Nicu to home health. Am I crazy?

AprilLewis · Jun 11, 2016

Ha! I switched from surgical ICU to home health. I only lasted 2 months and then I went back to the ICU. I suppose it depends on your goals and your reasons for switching. More information please:)

mlang, BSN, MSN · Jun 12, 2016

Why did you only last 2 months?

mlang, BSN, MSN · Jun 12, 2016

I work at the highest level NICU. The acuity is very stressful. I work nights and feel like I live to work. Always chasing sleep. I am 48 and this is a second career. I've already put in 17 years in another healthcare related field. I don't want to be this stressed this much

margin261 · Jun 12, 2016

Mlang- just read your last post & felt compelled to respond!

I just turned in my resignation at my HH job after only 4 months- the frustration & stress just weren't worth it at my age (46)

Seeing pts, spending time with pts, was great- I love it! I love when I feel like I make a difference in someone's life. BUT, the paperwork, well, tablet work is ridiculous. I would work all day seeing pts only to go home & chart for 2-3 hours every night! But even that wasn't the deal breaker-- the dealbreaker is the scheduling. I can't even really describe how ridiculous it was!! I ended up being so frustrated everyday, that it was affecting my health, my marriage, my whole life and I didn't want to deal with it!

I'm really not trying to scare you off HH. Just make sure you find one that has enough field employees & enough office employees too. And a scheduler that knows what they're doing! Makes a huge difference

The paperwork is overwhelming esp at first but the more you do it, easier it gets & faster you'll be at it

I do wish you luck!!

brillohead, ADN, RN · Jun 12, 2016

Instead of Home Health (many visits per day, driving all over the place), maybe look into Private Duty (working a whole shift in just one home).

Especially with your NICU experience, you'd be in high demand for pediatric home health -- babies and kids with ventilators, G-tubes, trachs, etc.

Much less stressful, only one patient, you typically get a lot more downtime, etc.

Downside is that the pay isn't as good as facility pay, and the benefits (if any) aren't as good.

It can also be boring -- same thing, every day/night, every week. That can be a good thing or a bad thing, depending on how much you personally enjoy routine or variety.

But it can be incredibly fulfilling, too.

You can easily pick up a shift here and there working PRN for an agency, to see if you like it, before making the switch, too.

Trauma Columnist · Jun 12, 2016

Moved to home health

nutella, MSN, RN · Jun 12, 2016

To be honest - home health is not easy peasy and not a "low stress job". I worked home hospice and palliative care for almost 2 years and a lot of people come and go. It is not only that you see a patient - you also deal with parents/caregivers, you will be a case manager and constantly on the phone to reach MDs, other nurses, and so on. Documentation is excessive and driven by reimbursement. Your car will put on a lot of miles and our trunk won't have space for groceries...

The agencies all have productivity and hold you to it, in addition they will constantly ask you to work "just one more visit". Payment is lower than hospital, mileage varies, you might have to do on call and so and so many weekends.

A lot of nurses make the mistake of thinking that community care is low stress only to find out that they are being paid for 8 hours (salaried) but add another 2-3 hours for documentation at the end of the day. I am about your age and went back to work in a hospital because of the constant push to work more and burning out staff. I got all my documentation done within the work hours but I am extremely organized and documented mostly in the home.

If NICU is too stressful what about some clinic in the hospital, part time, or regular ped floor?

If you still consider home care make sure that you shadow with a nurse for at least half a day.

Haddoa · Jun 12, 2016

I went from a high level icu to home health 9 months ago. Best decision I ever made. Most weeks are bliss. There are parts that can be frustrating and your phone rings all day. But in general not being in a building or even with one of more than an hour is amazing. I live in my territory as our office puts in areas close to home. I can see 6-7 pts between 830-230 most days. Sometimes you have the random outlier but that's life. You must plan ahead and being in charge. My pts are told I am in you part of town these two days do you want morning or after lunch? No set times. You will be given about 45 min notice. It will be almost the same each week. 99.9% are like ok yay. Also and this is a must, chart in the home. They charting if you are electronic like me is not bad and if you can do most when you are in the field then you should be spending less than an hour at night fine tuning and preparing for the next day. This does not include oasis paper work which is far more intensive and I do not do in a pt home. Those are the times at home I have more charting. But like I said I am normally home at 230. So if I have to chart til 5 it's still fine and I am home!!! I can pick up my kids and never miss an event. Ok so long story short here. It was the best decision of my life. I love my agency and coworkers!! You could also always think of going to pacu? Good luck!

Libby1987 · Jun 12, 2016

I'm not case managing anymore but my experience was very similar to Haddoa's. Difference being I've been a career home health nurse, both case management and administration, Haddoa seems to be one of those naturally inclined for the home health skill set and has picked it up very quickly.

Home health 2016 has a tremendous learning curve and with 5 star ratings initiated last year, the pressure has intensified from admin to clinical staff. It is extra challenging I believe to learn late career as it takes a huge amount of mental energy the first year and like most late career nurses you probably have other responsibilities/interests, tire more easily and not the luxury to recharge on your days off. (I learned in my 20's pre kids/mortgage).

If you're planning on working with the general population, strong working knowledge of adult/geriatric disease mgmt is essential. Home health focus is all about reducing need for acute readmission, you need to know those disease processes and how to manage/teach them in the out patient setting.

My pay as a M-F days case manager was good and comparable to any weekday 8-5 position. I lived in my patient territory and that makes all of the difference with time and mileage. As a Case Mgr I also scheduled my own patients, and I was very organized and knowledgeable re everything home health which allowed my clincal director to focus more on supporting the new nurses. Staying organized and running a smooth schedule in the office is much dependent on the nurses on staff. It only takes a few who aren't inherently organized, detail oriented and strong time managers to throw things off for everyone else.

mlang, BSN, MSN · Jun 13, 2016

Thank you all for the very helpful feedback.

AprilLewis · Jun 19, 2016

I loved going to client's houses and seeing them and doing some case management for them. However, the paperwork took so much of my time and I was not reimbursed for it. I really couldn't afford to work as a home health nurse as I had a daughter to support. I hope you have a better experience. I know it depends on the agency you work for. Let me know how it goes!