Is home health that bad?

  1. I have been interested in home health nurse since starting nursing school. I liked the idea of the freedom of the job and the flexibility that goes with it. You can also travel doing home health. From what I have read, charting takes forever and you are usually not paid to do it?!? You have to put a lot of miles on your car. There is usually not much orientation. Pay rates are pretty low. etc.

    Are there any good companies out there? Does anyone love their job? I don't want to make a big mistake by leaving a hard to come by hospital job and end up hating home health.
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  2. 39 Comments

  3. by   Farawyn
    How long have you been a nurse OP?

    What do you think you would like about HH?
  4. by   Libby1987
    Home Health is hard work, like any other nursing job.

    There is obviously driving. The closer you live to the office and your patient territory, the more of the mileage will be covered.

    There is a lot of documentation, due to being an unsupervised service with so much room for fraud. Commit to learning and understanding documentation requirements, sharply manage your time and have some inherent organizational and attn to detail skills and it will be much quicker and easier.

    Home Health case management carries a lot of responsibility for coordination of care and for your efforts you will see the effects of your good care and patient advocacy.

    You will build relationships with patients and their families and witness their progress from beginning to end regardless of the outcome. They will rely on you like no other on their healthcare team. Keep appropriate soft boundaries and you will experience old fashioned nursing care while providing more technical care that you didn't think possible in the home.

    The first year will kick your butt, just any other high responsibility nursing field. Accept that and know that it will get better with time and experience, know that there are good companies out there. We have nurses that have celebrated their 20 and 25 yr anniversaries. We offer a generous orientation and we all have each other's back. We stay with it because though it's hard work, we love what we do.

    There are many posters here that have had negative experiences, you will find the same on any of the forums here.
  5. by   Mom2boysRN
    I love home health nursing. I'm not sure what other type of nursing I could ever see myself doing. I love the impact I can have over my patient's health as well as the independence of it.

    That being said when you go from a nursing job in a facility to being in home health you are on quite a learning curve. You don't have anyone on a unit with you to help guide you so there are some qualities that will help someone have an easier time with this. You need to reach out when you have questions as soon as you have them, you can't allow yourself to get buried. You have to be disciplined with paperwork. You also need to be able to think through what to do in new situations.

    There is paperwork at home. If I see 5-6 patients, which my agency considers a full time day, I work 5-6 hours depending on how far apart my patients are and why I'm seeing them. That leaves 2-3 hours (to equal an 8 hour day). Now, if I sit and just do my paperwork then my total working time may be 8 hours or less. The Oasis forms take longer than a regular visit note, but I also get paid more for them. I get paid per visit so I am not paid separately for charting time. I feel my visit rate is fair and what I get paid per visit covers my time for the visit and charting, most of the time. I make a pretty decent salary and I work just shy of full time.

    The miles you drive depends on what area you work in. I work in a suburban area for a pretty decent size agency. I drive an average of 30-40 miles per day. If you work for a smaller agency or cover a rural area you will drive more. If you are home health you drive, it goes with the job. Ask what area you will be covering before accepting a job and understand if census is low you could end up covering an area that is farther from you in order to see your required number of patients.

    When I first started with my company I didn't get much orientation, but there is someone else running the agency now and they give an adequate amount of orientation. Everything you ever run into will never be able to be covered in orientation. Patient's love to give us surprises. This is where you need to be able to use your nursing process and be the type of person that will call someone to ask for help.

    My agency is a reputable one. We follow Medicare rules and are very highly regarded in the community. There are a lot of bad agencies out there so research the agency before you work for them. Find out what the local hospital's preferred agencies are to refer to.

    Since it sounds like you are undecided about home health maybe consider a per diem job to try it out before making the jump.
  6. by   homehealthWCN
    I've been a HH RN CM for over 7 years & I agree 100% with Libby1987 & Mom2boysRN. Can I ask which HHA y'all work for? You can PM me if you'd rather. Thanks!
  7. by   Libby1987
    Quote from homehealthWCN
    I've been a HH RN CM for over 7 years & I agree 100% with Libby1987 & Mom2boysRN. Can I ask which HHA y'all work for? You can PM me if you'd rather. Thanks!
    Where are you located?
  8. by   homehealthWCN
    South Carolina
  9. by   Libby1987
    Quote from homehealthWCN
    South Carolina
    I'm on the other coast and we don't have any offices on that side of the country.
  10. by   jojo489
    I recently started home health and I'm in training now. I can tell you that my agency is one of the good ones. I have talked to a lot of the staff and the feedback that I get is that management is very supportive and as an LPN there is always an RN to get a hold of to bounce things off of. We also have someone who specializes in wounds on staff that we can talk to or have come eval. Orientation is also very generous, it's very orientee centered and they want you to be comfortable before you go off on your own. I also got lucky and don't have to beat up on my car, the car is provided. I'm loving it so far. I'm coming out of LTC/rehab into this and I'm also in love with the fact that it's so autonomous and you get to spend time with and truly advocate for your patients. I can't wait to see what the next few months brings.
  11. by   trinan71
    What company do you work for if you don't mind me asking? I really would like to know some good ones. I don't know if you can private message a person on here or not, but if you would like to do that instead of post the company name, feel free.
  12. by   tachynut
    I took a home health job after MUCH consideration. I previously worked in the ICU. I thought I had thoroughly weighed all the pros and cons, but unfortunately I greatly regret my decision. My days are LONG- 9 hours minimum. Admission charting will make you rethink your entire nursing career. I feel like all I do is work and sleep. My schedule constantly changes- I can look up all of my patients and then something happens and I have to look up new ones. This obviously adds to the length of your day. My territory is very large and my patients can be 20 minutes from eachother. Trying to fit in 5-6 patients a day, with driving time plus documentation-- it just cant be done in 8 hours (and I am a VERY organized person). I am also being frequently sent into the very bad sections of the city, though I live about 35 minutes away. I grew up in the country and unfortunately cant say I have any street smarts. It scares me just DRIVING down those streets, let alone finding a place to park, walking past the gang in front of my patients house, and going in. Talk about fear . I also have some pretty creepy patients at times-- remember, you are in their house ALONE. I carry mace, but still..
    These are just some of the things that I failed to consider, so I hope they are helpful to you. There are positive aspects to the job as well-- you can start your day at home, finish your documentation at home, truly see improvement in patients, develop a connection with patients and care about them, and it is the best paying job I have had to date. I guess you just need to consider whether you are ok with very long days, and possibly being sent into unsafe situations. I noticed you mentioned about travel nursing. Most likely the places you would be sent as a traveler would be the places no one else wants to go . Just something to think about!

    I wish you well with whatever you choose to do! If you do take the plunge, you can always get back into the hospital if you end up hating it (I am currently applying). Like you mentioned though, you may lose a hard to find position (for me that was dayshift in a very well run ICU).
  13. by   trinan71
    Thanks for your honesty. I get down in the dumps just thinking about going back to work tomorrow but it sounds like it's better than home health. I would also have to deal with not having as much control over situations since I would be "in their house with their rules". I think I will try to get back into a primary care setting since that is what I did for years before becoming an RN. Hind sight is 20/20 unfortunately. I guess hospital nursing isn't what it used to be (told to me by several experienced nurses after becoming a nurse, even my supervisor). *sigh*
  14. by   Libby1987
    Quote from tachynut
    I took a home health job after MUCH consideration. I previously worked in the ICU. I thought I had thoroughly weighed all the pros and cons, but unfortunately I greatly regret my decision. My days are LONG- 9 hours minimum. Admission charting will make you rethink your entire nursing career. I feel like all I do is work and sleep. My schedule constantly changes- I can look up all of my patients and then something happens and I have to look up new ones. This obviously adds to the length of your day. My territory is very large and my patients can be 20 minutes from eachother. Trying to fit in 5-6 patients a day, with driving time plus documentation-- it just cant be done in 8 hours (and I am a VERY organized person). I am also being frequently sent into the very bad sections of the city, though I live about 35 minutes away. I grew up in the country and unfortunately cant say I have any street smarts. It scares me just DRIVING down those streets, let alone finding a place to park, walking past the gang in front of my patients house, and going in. Talk about fear . I also have some pretty creepy patients at times-- remember, you are in their house ALONE. I carry mace, but still..
    These are just some of the things that I failed to consider, so I hope they are helpful to you. There are positive aspects to the job as well-- you can start your day at home, finish your documentation at home, truly see improvement in patients, develop a connection with patients and care about them, and it is the best paying job I have had to date. I guess you just need to consider whether you are ok with very long days, and possibly being sent into unsafe situations. I noticed you mentioned about travel nursing. Most likely the places you would be sent as a traveler would be the places no one else wants to go . Just something to think about!

    I wish you well with whatever you choose to do! If you do take the plunge, you can always get back into the hospital if you end up hating it (I am currently applying). Like you mentioned though, you may lose a hard to find position (for me that was dayshift in a very well run ICU).
    If it's not working for you, it's not working, but with all due respect, you've been in HH only about 6 mos. if you were to stick with it another 6-12 mos, I'm sure you would see that time shave off. A couple of more years and with natural organizational skills, you'll be doing it with much more ease. Experience does make things go quicker and easier.

    As far as scary neighborhoods, that depends on where you live (we don't have scary neighborhoods in our entire semi rural/rural service territory) and what territory you negotiate. A HH Case Mgr with a couple of years + experience is marketable and you could find yourself something different/better.

    Good luck to you though, it sounds like you gave it a good try and it just isn't for you.

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