Typical day for a HH nurse... - page 13

by hoolahan | 192,252 Views | 259 Comments

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 HH what it is really like on... Read More


  1. 0
    Home health has been so good for my health...NO MORE NIGHTTURN OR 12 HOUR SHIFTS....Typical day for me....leave my home after 8 am, usually have a patient within a mile, then I will venture out to the furthest(10 miles max), work my way back and always finish up near my home to collect as many miles as I can.
    I am always home for lunch, have two big doggies who count on me. I am the only local fulltime r.n. We have a fulltime admission nurse, but I still do admits also at times, a few per diem nurses and a few per diem psych nurses. I have figured out a long time ago to keep up with your paperwork, keep all your supplies in order, and have a little note started for all the things that need called/ordered before the end of the day. One of the worst days is wed. Thats are stats and case conference day. For a few hours, nothing really is achieved. Usually our manager starts a conversation that goes into 10 different directions. After about 30 minutes, she starts another topic.
    Not sure if you folks have the atp's (advanced teaching path's) but they sure to make your skill much easier.Today. I was the lucky nurse to have the medicare reviewer with me and all went well. Thats a day most nurses do not look forward to, but someone has to do it..lol...So, a big hello to all you homecare nurses
  2. 0
    Hi. I have been reading this thread and find it very interesting. I am a LTC nurse w/ 19 years experience (unit manager/staff development/MDS co). After many years of trying I finally finished ASN program and went from LPN to RN. Now I would really like to think about trying a new career path and this sounds kind of interesting. I am married to a truck driver w/ erratic schedule w/ 2 kids 9 and 11 that are involved in everything( in other words I have full time car pool duty as well). I need a job w/ some flexibility and I don't want to be married to my job. Can anyone help me out with some further information. IE; What is starting pay like, what is weekend and holiday schedule like, what is gas reimbursement like? I read that alot of HHN are doing paperwork at home in the evening, is this normal? Acceptable w/ management? (Sounds good to me, I could do it when convenient for me). Thanks for any advice you can give.
  3. 0
    Quote from SriggRN320
    Hi. I have been reading this thread and find it very interesting. I am a LTC nurse w/ 19 years experience (unit manager/staff development/MDS co). After many years of trying I finally finished ASN program and went from LPN to RN. Now I would really like to think about trying a new career path and this sounds kind of interesting. I am married to a truck driver w/ erratic schedule w/ 2 kids 9 and 11 that are involved in everything( in other words I have full time car pool duty as well). I need a job w/ some flexibility and I don't want to be married to my job. Can anyone help me out with some further information. IE; What is starting pay like, what is weekend and holiday schedule like, what is gas reimbursement like? I read that alot of HHN are doing paperwork at home in the evening, is this normal? Acceptable w/ management? (Sounds good to me, I could do it when convenient for me). Thanks for any advice you can give.
    I work a very rural midwest territory,about 5 counties. I'm not able to predict when I'll be home. My husband is the one with the set hours. Call is feast or famine. There are 3 of us to split call and it comes to a 9,9,10 split to cover a 4 wk. schedule. W/e are unpredictable. Our branch is usually slow unless we have admissions or a Hopsice pt. crashing-we do HH,HOS & HIP. If i'm going to be short on hours I can pick up visits from our larger a bit more primary territory.
    I have been in nursing 20+ years and have enjoyed Home Care more than anything I've done so far. My ANCC certification is in Mental Health,but I get to do access devices of all kinds, wounds and all kinds of wound care,Hospice I get to do infusion pumps,use meds in creative almost fringe ways for symptom control ie using a med for the s/e to ensure comfort such as Periactin an antihystamine,used for its s/e effect of marked appetite stim. A small pill taken TID AC vs large doses of expensive Megace,gaggy liquid. I've used subq Ativan to manage terminal deliruim and drug withdrawl in the actively dying,used pedi angiocaths for a subq infusion in a pt. who had a violent localized reaction to every butterfly we tried,taught the caregiver of a schizophrenic to set out 60 Morphine Sulfate 1 mg. tabs every day so he could dose himself because he was so paranoid he couldn't take his Roxanol because he thought it was just water,but he was happy to count out 15 tabs every 6 hours and take that. I've put kitty litter in all kinds of containers under beds to control the awful odor of Ca lesions,seen family who haven't spoken in years reconcile, been called an angel for doing disimpactions and on and on and on.
    Not predictable,but great. Keep in mind we are small and cover a large rural area.
  4. 0
    Quote from hoolahan
    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 HH what it is really like on the good days and the bad.

    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.

    8:00am :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 streroids), reveiwed 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 backordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re pls 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 spirolactone 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 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 relived, 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.

    2:15pm. 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, finshed 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??

    My day started as I was driving in to work. At 6 a.m. one of my R.N.'s called in sick, so looks like we'll have to get his visits covered. As I arrived to the office, I was notified that 2 L.V.N.'s also called in sick. Typical Monday morning. First of all, staff is to personally call me when calling in sick, not to leave messages with anybody else but they continualy do it anyway, which means that we also have to cover those visits but I also will need to sit down again with these nurses to remind them about calling in.
    Visits get covered by other staff who seem resentful because their day just got busier. Wonderful, now I have resentment among workers.
    We got new glucometers that control solutions are not working properly, so now we have to hunt and borrow strips from other nurses so we can get our blood sugars dor the day and get with central supplies about ordering new control solutions.
    I have a family member on the phone who is trying to change appointment times for physical therapy to evaluate and I'm having difficulty in reaching the P.T.A.
    I have my office manager in the hospital having tests, they're not sure what the problem is yet, but payroll needs to get out in order for employees to get paid and the other office workers don't know how to do payroll.
    My boss calls from the parent office wanting to know if I've hired a marketing person yet. I don't even have any applications let alone any interviews.
    I do have an interview set up with a R.N., hope she works out.
    I get all kinds of spam on my e-mail that I have to sort through and reply. I have a meeting with staff this afternoon, if we don't get too long-winded, maybe I'll be finished by 5 p.m.
    On top of all that, my boyfriend recently had surgery to his right shoulder and is unable to work, clean, cook or drive. Oh well, there's always tomorrow.
    Alice
  5. 0
    Alice.....that is one crappy day girl! When I see my D.O.N. next time, and she looks frustrated, I will be extra nice to her


    Quote from AliceAngel
    My day started as I was driving in to work. At 6 a.m. one of my R.N.'s called in sick, so looks like we'll have to get his visits covered. As I arrived to the office, I was notified that 2 L.V.N.'s also called in sick. Typical Monday morning. First of all, staff is to personally call me when calling in sick, not to leave messages with anybody else but they continualy do it anyway, which means that we also have to cover those visits but I also will need to sit down again with these nurses to remind them about calling in.
    Visits get covered by other staff who seem resentful because their day just got busier. Wonderful, now I have resentment among workers.
    We got new glucometers that control solutions are not working properly, so now we have to hunt and borrow strips from other nurses so we can get our blood sugars dor the day and get with central supplies about ordering new control solutions.
    I have a family member on the phone who is trying to change appointment times for physical therapy to evaluate and I'm having difficulty in reaching the P.T.A.
    I have my office manager in the hospital having tests, they're not sure what the problem is yet, but payroll needs to get out in order for employees to get paid and the other office workers don't know how to do payroll.
    My boss calls from the parent office wanting to know if I've hired a marketing person yet. I don't even have any applications let alone any interviews.
    I do have an interview set up with a R.N., hope she works out.
    I get all kinds of spam on my e-mail that I have to sort through and reply. I have a meeting with staff this afternoon, if we don't get too long-winded, maybe I'll be finished by 5 p.m.
    On top of all that, my boyfriend recently had surgery to his right shoulder and is unable to work, clean, cook or drive. Oh well, there's always tomorrow.
    Alice
  6. 0
    Quote from steelcityrn
    Alice.....that is one crappy day girl! When I see my D.O.N. next time, and she looks frustrated, I will be extra nice to her
    Home Helth is very challenging, it is my passion in life. I do have crappy days but the good days outnumber them. Just this week we admitted an indigent patient. (we try not to turn anyone away but we are a for profit agency) My nurses are on salary, they have time to make visits to this patient to educate the family but we really cannot ask our boss to pay more out-of-pocket money for Physical Therapy visits needed, but our therapist has volunteered to do visits without pay also. I feel proud of this agency. Not only is this good public relations, but word-of-mouth advertising from our patients telling everyone how this agency helped them when others turned them away, it goes a long way.
    AliceAngel
  7. 0
    This is an interesting thread. I am a Home Health nurse as well, but I do pediatrics only. I love working with the children and their families, but I would kill to stay in the same county that I live in. While the adult nurses are split into teams (covering areas that are close to where they live), we do not have specific teams for pediatrics so we are responsible for covering the whole area which is 27 counties!!!! Usually they are good about trying to keep you in the same area even if you have to drive a ways to get there, but there are times when you are not that lucky. I am starting to really learn the areas that they send me to a lot, but I still have to allow a lot of time when they send me somewhere really far that I have never been to before. It seems that with the adult patients, you have a lot that stay on service for a long time. However, with peds, we have very few that stay on service more than a week or two. The majority of my patients I only see once or twice, and then they are discharged. We do lots of phototherapy babies, premies, and feeding pump teaching. We also do lots of infusions, mostly teaching the parents, but sometimes we have to do all the administration ( I hate giving tiny babies 4 shots just so they can get their Amp. and Gent). We also do wound care and we follow infants with complex cardiac defects. The paperwork is a nightmare, but I guess that is the general consensus about the paperwork in home healthcare. I enjoy going to see my patients at home because you can see one at a time, and when you are done, you leave and go to the next one. I really feel now that I have been able to develop confidence and have improved in my ability to educate parents, when I struggled at the hospital because of time constraints and interruptions. The downside, at least for me, is that sometimes it can get kind of boring doing the same thing over and over again (like infusions and phototherapy), and you are not dealing with acute situations in the home (well not most of the time) like you would be in the hospital and I kind of miss that somewhat. I am a fairly new nurse (going on 2 years next month) and I initially started at the hospital and never thought I would ever have anything to do with home health, and here I am today and I am enjoying it.
  8. 0
    A little back story and then I will vent. I was asked in May if I would like to train for the Assistant DON position, which I accepted. Well, one week later, the DON left. We didn't hire another until 2 weeks ago, and she quit last week. I have had very little training, mostly picking up what info I could along the way. Fly by the seat of your pants thing, really. Well, I was on call this weekend, rained and rained and rained. Had to drive to timbuktu to admit patients all weekend. No one could or would help. What could go wrong did go wrong. Patients called, trouble breathing, major stuff, it couldn't be anything minor. UGH. So fast forward to monday, I am feeling under the weather, so I am gonna go in, finish my paperwork, and go home. WELL....... TWO WORDS.........MEDICARE AUDITORS! UGH!!!!!
  9. 0
    With this home health nursing do you get to pick your assignments or patients or are they chosen for you?? I got an offer from an agency and I am wondering who is doing HH nursing?? LPNS or RN"S??
  10. 0
    Hi, Steelcityrn- Can you please explain advanced teaching paths? I am unfamilar with the term. It sounds like it could be very helpful!! Thanks, nvrn


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top