Originally posted by angelaADSN:
I am a student nurse working on my associates degree. I hopefully will graduate May, 2001. I am interested in home health, and was hoping someone could answer a few questions. I am not to crazy about staying cooped up in the hospital and I thought home health would be something for me. When you go to patients houses what exactly do you do when you get there? Are there ever any times you get lost and can't find your way? Is there a lot of paperwork to fill out? What is the estimated starting out pay for someone with an ADN degree? Do I have a good chance starting out in home health after I graduate, or in your opinion am I better off getting experience first before going to home health? Do you enjoy your job? I feel comfortable doing my clinicals but I don't know how I will do when I finally graduate. Where any of you scared? Thanks for your time?
I think it is great that you are considering home health. However, I would strongly encourage you to get expertise in the hospital in the area that you plan to focus on the most in home health. Some agencies will hire a nurse that specializes, i.e. psych, peds. I think that the best foundation for home health is med-surg with some focus on ortho, rehab, restoration, and a possible stint in ER and case management. Most home health agencies require that a nurse have at least a year or two of hospital training.
The practice of home health, in my mind, makes a hospital trained nurse complete. The hospital, by and large, is a structured organism. The patient and family essentially have no control over what happens to them in a hospital environment. In the home setting, the patient and/or family is in charge or should be, and the nurse is the guest. This is what makes the practice of home health unstructured.
If you work for a Medicare/Medicaid certified agency, you may walk into any kind of condition. I have been in some real ragged situations. Then I have been in some very nice ones. You really have to have a love and understanding of home health to accept the conditions for which you may be required to work under. In your driving,you may get very lost if you work in the rural areas where the place may only be identified by a rooster on the mailbox (there may be other mailboxes in the area with a rooster on the mailbox). Or, you may find that the directions are not written quite right. For patient care, you will have a care plan or plan of care outlining the physician's and nursing orders. Your client care and documentation has to follow this explicitly, because reimbursement is based strictly on that plan of care and whether your notes are in sync with it.
Yes, there is a lot of paperwork, and it has steadily increased over the years. The agencies that I'm aware of now have anywhere from 40-45 pages in their admissions packet, for instance. This has frustrated many nurses, including yours truly, but I find that for direct patient care, I prefer home health over hospital nursing.
You have to research and shop around for a good agency. You want to find an agency that is employee-oriented, that will give you a good quality orientation and will not overwhelm you with unreasonable demands. I cannot tell you what your pay would be in your area. It would also depend on if you're salaried or per visit. Most HHAs in my area have gone to salaried pay. I have found that we may make a buck or two more per hour than the hospital based nurse in some cases. When I went into home health, I had over 5 years of experience in hospital-based nursing. Degree doesn't have any bearing on front line work in my neck of the woods.
I suggest that after you get some med-surg under your belt, you consider working home health part-time or prn to see how you're going to like it over a long period of time. With home health, you are in a situation in which you will have to rely on more than your God-given 5 senses to achieve the best outcome for the client, you, and your agency. You won't have the type of support like you have in the hospital. Best wishes.
[This message has been edited by Mijourney (edited June 28, 2000).]