Home health vs med surg

RN3339 · Apr 10, 2014

It's two totally different worlds. And I'm home health there are a variety of roles including private duty shift work, skilled nursing visits, or roles that are more case management. Will this be your first nursing job, if so med surg may be a better place to start because you will gain valuable experience that would be useful in the field. Also, although there should be training and support systems in place in home health you are in the field alone. What type of home health position are you considering? If you would like to provide a little more detail I could give you a more specific answer. I have personally worked at the bedside as well as doing private duty, skilled nursing visits, and clinical care management in home health :-)

FutureResearchRN · Apr 10, 2014

I graduated last spring and I'm currently a med surg nurse and have 8 months of experience. I strongly dislike med surg. Home care sounds like it fits my personality better- I like working with one pt at a time, slow pace, and working alone. The job would be private duty. Just trying to decide if I should finish my *one year* of med surg or jump on this opportunity. Also I moved 250 miles away for the hospital job and am miserable there. The home care job is In my hometown which I love.

softrbreeze · Apr 10, 2014

If you have a job offer, go for it! I've been in my current position (home hospice) basically 8 years after working for 9 months in the ER straight out of nursing school. It suits my personality better with the 1 on 1 pt attention and slower pace. Just make sure the company you go to work for doesn't have any hidden issues like high nurse turnover- that usually indicates a problem you most likely will want to avoid!

RN3339 · Apr 10, 2014

Ok, awesome, I'll give you my perspective on PDN. First, depending on what state you live in rates may be really low compared to what you are making now. Reimbursement rates have either not changed in years or have been lowered over the years. The hourly pay for a case is based upon the credentials required rather than the credentials you have.... meaning the majority of the cases only require a LPN and if you are a RN you will only be paid the LPN rate for working the case. I'm not saying you won't me able to get a RN case it just depends on your location's census, but as a rule there are many more LPN cases. At the company I worked for in FL we had around forty cases and only three were RN acuity. Again, this all varies state to state, but it's definitely something to ask about. My agency would not tell this to RNs until after they were hired and went thru orientation and people would get frustrated because the RN rate was already much lower than area hospitals. That being said due to a major change in Medicaid reimbursement rates in Florida are going to be much better in the next year or so and that should reflect the hourly wages in a good way.

Ok, I know that wasn't really what you were looking for, but I felt it necessary to share. As far as the with itself it can be awesome! Having only one patient to dedicate your time to is amazing, especially if it's pediatric patients. Sometimes it takes running through a few cases before you find one that is a good fit. While sometimes parents work or your there at night when they are sleeping there are also cases when family is always present. Some families want to treat you like your a member of their family while others micro manage and everything in between. It's really beneficial to find a home that your comfortable in while still being able to maintain professional boundaries as for some nurses they tend to get blurred in the home environment.

Now, I'm assuming it's pediatric PDN... you will have patients with GT, JT, or GJT, seizure disorders, trachs, suction, vent dependent, etc. Sometimes they are little ones transitioning to getting off of these things and sometimes they are chronic patients that will depend on these things for their entire lives. The agencies will provide training for you in the areas your not experienced in and there is always someone to call for clinical help 24/7, but the bottom line is you are on your own. Also, the amount of training and how much clinical support you actually have varies location to location as well. Some are really great.

Personally, I had a great case that I worked well over a year, the family was awesome, I bonded with my patient and I enjoyed the autonomy of working alone out in the field, but it didn't pay enough. I wound up picking up visit cases and eventually moved in to Clinical Care Management. Although the money was much better at that point the amount of days and hours I worked burnt me out and I moved on to the hospital and make about the same working there three nights as a staff nurse. If the money is decent in your area, or if you can afford a lower salary in exchange for much less stress and are comfortable with the skill level of the cases, it can be a great job.

One other thing to note, if you have reviewed some of the threads on here something that comes up often is whether or not private duty nurses are required to do domestic chores. Again, you will find various answers depending on location, but in my experience we never required our nurses to do anything more than wash and change the patient's bedding if the parents didn't do it themselves and keep the work area clean.

I really hope this helps you some. I was kind of all over the place in my answer. If you have any specific questions just let me know. Good luck to you.

FutureResearchRN · Apr 10, 2014

Ok thanks for your answers! The job would be working with both children and adults. I think it would be a good fit for me. I'm getting closer to accepting the job but am not 100% sure. I'm going to chat with the manager and ask some questions before making a decision. I thought it was a little weird that I was offered the job on the spot on the 1st interview but it sounds like that may be typical for home health agencies?

RN3339 · Apr 10, 2014

Yes, that is typical. Many do a group interview with a basic test and if you pass your hired. Others basically hire anyone that meets their minimum qualifications and passes their background check. I wish you luck and hope it all works out!

brillohead, ADN, RN · Apr 10, 2014

I got hired at my first interview, too. I think it's more likely to happen in Home Health / PDN because you're not dealing with the whole "corporate structure" thing like you are in a facility.

A hospital has an HR department that vets you first, then you typically get an interview with the unit manager that you'll be hiring into, and sometimes an interview with peers from the unit as well. They want to make sure you'll "fit in" with the culture on the unit you're being hired for.

But in home health, you are your own unit, for the most part -- you'll very rarely, if ever, actually see another employee from the agency in person. So it all boils down to whether the interviewer feels that you are the right fit for the job in general. Do you have common sense? Are you calm under pressure? Are you independent and comfortable with being your own back-up? Are you able to articulate well (to be able to advocate for your patient, or to be able to properly document what happened on your shift)?

As for what to do.... make sure you're comfortable with the hours / pay / benefits that they're offering you, then take the job and move back home! :)

startofcare · Apr 11, 2014

I have been in home health the last 6 month, although I did not have medsurg background I was confident in my assessment skills. Ask you agency if they check you off on skills or if there is educational reference material. Unfortunately the agency I was with advised you to learn skills off of youtube. The most common day in and day out skilled I do:

1. Assessments head to toe

2. Vital signs

3. Wet to dry dressing

4. Wound vac

5. Wound care (clean with x and apply x cover with sterile dressing secure with cloth tape/ paper tape per POC)

6. IV infusion via PICC line

7. PICC flush

8. PICC line dressing change

9. Ostomy, Urostomy, Nephrostomy care

10. Insulin Admin

11. INR checks

12. BP checks

13. medication mgmt./education

You will develop the critical thinking that will make you stronger. Good Luck