Typical day for a Home Health nurse... - page 18

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like... Read More

  1. by   caliotter3
    You can find plenty of threads covering this in the home health forum.
  2. by   mightymitern
    WOW what a great thread! I am considering HH and am happy to see how the days go. I work in a Hospt. med/surg tele floor, but since starting have never felt so stressed, and have been sick more than I ever have been in my whole life. Are any of the HH agencies unionized, or are they pretty much private? Thanks for all this info it has been a pleasure reading.
  3. by   pear8
    Hi,

    i was wondering because 5-7 clients are seen per day at their homes and it seems to be maybe 1 an hour. is there enough time to drive to different houses and provide them the care they need in your day? or is it just in, out, quickly, next house? cause i dont know if you can give them adequate care in just less than 1 hour like 30 min? cause then it takes time to drive to the next house. is it under pressure and stress?
  4. by   elprup
    Quote from LoriAnnRN
    I can't go into details about my daily routines, but I did home health for about 8 years and I really enjoyed it. It has it's negatives but remeber this: your worst day in home health is still 5 times better than your worst day in the hospital setting!
    Love that quote! Thanks
  5. by   ED_Bound
    Quote from ginab2
    Hi! I'm trying to get the nerve to leave the hospital and go to HH. Could anyone give me some of the pros of going to HH over the hospital setting. I'm looking for a position in nursing that might work better with having kids, didn't know if HH was the way to go?
    I'm actually looking for the answer to this one as well. I enjoyed it during my one day clinical requirement in school but that of course was just an 8 hour glimpse into the HH world....
  6. by   Blackheartednurse
    I read twenty all twenty three pages of this thread.Wow awsome journeys you guys have been on.I was amused,shock and impress by all of your stories.I hope I can join in as well and share some experiences with you too.For now I would like to thank everyone who contributed to this thread,I learned a lot,thanks.
  7. by   mmiller1887
    Thank you so much for that glimpse in to your day. I am a second year nursing student and I am trying to determine my best fit for preceptorship. I am torn between med-surg, just for the fast-paced experience, or home health because I really think I would enjoy it.
  8. by   Blackheartednurse
    That happend last friday.
    1.So I see my first patient.She lives in a senior building and anyone who wants to get into the building needs a visitor pass.So the lady at the front desk ask for my photo ID,I reach into my walet for my Driver license and it turn out I lost my driver license.I literally beg her to let me in since I was here before and she knows me.She finally agrees and let me in just this once.The visit goes uneventful except that I discover a fungal infection in my patient foot and my patient barely understand English and the caregiver who speak English and usually is present when I'm there is off for a doctor appointment!

    2.I go to see one of my patient.He is outside of his building waiting for me with his neighboor.That is unsual of him.He states that he didnt pay for his phone so now it is disconnected (it is a secured building so I have to call him in order to get in).
    So we are headed to his building ,his neighboor opens us the door and then takes off somewhere.We walk up the stairs and reach my patient apartment and he is trying to look for his keys to open the door.He cant find it and claims that probably his neighboor took his keys by mistake but left somewhere but will be back soon.So we sat down on the stairs waiting for this other guy to come back.In the meantime my patient states he feels very weak and puts his head down. I rush to my bag and take out blood pressure machine and blood sugar machine.Have you ever took someones else BP,sugar in extreme condition as if on the very narrow stairs? If you didnt join a home health care,aboundant opportunities arise! Well his BP is within normal limits, and blood sugar is elevated but nothing drastic,well anyway the neighboor with the keys doesnt come back so my client decides to go one floor down and get help from another neighboor.I'm staying put sipping on my Donkey Doughnuts tea.So after literally what it seems like FOREVER my patient comes back with his downstairs neighboor,an older lady that does not speak English at all and her son.The lady speaks to me in a foreign language and even though I let her know I dont understand at all what she is saying she stills attempt to communicate with.Her son holds a screwdriver and decides to "open" the door. So me and my patient thank me and step into an appartment.Having an intuition I go into a patient's bedroom and guess what I find?! The keys!! I show it to my patient and he looks very surprised LOL.Next I set up a meal for my patient (a chicken soup) and motivate him to eat it,check the medication box (to see if the patient took his meds) only to find that of course he skipped some of the days cause according to him the med box is too confusing and he sometimes forget what day is it in the week.So I instruct him to comes back to taking the meds from the bottle (as he did before).Uff than I work on the rest of my assesment.Finally I'm ready to leave.As I attempt to open a front door I discover that the downstair neighboor's son broke the knob.So now the front door dont want to open.The patients reaction was "oh well I'l just use the back door to get out I asked him for the phone number of his landlord,of course he couldnt locate it so he goes again to his downstair neighboor to ask for one.He comes back after some times with the number.So I call the landlord and the landlord promises to send someone TODAY Then the downstairs neighboor comes with a big watermelon and she inform my patient in a different language that the half is for me.

    I must me crazy for doing HH))
  9. by   RyanSofie
    Quote from pear8
    hi,

    i was wondering because 5-7 clients are seen per day at their homes and it seems to be maybe 1 an hour. is there enough time to drive to different houses and provide them the care they need in your day? or is it just in, out, quickly, next house? cause i dont know if you can give them adequate care in just less than 1 hour like 30 min? cause then it takes time to drive to the next house. is it under pressure and stress?
    if it were a perfect world a hh nurse could work an eight hour shift and see one patient every hour. unfortunatley that is never the situation..a start of care oasis..requires an hour just in paperwork ( at the home) in addition to the reams of additional documentation ( poc, clinical pathway overview. variance tracking. medication list with all meds numbered for reference for the patient , physician notification with orders, contacting any other disciplines you access are indicated, hha poc, writing out your visit calendar and noting dates for recert window etc etc etc etc...multiply this x 5-7 visits a day. not only paper work but crisis ( i recently had an entire family flipped out because mom was "boiling towels on the stove" which physical therapist informed the family was due to possible "appendicitis" because mom had flank pain. i was called and went immediately as ordered to do prn on patient and methodically unraveled the situation , calmed the family and patient. the diagnosis? uti. i obtained a simple urine specimen , calmed the family and patient and went about my business for another 10 hours . time invested: 2.5 hours ! my quota required by my company 5-6 patients a day...if crisis occurs and you miss appointment...continue the day until you reach quota or add to the next day to make quota. . needless to say the treadmill was too fast for me...i had to go contigent i simply could not work 14 hours or more everyday . in the end earning less than i would at mcdonalds flippin burgers. driving? try 86 miles for one patient...then another 100 plus that day to see the remaining..an hour drive to that one patient and an hour drive back to see the remaining ...
  10. by   xEdgexRNx
    Do visiting Home Health RNs have on-call hours? What are the typical shift hours (start to finish)? Do you work past your shift often?
  11. by   RyanSofie
    The company I work with rotates call between clinicians. One week on usually a month which includes a weekend ( Friday to Friday). We have no "shifts". If you work in the field you work until you finish your required "quota" of 5-6 visits. You set the appointment times with your patients and that determines your work hours. Typically I say "I have an opening in the morning between 8am and 12 noon or afternoon between 1p.m and 6pm. I have learned not to set precise times for appts because of the variables that can occur ( traffic, previous patient in crisis ,etc). I can see typically 4 routine visits between 8am and 12noon if all goes smoothly which is rarely the situation. If I have SOC's ,RC's or ROC's they consume at minimum an hour and a half excluding travel time because of assessments,wound measurements, report to physician ,etc etc. Of course the other factor is mountains of paperwork and that is many times hours in addition to my day. Home care is not an easy task by any means. My team and I have calculated our true rate of pay based on hours invested and we would earn more at McDonalds. On call is another thing, typically you can triage on the phone and if the patient is having a critical situation the advice is 911 EMS to hospital. If the call is in regard to cath coming out or something a nurse can address you get in your car and hit the highway to that patient. We are paid 50.00 /week for on call and per visit for visits. Weekends or evenings may also include late referrals or hospital d/c's that require immediate SOC or ROC. I have had to drive 160 miles round trip to see "1" patient and make that daily quota of 5-6. We are given points for visits...routine (1 point) SOC (2 points) ROC (1.5), D/C (1.5 ). If clinician must drive 10 miles or 200 miles to see a patient the points are the same. A nurse must make "productivity" that is "30-32" points per week. We are expected to work Mon thru Sat every single week. So? What do you think? Beneath all this...frail elderly many living alone in financially and support lacking circumstances. patients with numerous chronic disease procesess in addition to the acute problem that results in home care eligibility. Good luck nurse...hold onto your hat its a heck of a ride...
  12. by   Nursecathy123ca
    I understand what you are saying. The 'extra' hours spent on paperwork are ridiculous. We have lost some good nurses due to the ever-increasing paperwork burden. And I refuse to work 50 hours for 30 hours' worth of pay. So I looked for another job with a reasonable salary. When I found it and told my current employer, they suddenly decided that they could meet the offer of the other company.

    So don't sell yourself short. If you have experience and good references, look around at what's out there. There are employers who value good nurses!
  13. by   RyanSofie
    Quote from osborncs
    I understand what you are saying. The 'extra' hours spent on paperwork are ridiculous. We have lost some good nurses due to the ever-increasing paperwork burden. And I refuse to work 50 hours for 30 hours' worth of pay. So I looked for another job with a reasonable salary. When I found it and told my current employer, they suddenly decided that they could meet the offer of the other company.

    So don't sell yourself short. If you have experience and good references, look around at what's out there. There are employers who value good nurses!
    We are advocates for our patients. We will use our critical thinking skills at solve issues with intelligent, experience based knowledge that we have diligently worked to aquire in our professional settings. Why then do we as NURSES simply "HOPE' things will improve ? We as nurses must begin to recognize our VALUE to healthcare. We fail to use our voices where they count in the legislative halls of the government. We are millions strong across this nation and we can make the changes that need to be made through our united efforts. Physicians are heard ,pharmecuetical companies, insurance companies etc. We are an integral part of healthcare and I say NURSES stand up...be counted and recognize your place in healthcare is VITAL.

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