Home Health Orientation for PRN RN?

  1. I've worked in a busy ER for 10+ years. A friend asked if I'd be interested in working in Home Health at her company she's at. I thought, why not? I'll give it a try.

    I am hired as PRN RN and have started orientation. My orientation to the job so far has consisted of shadowing. My first case I shadowed was an SOC, the RN just walked in did some basic vitals, had the patient sign some forms and walked out (It was like less than 10 minute visit). I asked him if anything else needed to be done... the reply was " he's a walky talky, healthy guy... he doesn't need much". We got in our cars and left. I did not get to see the documentation. The second case I shadowed another RN that was an ROC... the patient cancelled right when we got there.

    After shadowing 2 cases, (literally just got into my car after the 2rd case) I am being asked to take on live cases independently.My orientation to OASIS consisted only of giving me a user name and password and was told to play around with it. No one has gone over it nor has model of how to complete a chart correctly has been given to me to study.

    I immediately refused and requested more training. I feel like I am not clear on the function of what a Home Health RN does exactly or what I need to do on a visit. I requested someone to go over OASIS and someone show me whats in those packets that they hand out to patients... what exactly am I suppose to be doing?

    When I spoke to the other RNs and management about my concerns, they say that no one is acutely ill in home health. That i can just learn as I go, I should just take on cases and after that they will guide me in OASIS and documentation. Everyone else is trained like this.

    My question is, is this typical orientation in the Home Health for an RN? Should I just be taking on live cases, and learn on the go? Or is this not typical and I should request more training and not put my RN license at risk?


    Thank you for any feedback or information!
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  2. 5 Comments

  3. by   caliotter3
    Are there other home health agencies in the area that you could find employment with? You have not described appropriate training. True, you can teach yourself everything, but why put yourself through the aggravation? This does not sound like a good employer to work for in the long run.
  4. by   Libby1987
    90 day orientation with a dedicated preceptor. 8 hr EHR and tablet class. 8 hr OASIS class and testing by well prepared educators. Competency check off on live patients before performing procedures independently. Structured orientation road map. Competitive respectable pay with outstanding benefits including 100% paid premium healthcare. Dedicated territories. Reasonable productivity expectations.

    Patient acuities range from 23 hr post op to the high risk medically complex.

    Would never invest the 40K on a nurse without home health experience into a prn position.

    Look for a reputable healthcare organization, be prepared to compete with strong clinicians with home health experience.
  5. by   jodispamodi
    UM, OP, I have to disagree with the "no one is acutely ill in home health", When I did home health (VNA) many of my patients were very seriously ill and several were fairly unstable.
    Usually a soc involves the process of admitting the patient, observing his status as to how independent he is, assessing any services he might need, pt, hha, msw, etc Usually that is at the very minimum usually 45 minutes with the patient, and then charting his meds, medical hx,care plan et al, after that-admissions even uncomplicated ones usually take much longer to complete I've done uncomplicated ones with the patient on few meds that took about an hour and a half to very complicated ones with the patient on many meds, comorbidities etc that took over 4 hours. The computer program they use can be a help or hindrance in getting it done faster.
    ROC basically takes a few minutes just requires patients to sign forms and "if you have any problems call your doctor"
    as far as them not teaching you oasis, that is kind of silly on their part, oasis really isn't complicated but the phrasing of certain things is... and not giving you proper training means you may inadvertently cost them money by having a soc, or re-certification denied or audited by CMS-very not good.
    When I worked home health (VNA) I was told that ber CMS, and insurance guidelines we had to physically be in the home at the very minimum 30 minutes. Now if you're seeing a total joint and just doing a wound check, honestly that can get challenging but in most cases I would work around it by telling the patient I was required to chart in the home, and starting charting there as well as using the edmonton scale, so most times I was able to make a 1/2 hour, then I would finish charting in the car in their driveway (try not to do charting at home) for the patients who wanted me in/out I would try to leave within 30 minutes. I almost always finished charting in the house or the driveway. then there are the patients who see your visit as a social occasion, and offer you food and drink.
    Sorry, I digressed, but in my experience working for multiple agencies, this is not really typical of orientation, usually you will either look over the persons shoulder while charting or do a "dummy" chart that they can review. and the fact they don't seem at all concerned about oasis training is weird in that how those questions are answered can result in them not being paid. Unless they are a complete private pay company (there are some) I can't see why they wouldn't want to give you at least information, I've had oasis training at different companies that varied from 8hrs to 3 very long, very boring days. Best of luck.
  6. by   LVNblue8
    The lack of training unfortunately is typical for both HH and Hospice. I got so lucky that I had 3 weeks of full time paid training at my first Hospice. Now I get treated like the pro at every HH and Hospice I've been to since. Some agencies have even had the RNs shadow me although I'm LVN, just for the basic ins and outs of a home visit. If I didn't have that initial training I have no idea if I would have even lasted a month.

    But that particular home health you are describing sounds fraudulent. If they are claiming that most home health patients don't need much and doing 10 minute SOCs, they likely just take on a lot of medication management patients and keep them on long term. I've worked for similar agencies and I don't stay long once I see that they won't even take patients with real needs. That's ethically questionable and could get you into trouble too, since you'd be charting these patients as appropriate for home health when they may not really be.

    Look for a HH that takes on legitimate patients (wound care, IV, g-tube, post surgery, diabetes teaching, etc) and is not afraid to discharge patient when care is no longer needed. BUT then you still have the problem of lack of training- insist on shadowing in the field and in the office until you feel fairly comfortable, I'd say spend a full day in the office with case managers and then go on at least 5 visits, preferably with at least 2 different nurses. Then every 6 moths or so shadow with someone different on a visit just to see how they do it. I do joint visits every once in a while and always learn something useful.

    I really enjoy the job now, but I had to find the right agencies, and that took some time.
  7. by   dthurston123
    Hello, I am a Clinical Manager (RN) for a rural home health agency. The way the admission nurse handled the admission is FRAUD to the nth degree! I would be seriously concerned for the way the agency practices if they are training you in this way. There are strict Medicare regulatory guidelines and requirements that must be met. They must meet homebound criteria (a bit of a gray area), they must have a skilled need (RN, PT, OT, or SLP to qualify). For Medicaid, it's a little different but the basics are the same (they must have difficulty accessing care in the community but do not necessarily need to be homebound).
    If this patient is a "walky, talkie, healthy guy" then they absolutely do not need home health services. A typical admission if you are following all the rules is about an hour and a half or more in the home followed by about an hour to an hour and a half documentation and follow-up.
    Home Health patients in my area are sometimes "too sick" or too much of a citation risk for the nursing home to accept them. Home Health regulations continue to be more and more burdensome because of agencies practicing in this way you described. I sincerely hope that your HH agency puts more effort into orientation and HH benefit education to their new staff. Get out of that agency. Your license is at risk.

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