Typical Day For A Home Health Nurse | Life of a Nurse

Hi guys, I thought it would be nice to start an ongoing thread to just post/vent about your usual day. With a lot of entries, it can sort of serve to show nurses who are thinking about getting into Home Health what it is really like on the good days and the bad. Specialties Home Health Article

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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 I usually try to do.

8:00 am:6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that.

First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec steroids), reviewed her meds, VS stable, edema but no change. Off I go.

Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is back ordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re please give pt RX for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go.

Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now)

Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go

Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently, she was on spironolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back Thursday for labs. off I go

Next, funniest LOL, she answers the door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook and was taking her meds correctly. Then she pulls out five RX dated 1-21-03, two are new meds, but PRN types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason, she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relieved, she gives me a big hug. Off I go

Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad.

2:15 pm. Back to my township, drop wee wee at quest labs, drop off RX at the pharm, get to my house. Reheat leftover Chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much.

Worked on paperwork until 4:45, finished time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow.

Pretty routine kind of day today.

Anyone else want to share??

A Day in the Life of a Public Health Nurse...

 

I love this thread! I got started in home health April of last year per diem, then in September went full time. The office was 1 1/2 hours away from my house but I had a "hook-up" with getting an interview because I knew one of the supervisors (PCC). When I went full time I went from per visit to salary with "compensation." That is, I get a set salary, plus car allowance and cell phone allowance. I am required to get 35 points a week, and anything over that I get the per diem visit rate for each point over 35. Boy did I blow up the bank on that one! I was averaging 45-50 points a week. However the strain on my car, time and family was too much, and a few months ago discovered that another branch of the company had a full time position open for a section of the county I lived in that was 15 minutes away from my house. Woot! So I transferred. Big mistake. Can't stand the supervisor, she is an IDIOT and can't ever get things done in a timely manner. Not really a fan of my fellow field nurses, the two I work with in my area are per diem LPNs and they used to get tons of visits but since me and another FT nurse started they get squat now and they are very vocal about it.

Anyway I've been reading other posts and I saw one that she covers 27 counties??????? Whaaaa???? Not sure how everyone else does it but my company generally has a branch in whatever county they are covering here in Florida. The exception is my current branch. Their office wasn't getting alot of visits so they took the southern end of the county just north to them (my current territory) because the area is SO BIG. We are paid by Medicare so I see nothing but little old people and the younger ones on it for disability. Just a little back story. On to my day!

I had to move some patients off tomorrow because they are making me take the day off because I'm on call this weekend. Yes, MAKING me. I would rather work, it would just make my life easier. I've had to give away visits because I've had almost 14 regular visits every day. So today I originally had I believe 10 regular visits, no admissions (thank goodness). Making my phone calls last night and one of my pts had an MD appointment today to get the wound below her stoma looked at. So I told her we would skip the weekly check up this week (she does her own wound care, long story, unable to d/c due to open wound and the surgeon doesn't know what to do so we help determine WC). Down to nine visits. Doable!

Had to get to the office early this morning to drop off paperwork (yes we are still on paper in this day and age!) and of course get held up by my supervisor yammering *yawn*. Finally get out of the office (which BTW is 30 minutes from my area I cover) around 900. Which is great since I was due to be at my first patient at 900. Show up at 930, he isn't there. Greeeeat, will try again later.

On to #2. He has a wound on his foot that everyone thinks is a diabetic ulcer....except he's not diabetic.....anyway he goes to the wound care center weekly, they send new orders, yadda yadda. They decided to totally change up his wound care, using something I had to Google. It's called Tritec by Milliken. Interesting. Will have to see how this goes. He then informs me that even though his orders from the center say F/U in 1 week that would be Memorial Day, so it's 2 weeks. Will have to call and clarify since our orders will end next Monday. Pretty lengthy wound care, but shuffle through then it's off to my next one who is about 20 minutes away.

#3 is the sweetest little man. He's a quad x 7 years since neck surgery gone awry. He gets weekly foley changes and currently has a massive heat rash to back and booty and has a wound on his arm he got at the hospital that is healing up nicely. He lives with his little old wife who takes care of him and has hired help bathe him 4x week. I change the bandage, his wife tells me she had to change the foley sunday because he had so much sediment it clogged the cather (again). Suggested he drink more fluids and start running on the treadmill to decrease the sediment. That got a laugh out of both of them. Off to the next, another 20 minute drive back to the area I was at this morning.

#4 He had back surgery, they left a sponge in, now he has a huge wound on his back. Daily wound care, luckily his cute little wife can do it sometimes too. Whip through that visit, smell that their son got a pizza for lunch and hear my stomach growl. Realize it's now 1200. Off to the next patient!

#5 zip over to him right quick about 5-10 minutes down the road. He also has a chronic ulcer on his foot that IS complicated by Diabetes. And he's mildly overweight. And he smokes. He has a cute little doggy though. He goes to the same clinic as #2, same doctor, ALMOST the same wound care. He also tells me his next appointment is in two weeks, and his order says F/U 5/29. Hmm.....something is fishy.....will have to call and clarify this....but it's 1230 so they are at lunch......mmmmm food.....

Stop at McD's and eat since the Big Mac is on sale for $2 :)

Head over to #5, little old man with a skin cancer removal from his head we have been treating for a few months. I almost had the joker healed 3 weeks ago and the flipping dermatologist thought it would be a great idea to put silver nitrate over the WHOLE THING. So I feel like we are back at square one again. Play with their collie for a few minutes, I think they want me to take him, they keep commenting how my little boys would love him. Lemme get out of here before they ask!

Head over to an ALF memory care to see #6, 7, and 8. They all live in the same unit (how convenient!) and two of them are husband and wife (how cute! they're demented together!) Do the husbands wound care (this is a joke, flush his toe with saline, apply TAO, and literally put a band aid on it. but the alf can't do it.) Go to do the wife's skin tears and man! Is she crotchety today or what!!! Come to find out from the staff she went to the doctor today. So I don't have to see her after all. Which was fine by be because she was all mad because she thought her husband was flirting with the cup of popcorn in front of him. So I decide to see #8 (who is now number 7). She had fallen out of bed and broke her arm. Went in to check on her and guess what. She's taking a nap. So I'll just move her visit to Friday since she's 1x week anyway.

My #9 was supposed to receive IV potassium and mag, however she is in the next city with her dad who is dying of lung cancer, so she decided to delay the medicine (this would be her first dose x 3 doses) until this is all done.

Back to see my original #1. He's home, so I get to do his wound care. He has a traumatic wound on his leg I've been treating for a few months. It was sooooo sloooow to heal, and I had to recert him last week. It has shrunk down so much in the past week I think I may be able to discharge him in a week or two. Woot!

So saw a total of six people today, finished visits by 3pm. Headed over to the satellite office we have up here so I don't have to drive back down to the main office, call and confirm my visits with my scheduler, and make a few phone calls. Had to clarify those follow up appts with the wound care center. Yes both patients were right. So guess who gets to write the new order and tell the scheduler two of her 3x week wound cares are now daily x 14 days? Yeah boy! Me! Notified the doctor's office of the lady with the dying dad that she will not get her medication until she gets back from that and we will delay the post med lab work until after the med is done. All in all was home around 415 today, had most of my charting done in the patients homes for a change so just need to document one or two items!

Wow just realized how long that was, so sorry! :)

You are one organized individual!

Was loving reading this thread before realising it was created when I was a child... Crazy to think that I wouldn't have understood a word of the posts back then, now I'm really enjoying reading the typical day of a HH nurse!

It's sounds incredibly challenging and rewarding!

I've been thinking about a career move to another field of nursing and HH has been on my interest list. But I must say that I found this thread so interesting I read every single post and have decided HH is exactly what I should be doing. I work very well with a team but there's nothing I enjoy more than autonomy and my independence. Thanks for all the insight :up:

So glad this column helped you make that decision. I did home health nursing for 8 years and have no regrets!

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

0300 hours: alarm went off, got up an turned on computer, brewed coffee.

0320 hours: plotted out my visits for the day, driving times, expected visit times, ect.

0415 hours: reviewed the care plans, printed teaching materials for presentation to clients.

0530 hours: began documenting previous days visits

0630 hours: breakfast

0700 hours: wrote and printed Faxes, orders, etc. for physicians

0745 hours: personal time

0815 hours: shower, etc., prior to leaving for office

0900 hours: arrived office, emptied in-box. Dealt with that crud.

0930 hours: began calling and negotiating with clients for visit schedules. Most didn't answer their phones.

1000 hours: office politics, gathering supplies, etc.

1030 hours: avoiding highway patrol speeding towards 1st visit.

1050 hours to something like 1130 hours: 1st visit, got my dressing change urinated on by the client. Had to re-set up my gig.

1130 to 1150 hours: driving through bad part of town to get to next client; hard time finding a place to park. Glad that my battered ol' truck will not stand out for thievery.

1150 to 1205 hours: attempted to see client, had to wait and enter through security gates. Pt. was smoking in apartment, I had asthma attack, had to bail from the scenario, almost calling 911 (for me). Almost overdosed on albuterol. Patient not "seen," little pay for this encounter.

1205 to 1330 hours: traveling to and seeing next client. No problemo! Go figure, eh?!

1330 to 1430 hours: traveling to next client; traffic jams. Detours.

1430 hours to 1530: Foley catheter malfunction; replaced. C-PAP mask misunderstanding; fixed.

1530 to 1645 hours: Drive home, long distance without reimbursement, stop and go traffic, some 39 miles or so.

1645: grocery store for diner supplies.

1700: Home. Blowing off charting. May blow off diner. 1/2 bottle of merlot, then bed by 1930 hours. Wondering where my personal life went.

0300 hours: rinse, repeat.

Can totally relate to Yosemite, RN. I gave it 10 months. Just quit 2 weeks ago with no other job even lined up.

Time invested divided by pay equals not even close to worth it.

It's a rare day I see 9 patients but when I do I would make $585, more if any were IV/vac/discharge. Plus OT.

I've worked for a total of 4 different HHA employers, I haven't had such negative experiences as I read here.

Specializes in Med/surg, home health.

That's promising!! I just accepted a job in HH today!! I have been working on busy med/surg units in the hospital for the last 4 years! I'm getting burnt out! :-)

I have never worked as much as I do in HH, and it remains my favorite job in my 10 year nursing career. I didn't like the type of stress a coding patient brings, I'm not an adrenaline junky. HH definitely brings stress, just of another variety completely. I am very organized, and that is how you survive in my opinion.

Specializes in FNP- BC, Med-Tele, PCU, Home Health Case Manager.

I just got offered what will be my first job in HH and the company (plus previous posters) have all forewarned me about how it takes a little getting used to and its a lot of work but you can really love it. I've been working in an over-worked busy M/S/PCU floor for the last year and I still hate it. HH is something I've been wanting to try but never got any bites and this company is putting their faith in me and offer lots of training/support to take me in. I also was offered a job today on M/S floor at a different hospital but the 12 hour days have been hard on my son and I and I've been desperately seeking more 'normal hours'...so will it just be same sh*% different hospital? Idk what to do? I'm taking the night to weigh pros and cobs of each job but I'm leaning more towards the HH job because its something different and I think I'd really enjoy. Thoughts?

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