, RN · Feb 29, 2008

It's not at all like hospital nursing. Once you're out in the field, you're a one-man show. I really loved that part of it. The autonomy is refreshing. You meet people who are most often past the acute stage of their disease, on the mend. They're in their own homes and have more control over their daily lives = generally happier disposition than in hospital. You are aware that you are a guest in their homes. The relationship is balanced. A lot of good people will offer you refreshment. I loved my rural patients. Good down home people. On good weather days, I'd often think there was nothing I would rather be doing.

Unfortunately I left HH. The agency we work for can make or break what could be a good thing. The agency I worked for is going down the tubes from mismanagement and an already saturated region. If I could have found a HH position that fit my bill, I would have taken it. There just wasn't a lot out there when I was looking. But managed properly and with self discipline, it's a wonderful way to be a nurse.

BTW, computer documentation is the way to go. It will keep you out of the office and out in the field, home earlier. It's a better way to manage the paperwork. When I went looking the second time around, I made it a requirement.

Let us know what happens. Good luck!