Is this a typical experience?

KateRN1 · Oct 9, 2011

Three words: Run Like Hell.

Not a safe situation for you or for the patients. When home health agencies hire new grads, there's usually a reason. They want people who don't know what they don't know.

paddler · Oct 9, 2011

THis agency sounds like a total joke. Quit now!

KateRN1 · Oct 9, 2011

I have more time now to sit and address a few of the issues, was posting in a hurry earlier.

It sounds like you were expecting "skilled nursing" visits but this agency apparently does shift cases, which does not require there to be a "skill." Generally they require a licensed nurse to administer meds, care for feeding tubes, vents, and trachs. Pretty much everything else is task-related and can be done by a HHA.

However, as a licensed nurse, you were trained to do the same cares that a home health aide does--feeding, bathing, toileting--these are all basic nursing skills that are frequently delegated to nursing assistants or home health aides, but they are still nursing skills that you should have learned in school. There's nothing I hate more than a nurse who believes s/he hasn't been trained to be an aide--yes, you have. It's called Nursing 101. If you truly believe that you haven't been trained to do these things, that's something that you should take up with your nursing program. But if you believe that you're above doing those things, that's a personal issue that you will need to come to terms with on your own. Trust me, you're not. None of us is.

I'm an RN, been doing home care for years, and I can't tell you how many times I've functioned as a home health aide and what a benefit it is to both me and the patients. I get the opportunity to really see how they function with their ADLs that are the highest risk--bathing and transferring--and I get the best possible skin assessment. Plus, the opportunity to talk to the patient or caregiver about safer ways to transfer, skin integrity interventions, nutrition, etc. Plus I get paid to do it! What an awesome opportunity! I've always jumped at the opportunity to be my own home health aide and highly recommend it to every nurse out there. It's a win-win situation for everyone.

But I wouldn't recommend it with the agency that you're starting with. There's some shady dealings going on there.

caliotter3 · Oct 9, 2011

Versions of this behavior can be found when newly introduced to many agencies. They act as if you are nothing more than something off the assembly line, plug and play, no orientation, no information, particularly pay rate information. Run away. Find a better agency. Too much here to deal with and you shouldn't be dealing with most of it from your end. If the agency wanted you, they would make an effort to see that you are treated the way a new employee should be treated.

JustBeachyNurse, LPN · Oct 10, 2011

I have more time now to sit and address a few of the issues, was posting in a hurry earlier.
It sounds like you were expecting "skilled nursing" visits but this agency apparently does shift cases, which does not require there to be a "skill." Generally they require a licensed nurse to administer meds, care for feeding tubes, vents, and trachs. Pretty much everything else is task-related and can be done by a HHA.
However, as a licensed nurse, you were trained to do the same cares that a home health aide does--feeding, bathing, toileting--these are all basic nursing skills that are frequently delegated to nursing assistants or home health aides, but they are still nursing skills that you should have learned in school. There's nothing I hate more than a nurse who believes s/he hasn't been trained to be an aide--yes, you have. It's called Nursing 101. If you truly believe that you haven't been trained to do these things, that's something that you should take up with your nursing program. But if you believe that you're above doing those things, that's a personal issue that you will need to come to terms with on your own. Trust me, you're not. None of us is.
I'm an RN, been doing home care for years, and I can't tell you how many times I've functioned as a home health aide and what a benefit it is to both me and the patients. I get the opportunity to really see how they function with their ADLs that are the highest risk--bathing and transferring--and I get the best possible skin assessment. Plus, the opportunity to talk to the patient or caregiver about safer ways to transfer, skin integrity interventions, nutrition, etc. Plus I get paid to do it! What an awesome opportunity! I've always jumped at the opportunity to be my own home health aide and highly recommend it to every nurse out there. It's a win-win situation for everyone.
But I wouldn't recommend it with the agency that you're starting with. There's some shady dealings going on there.

I have no problem doing whatever a patient needs, I am very much not beyond bed baths, skin care, etc. (The personal care aspect when in nursing school clinical rotations was totally expected, and it helped to get to know a patient while completing an assessment. I helped with many bed baths, AM care, toileting, and lots of skin care plus the opportunity to practice my communication and pt interview skills. My nursing instructors were VERY clear that as students and future nurses basic care was ultimately the nurses' responsibility, even if delegated.)

But the care for the particular shift was (as per the patient and the nurse present) supposed to be a HHA. It was getting her ready for bed, using the ceiling lift to get her out of the w/c, providing skin care (not "assessment" per the LPN on site, just applying cream as skin assessment was a "nursing skill" ), peri care, no meds (as that was a "nursing job" per the LPN on site and this shift was a "aide" job), positioning the patient then going up stairs 3 other times throughout the night to reposition the patient. Per the LPN on site this particular shift was supposed to be basically someone to sit downstairs (no tv, etc. permitted) all night after getting pt ready for bed then doing the turn/reposition q3-4h. No feeding. Pt did have a foley, but other than peri care I was told nothing else was permitted on the night shift as it was an "aide" shift. If there was an issue with the catheter (kinked, clogged, fell out, etc.) the on call LPN or RN was to be called.

Another agency was willing to interview new grads, but was clear that most would not be hired. Their agency required that all new hires go through specific training (pediatrics review if new or not a pedi nurse previously, adult care (if new or not a med surg nurse previously), wound care & skin assessment, skills assessment (verify that nursing staff is competent in VS, etc.) vents and trachs if applicable, and other training.) All new hires would be oriented to cases/employment for a specific period of time relative to the new employee's background & experience. Some of this agency's cases are skilled visits and some cases are shift work depending on the patient. (Head/spine injury patients and pediatrics were generally shift care.) I was not disappointed when HR called me back and said the DON would prefer to hire LPN's & RN's with nursing experience at this time, but to follow up in 6 months or so after I gained such experience.

What bothered me most was that I was sent to orient with a patient but had no information other than her name & address and what time to show up. (I didn't think to ask as I erroneously assumed the person orienting me would be from the same agency that I was allegedly hired by.) I was not given any diagnosis or background on the patient, nor was it ever mentioned that "if the patient liked me I was supposed to work an overnight shift in 2 days and then every other Saturday." :mad: The patient & LPN on site were pretty clear that this shift was a "HHA" shift. Per the BoN in my state you cannot work with a job title of CHHA without a certificate, even if certified as a CNA or licensed as LPN, or RN. An LPN can perform the majority of CHHA skills, but cannot be working with the title of CHHA without certification. Apparently this agency felt anyone with a license could work with the title of "HHA".

This agency originally stated that orientation was to be 1-2 weeks, plus training on their charting/paperwork system and time sheets. Supposedly I was not to be sent out to the field until one of the DON/ADON was able to verify my skills. Plus supposedly I was not to start to work on my own until the background check was complete and an official offer of employment was made. None of this happened. :eek:

Thank you for verifying that my gut feeling was that this was not right. It should have set off warning strobes when they made a big deal on how they were going to hire many new grads!

While I think that I could be capable of working in a home health situation, I'd prefer to work with an agency that has actual orientation, makes an actual job offer and is willing to reveal the pay rate, and at least shows me their company specific paperwork. (The LPN on site only knew where her agency's book was in the home, she wasn't sure where the book was for the agency that I was supposedly working for! :uhoh3:

So I'll stick with my original plans and tomorrow go visit the long term care and sub acute facilities with resume & references in hand dressed in my business best. (The facilities stopped taking online applications as they found in person applications are much more useful and revealing.)

RNMom2010 · Oct 12, 2011

Yeah, you might want to get the heck outa there fast!! And as an RN you can work in the capacity of a HHA or Homemaker. I work for a very small HH agency and I do the SN visits, the Aide visits and some homemaking visits. :-)