My First HOME HEALTH Job :)

Specialties Home Health

Published

Specializes in Medical-Surgical, Supervisory, HEDIS, IT.

So, I finally got a job as a home health nurse. I graduated from nursing school in April 2013 and have been working as a Med Surg RN since October. I have been wanting to do Home Health since I graduated but I needed experience first. I start tomorrow morning!

Any advice from any seasoned Home Health RNs would be greatly appreciated??

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Congrats on getting the job you wanted. I graduated in May 2013 and went straight into home health. The company I applied to also said they required 1 year experience but they took a chance on me and so glad they did.

Will you be visiting multiple patients a day or 1 patient for 8+ hours at a time? I ask because I stay with a patient overnight and that is very different than multiple patients

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Specializes in Complex pedi to LTC/SA & now a manager.

Shift work is generally considered private duty whereas home health is skilled nursing intermittent visits (assessment, education, med admin, wound care, lab draws, infusion, etc).

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Specializes in Medical-Surgical, Supervisory, HEDIS, IT.
Congrats on getting the job you wanted. I graduated in May 2013 and went straight into home health. The company I applied to also said they required 1 year experience but they took a chance on me and so glad they did.

Will you be visiting multiple patients a day or 1 patient for 8+ hours at a time? I ask because I stay with a patient overnight and that is very different than multiple patients

I will be visiting multiple patients.

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Specializes in Med./Surg., Diabetes, Med. ICU, home hea.

I'm back into HHC after about a 20 year hiatus, still struggling. I'm sure others will give you better advice, BUT, I believe organization is a key factor. I use Microsoft Office Excel to plot my visit schedules. I use Medscape, Drugs.com, Mayo Clinic, Web MD for teaching points that I print out for the chart & Pt. teaching in MS Word. I plot my route for the day using Google Maps. I print out a daily visit schedule using MS Word; I estimate travel times, visit times, times for next visit so that when I hit the office, I can call my Pt.'s to arrange visit times. I use an app to see "real time" traffic as to avoid traffic jams, if possible.

I use a LARGE nursing bad with a wheeled carrier. I find many Pt.'s either don't have furniture/chairs/etc. to lay my equipment out on or they're in areas that don't have same; it acts like a small table. While I carry a (small) variety of dressing change supplies in my bag, I plan my day by bagging (using cheap generic wastebasket sized plastic bags) my dressing supplies for each Pt. I grab said bag and I'm good to go. I hoard supplies in my vehicle... just in case. Sanitizing wipes... my BEST friend. Paper towels. Gloves, GLOVES... plenty!

Extra batteries... always for what ever devices you have. Extra pens... always. Something to scribble notes on. I use an aluminum clipboard with cover and small storage space for writing surface.

A GPS device of SOME sort is SO much better than maps and the dread Thomas Guide. Plan ahead; traffic, weather. Pt.'s new symptoms, etc., WILL mess your schedule up. I avoid being too exact when telling Pt.'s my estimated arrival time. Bluetooth ear bud, you DON'T want to miss that M.D. callback when you're driving as most don't play "phone tag" well. I NEVER give out my personal cell phone number except to the MOST trusted Pt.'s/families; I give them the office phone number. I use FAX a LOT to communicate with physicians. It gives me a record that I DID communicate and what was "said."

SOC's (Starts of Care)... the dread OASIS. I always plan for 2 hours 1st visit, with likelihood of visit the next day to finish. Initial call to SOC Pt./family: PLEASE have ALL medications out in ONE location... prescription, OTC, supplements... NOT a list, but the actual containers themselves; if there are discharge instructions, please have them handy (NOTE: discharge instruction medications can be notoriously inaccurate as they're OFTEN changed at the last minute). Make sure SOMEBODY there speaks fluent English AND somebody there knows the Pt.'s history if they can't clearly speak for themselves. Before my 1st visit, I use Google Maps to "zoom in" on Pt.'s location/building to "case the joint," i.e., to get a "feel" of the neighborhood, familiarize myself with the area. I make sure, on the initial phone call, that there will be NO smoking in the residence; if there IS a smoker, I explain that I cannot be in the house while someone is actively smoking. If there IS a smoker in the residence, I explain that they must open windows/doors to air the place out prior to my arrival. If this is not possible, I explain to my supervisor and the scheduler that I can't take the case for medical reasons and will get a signed note from my physician if need be. If case is a discharge from SNF/rehab facility, I verify that NECESSARY DME is already in the house prior to my arrival; I tell you that there's NOTHING like showing up at a dingy apartment, full of cigarette smoke, a morbidly obese, non-ambulatory, Pt. in a dilapidated power chair held in precariously by a frayed safety belt, Foley catheter bag nearly bursting with urine, no bed/hospital (or ANY) bed to transfer to as to inspect the inevitable coccyx stage II (or worse) pressure ulcer that was unreported, the smell of feces and no supplies or clothing to change Pt., no food in residence, glucometer out of battery power AND strips (visible McDonald's empty bags and the obligatory "big gulp" soda jug), promised care giver no where in sight, unreported venous/stasis ulcers with no orders for care, dog barking menacingly at you while Pt./family ignores it, and the obligatory expectation of the Pt./family that you are there to provide "total care" for the Pt., NOT to teach them how to do so. I find it's IMPORTANT to find out the Pt.'s/family's expectations; MOST have NO idea what you're there for and SOME will be upset when you don't meet those expectations, unrealistic as it may seem. I find it NOT unusual that the Pt./family had NO idea (or claim to) that HHC was ordered.

I carry a back pocket with plenty of quarters... parking. Credit card: parking. Cash: NONE. Syringes, needles: NONE unless I absolutely have to for the particular case; if I have a case that needs them, I leave them in my vehicle until that visit.

Well, I'm sure I missed a LOT, but now it's time to document till I pass out. Good luck, best wishes. It WILL be rough, but (likely) will get better, too!

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Specializes in Medical-Surgical, Supervisory, HEDIS, IT.
I'm back into HHC after about a 20 year hiatus, still struggling. I'm sure others will give you better advice, BUT, I believe organization is a key factor. I use Microsoft Office Excel to plot my visit schedules. I use Medscape, Drugs.com, Mayo Clinic, Web MD for teaching points that I print out for the chart & Pt. teaching in MS Word. I plot my route for the day using Google Maps. I print out a daily visit schedule using MS Word; I estimate travel times, visit times, times for next visit so that when I hit the office, I can call my Pt.'s to arrange visit times. I use an app to see "real time" traffic as to avoid traffic jams, if possible.

I use a LARGE nursing bad with a wheeled carrier. I find many Pt.'s either don't have furniture/chairs/etc. to lay my equipment out on or they're in areas that don't have same; it acts like a small table. While I carry a (small) variety of dressing change supplies in my bag, I plan my day by bagging (using cheap generic wastebasket sized plastic bags) my dressing supplies for each Pt. I grab said bag and I'm good to go. I hoard supplies in my vehicle... just in case. Sanitizing wipes... my BEST friend. Paper towels. Gloves, GLOVES... plenty!

Extra batteries... always for what ever devices you have. Extra pens... always. Something to scribble notes on. I use an aluminum clipboard with cover and small storage space for writing surface.

A GPS device of SOME sort is SO much better than maps and the dread Thomas Guide. Plan ahead; traffic, weather. Pt.'s new symptoms, etc., WILL mess your schedule up. I avoid being too exact when telling Pt.'s my estimated arrival time. Bluetooth ear bud, you DON'T want to miss that M.D. callback when you're driving as most don't play "phone tag" well. I NEVER give out my personal cell phone number except to the MOST trusted Pt.'s/families; I give them the office phone number. I use FAX a LOT to communicate with physicians. It gives me a record that I DID communicate and what was "said."

SOC's (Starts of Care)... the dread OASIS. I always plan for 2 hours 1st visit, with likelihood of visit the next day to finish. Initial call to SOC Pt./family: PLEASE have ALL medications out in ONE location... prescription, OTC, supplements... NOT a list, but the actual containers themselves; if there are discharge instructions, please have them handy (NOTE: discharge instruction medications can be notoriously inaccurate as they're OFTEN changed at the last minute). Make sure SOMEBODY there speaks fluent English AND somebody there knows the Pt.'s history if they can't clearly speak for themselves. Before my 1st visit, I use Google Maps to "zoom in" on Pt.'s location/building to "case the joint," i.e., to get a "feel" of the neighborhood, familiarize myself with the area. I make sure, on the initial phone call, that there will be NO smoking in the residence; if there IS a smoker, I explain that I cannot be in the house while someone is actively smoking. If there IS a smoker in the residence, I explain that they must open windows/doors to air the place out prior to my arrival. If this is not possible, I explain to my supervisor and the scheduler that I can't take the case for medical reasons and will get a signed note from my physician if need be. If case is a discharge from SNF/rehab facility, I verify that NECESSARY DME is already in the house prior to my arrival; I tell you that there's NOTHING like showing up at a dingy apartment, full of cigarette smoke, a morbidly obese, non-ambulatory, Pt. in a dilapidated power chair held in precariously by a frayed safety belt, Foley catheter bag nearly bursting with urine, no bed/hospital (or ANY) bed to transfer to as to inspect the inevitable coccyx stage II (or worse) pressure ulcer that was unreported, the smell of feces and no supplies or clothing to change Pt., no food in residence, glucometer out of battery power AND strips (visible McDonald's empty bags and the obligatory "big gulp" soda jug), promised care giver no where in sight, unreported venous/stasis ulcers with no orders for care, dog barking menacingly at you while Pt./family ignores it, and the obligatory expectation of the Pt./family that you are there to provide "total care" for the Pt., NOT to teach them how to do so. I find it's IMPORTANT to find out the Pt.'s/family's expectations; MOST have NO idea what you're there for and SOME will be upset when you don't meet those expectations, unrealistic as it may seem. I find it NOT unusual that the Pt./family had NO idea (or claim to) that HHC was ordered.

I carry a back pocket with plenty of quarters... parking. Credit card: parking. Cash: NONE. Syringes, needles: NONE unless I absolutely have to for the particular case; if I have a case that needs them, I leave them in my vehicle until that visit.

Well, I'm sure I missed a LOT, but now it's time to document till I pass out. Good luck, best wishes. It WILL be rough, but (likely) will get better, too!

All I can say is WOW! Thank you so much for all of that! :) I really do appreciate it. There is so much good stuff in there :) I have had a few people tell me to always hoard gloves, alcohol sanitzer and wipes. I laughed a moment when you said the DREADED OASIS. I got a small amount of training on that today. I will be starting with routine visits and then going to train on SOCs.

Another thing that was told to me that you mentioned was to FAX the providers. They stated the same reason, that you have a record that you contacted them.

Thank you so much for all of your advice. If you do think of anything else, please send me a message on here or just reply again :)

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Loved this post!! A day in the life of a home care nurse. I may go back to it someday soon, I totally was due for a break.

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Specializes in ICU, CM, Geriatrics, Management.

Great post, Yosemite!

Thanks.

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"I make sure, on the initial phone call, that there will be NO smoking in the residence; if there IS a smoker, I explain that I cannot be in the house while someone is actively smoking. If there IS a smoker in the residence, I explain that they must open windows/doors to air the place out prior to my arrival. If this is not possible, I explain to my supervisor and the scheduler that I can't take the case for medical reasons and will get a signed note from my physician if need be. If case is a discharge from SNF/rehab facility, I verify that NECESSARY DME is already in the house prior to my arrival; I tell you that there's NOTHING like showing up at a dingy apartment, full of cigarette smoke, a morbidly obese, non-ambulatory, Pt. in a dilapidated power chair held in precariously by a frayed safety belt, Foley catheter bag nearly bursting with urine, no bed/hospital (or ANY) bed to transfer to as to inspect the inevitable coccyx stage II (or worse) pressure ulcer that was unreported, the smell of feces and no supplies or clothing to change Pt., no food in residence, glucometer out of battery power AND strips (visible McDonald's empty bags and the obligatory "big gulp" soda jug), promised care giver no where in sight, unreported venous/stasis ulcers with no orders for care, dog barking menacingly at you while Pt./family ignores it, and the obligatory expectation of the Pt./family that you are there to provide "total care" for the Pt., NOT to teach them how to do so. I find it's IMPORTANT to find out the Pt.'s/family's expectations; MOST have NO idea what you're there for and SOME will be upset when you don't meet those expectations, unrealistic as it may seem. I find it NOT unusual that the Pt./family had NO idea (or claim to) that HHC was ordered."

LOL this is real life hh right there. No joke.

Good luck! Dont worry, they aren't all like this. But this is scarily accurate for some.

Julie

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Excellent post by Yosemite. I'll add that you should do as much documentation at the visit as you can. Don't get into the habit of taking notes.

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Specializes in Ped/Adult Home Health, Public Health.

Hey! How is it going, you're probably 2 months in, right? What are you experiencing now? How is your patient and patient's family? Any questions or things you want to share?

I truly love home health and want to help any nurse who feels their calling is the same. good luck! hope things are going well!

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I've been a CNA in home health and can relate to much of this, thanks!

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