New Grad Home Health Possible or Impending Doom?

Specialties Home Health

Published

Hi guys,

I am a new grad with license of one month. I was offered a HH position at an agency and the DON made the position sound straight forward (admission head-to-toe, pain assessment, report abnormal findings, d/c, pt edu, IV antx, foleys, labs) After weeks of desperate job hunting with zero calls back, I said I'm on board.

BUT the thing that scares me is that while she's willing to train me with OASIS, she said I don't need to train/shadow an RN before I go on visits on my own. Not even once. So come Monday I'm on my own! I'm afraid that since training isn't provided, I'm basically going by what I learned in the program. What if that's not enough and I make a mistake? What IF my IV infiltrates after I leave the patient? What IF the foley is faulty? What IF I make a piggy back error? At the hospital I'm there with the patient after the intervention. A mistake is observable and fixable with charge nurse to help. What scares me is that a mistake will happen and I won't know until after I leave. I don't want to harm anyone and lose my license. Anyone have any suggestions?

I am all for working hard on this, I want to be good at HH. But if there's anything I learned in nursing school is that RANDOM freak accidents can happen, even with careful nurses. The difference is, at the hospital you're there to fix your mistakes. In HH you're gone after the visit and ill prob spend many sleepless nights wondering if my foley was inserted correctly or if that IV was okay... Does any other HH nurses worry about this?? Help!

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Specializes in Home Health.

RUN!!! That does NOT sound safe! I would not work ANYWHERE that didn't orient me properly. You will need orientation to policies and procedures, proper bag technique, home care rules and regulations, not to mention charting on the company software (if they are computerized)...

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

Yeah, skilled intermittent visits with no preceptor, training or orientation as a new grad is recipe for disaster. At least you realize you are not an expert and know that you don't know everything....think of other new grads that would not second guess such a job with no preceptor or orientation?!.!? There are some agencies that offer extensive training and orientation for new grads in skilled home health usually 60-90 days!

Did they eve ask you to demonstrate necessary skills or write sample documentation?

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That's scary, if anything these skills are more difficult in the home. In the hospital setting as a new grad you have those with experience to fall back on and ask for help. In the HH environment you don't have that. You must be confident in your skills and your knowledge base to be able to provide safe care in the home. I would say absolutely not take this position. I'm not saying no to HH, just that I'm sure there are agencies out there who are willing to provide an adequate orientation period especially for a new grad.

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Thank you all for replying,

The DON will train me on charting on OASIS. I put my foot down today and said I absolutely need to shadow a RN at least one day, she gave a whopping ONE visit to shadow, saying it is against their policy to send more than one provider at a time.

Idk if you guys remember what its like to be a new grad, no one will hire you without "experience" but how can I gain experience without getting hired?! Oh the irony. I'm going to go about this extremely careful. I will refuse any cases or any procedures I'm uncomfortable with. I will get a pay-as-you-go phone of my own to allow pts to call me that same day if something happens. Anything I haven't done before (she mentioned IV antx by gravity?) I'm going to refuse and ask to watch a nurse do it first. I'm a realist and being paranoid will help cover my ass. Come 6 months ill move on to something else.

Any other tips/suggestions? Thanks!

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Specializes in Infusion Nursing, Home Health Infusion.

You do not need to be frightened if you are going to have to give antibiotics by gravity especially if you will be with the patient the entire time. Gravity sets are perfectly safe in home care they usually will send out a dial a flow type of primary set. You do need to make certain you have an ANA kit in the home and know your Anaphylaxis Protocol. If you will be teaching a patient or caregiver how to self administer them you must teach them and make certain that they are competent to do so before you release them for self administration and of course document that.

Yes!.... IVs infiltrate but often in home care the patients have PICCs or ports. If the patient does have a PIV then you instruct them how to assess for complications and what to do and how to report it. You must be good at teaching or get good at to do home care. Documentation is extremely important and remember you must make certain that the patient and/or caregiver must be instructed then deemed competent before they can assume care and if that never happens you must notify the supervisor and the provider.

You may feel alone but you are not. You have a supervisor that you can consult and also make friends with the other nurses so you can consult them as needed. Make sure you have all their contact information.

The Oasis form seems like it will take a decade to acquire the info then fill out. I got so good at it that I could acquire the info as I did my visit without really ever having to do a line by line questioning. I made myself a cheat sheet of the things I tended to forget. My sheet cheat included, such things as glasses,pharmacy pt uses with number ,religious preference, use of any assistive devices. Make sure they explain what home bound status is and how to document it correctly.

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Specializes in Infusion Nursing, Home Health Infusion.

You can always come here for help and advice as well. I have been doing PD in home infusion since the early 90s..been a nurse since 1981. Just do one day at a time..it will be a learning process but you can do it and use your resources. They are there even though it is different than being in a hospital setting .

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Specializes in Gerontology, Med surg, Home Health.

I think you're crazy to take a home health job as a new grad. You'll be on your own with no experience? You worked hard for your license....it sounds like it will be in jeopardy.

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Do listen to any negative people here. You will gain as you go. If you're uncomfortable with a situation then don't do it. You will be fine!!! Gain some experience. It's never easy for any job the first time. Good luck!

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Don't**

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There is no way this is legal. New grad or not, every nurse new to a company should be checked off on competencies. In order to be checked off, you would have to go out with another nurse. I believe new grads can make great home health nurses, but only with proper orientation. If this company is trying to send you out on visits with no shadowing, not only should you run, but you should report them. If this is how they operate, I would hope someone reports them! Think of the poor patients they serve! How unsafe!

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Specializes in Home Health, Geriatrics, Women's Health, Addiction.

I agree. I am a newly licensed grad who will be starting in home health soon not because I couldn't find a job but as my first choice. So I get a little touchy when I see situations like yours because there is a school of thought that new grads should not go directly into home health. Yours is a recipe for disaster because of the lack of training and self confidence on your part. After my home health rotation I researched the companies in my area because I knew that was the specialty I wanted to work in. The company that hired me has a full time preceptor who will work with me a lot longer than a typical hire as they do not hire a lot of new grads. I won't be "observing" other nurses while they work, instead I will be opening my own cases and training on how to do my own cases. I won't be expected to do anything I haven't received training from them on. There are a lot of positive things about this company but mainly I wanted to stress in regards to your post, "Who does that?!!!" Who blindly sends out a new grad without assessing their clinical abilities? But they want their paperwork right; they'll train you on that. Big red flag. I too think new grads can be great in home health but just like every other specialty you must be properly oriented and constantly learning daily just like any other nursing position. Knowing your skill limitations is an asset and good for you for speaking up. You may have had a lot more confidence if they just had oriented you correctly. Best wishes.

There is no way this is legal. New grad or not, every nurse new to a company should be checked off on competencies. In order to be checked off, you would have to go out with another nurse. I believe new grads can make great home health nurses, but only with proper orientation. If this company is trying to send you out on visits with no shadowing, not only should you run, but you should report them. If this is how they operate, I would hope someone reports them! Think of the poor patients they serve! How unsafe!
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