Typical day for a HH nurse... - page 9

by hoolahan

184,596 Views | 254 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


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    Tomskatt, thanks for that, it was my intention, and it has just taken off, and I am so glad. I hope you find what you are looking for.

    Kasey, I agree with Alintanurse, it is best to have some hospital experience under your belt. It is brutal, I won't lie, but if you can stick with it for a year, that would be a solid background for HomeHealth.

    There is a lot of pt education in homecare, and that is really hard to give if you don't have some first hand experience in pain management, identifying wound infection, subtle changes in cardiovascular status, etc..

    That said, it is not impossible to do HH as a new grad. But, I think you may have difficulty convincing an agency to hire you w/o the expereince, and if they did, you would need a much longer and supervised orientation. Recent threads here suggest that is not happening in reality. Even expereinced nurses don't feel they have gotten enough orientation.

    I agree, the hours are great for a parent, and so is the flexibility.

    Can you work as a Home Health Aide for a few months while finishing school? This may give you some insight, and make the agency more willing to take you on. You would also be able to make observations, see the other nurses occassionally in the field, and still not have all the responsibility until you pass your boards. You may also do this and say, Ug, I hate this, who knows??

    Good luck to you, let us know how it works out.
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    I thought I would give you my typical day as a home health aide. Which I think is quite interesting.

    7am-8:30am
    -Get up, shower, drink my hot cocoa, look at my schedule and out the door I go

    8:30-2pm
    -First client, 27 years old, 3 years ago involved in a DUII MVA. Resulting in fractured back, crushed pelvis and closed head injury. Was in a coma for 2 months. Currently is ambulatory, can do many things on her own however cannot stand or sit for long periods of time. So she cannot hold a job. She is in the process of getting SSDI.
    -I get her up in the morning, shower, help her dress, medications, cook breakfast. Then I start cleaning. THe house is trashed everytime I come there. THe day before I am there I leave the house spotless but the next day it is trashed. Her husband is the laziest person in the world. Will not even do a dish, take the trash out, pick up his clothes, I could go on and on. They also have a child so that adds to the mess. I just take a deep breath and begin my 4 hour cleaning routine. Make beds, do dishes, wash clothes, scrub bathroom and kitchen floors, vacuum, pick up toys (client cannot bend over to pick things up), scrub toilet and so on. I love cleaning, its something I have always like to do I guess I am weird like that. So I really don't mind cleaning. What bugs me is how incredibly lazy her husband is. He NEVER does anything! I was told I was only supposed to do my clients laundry, dishes and pick up after her, no one else. WEll, I cannot really do that easily. I guess if it gets really bad I can go on strike and make him do something. He is really immature and spends what little money they have on video games. Lovely, huh? In fact I had to buy my own cleaning supplies.
    -And besides cleaning I have to make sure my client has everything she needs, assist her with her shoes and socks and other things. WHen I first started working there their house was awful, black mold everywhere, just terrible. Now with me there we are starting to organize things so its not so bad.

    2pm-6pm
    -My second client, 50 some year old lady with COPD, Fibromyalgia, diabetes, and on oxygen. I do the same for her as I do with my other client except she is more of a hoarder, stuff everywhere. She has a problem with sugar, eats a lot of junk. Sometimes she has me make a cake or a batch of cookies and eats all or most of it! WOW. THe one thing that really scares me is that she smokes while she is on oxygen.

    Anyways, I cannot emphasize how much I love my job. Although its not really reliable, your never really guarenteed hours or would if someone dies or gets their hours reduced. I get health insurance through them which I really need so I hope I don't have a problem with that.

    Anyways, that is my typical day. I hope I didn't break any confidentiality rules, I didn't name any names and I didn't say the town or state so hopefully I am okay.

    Thanks for listening. CS
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    Quote from Scavenger'sWife
    Oh, forgot to tell ya....the big thing at this hospital right now is we are scheduled for JCAHO in April. So, of course, all the managers are trying to get us prepared. I asked about what I could wxpect...I think I will get off easy b/c I am a new employees to the HH...bt I might get picked out to answer questions regarding orientation stuff. We have been given a booklet of info to know in prep for inspection. The nurses told me that the HH Mgr made a game out of it w few weeks ago....had a meeting where they played "Family Feud" and asked questions...one person was the "Richard Dawson" character, dressed in s uit and tie etc...she said she did the role except for NO KISSES, lol....the winning team got prizes of little plastic bird feeders filled with jellybeans for their desks. How cute!
    If dog's are like children, only with fur, then are children like dogs, only without it? Loved your essay, new to this site, not sure how it works, hope this gets to you. A RN for 25 years, been away from the bedside for ten years. Specialized in gero-psych, seems like most of the patients expressed in these posts are elderly, many with some behavior problems, some perplexing to the nurses. Moving away from behavioral health, applied to HHA. Lots of field experience, nothing in the recent order of you guys. If they hire me, sure, it's a risk, taking a chance on me, but so am I. I'm encouraged by your optimism and gratitude. Do I have the same to look forward to, even though I don't have the recent med-surg experience you have grown fond of but didn't mind leaving behind for this experience?
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    Hi Kristi, not quite sure I am getting your question, but, I can tell you that most of the psych nurses in home health, that I have worked with, are also responsible for the med-surg component of the visit, like assessing vitals, doing wound care, etc...

    You should get checked off on this prior to finishing orientation, and you can always call the sup for advice from the field.

    Since you are not a new nurse, I am sure you will be fine. I don't know of too many agencies that are strictly psych nurse.

    Welcome to the board.
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    Quote from hoolahan
    Hi Kristi, not quite sure I am getting your question, but, I can tell you that most of the psych nurses in home health, that I have worked with, are also responsible for the med-surg component of the visit, like assessing vitals, doing wound care, etc...

    You should get checked off on this prior to finishing orientation, and you can always call the sup for advice from the field.

    Since you are not a new nurse, I am sure you will be fine. I don't know of too many agencies that are strictly psych nurse.

    Welcome to the board.
    Hoolahan/Scavenger with the furry mend, don't know this site well enough to know to whom I am speaking, hope Scavenger is back to work, probably cast and boredom so long gone this is appropriately obsolete..
    Hoolahan, if I may be so bold to speak, you appear to be the Mother of this thread I just discovered. Your attention to detail and committment to work, time to articulate your day-to-day with hubby somewhere close, two almost-grown kids, and stuff either growing in the kitchen or planted sincerely in your mind, you are indeed inspiring.

    I have so enjoyed following your accounts of weather, can't tell you how greatfull I am to know rain, floods, mud-slides, catastrophic summer fires, and the trial-and-tribulations of celebrity news like Michael Jackson keep me just distracted enough to realize my sisters on the east coast are still doing the do, sometimes in the snow.

    You answered a post from a MSN in Canada who thought she was being abused. You were kind not to address the socialized system of medicine she works under. You were personal and reassuring. Now I have a question for you.

    I am a psych RN. Have been for 15 years. We know that Behavioral Health is going bye-bye in this country, PPS to impose itself soon. I know that to remain solvent I have to transition out from under psych. I am a RN since 1978, but I can't get anyone to notice me because I haven't had one year of recent acute care experience.

    I applied to a HHA to implement my community-based talent, but my clinical bed-side skills are more impotent than the acute skills I read in your thread. You have taught me a great deal, mostly about organization and time management. Psych discharge follow-up can be critical and timely, as you validated with Canadian RN. I know now there is a productivity profile. This thread has made me nervous, but excited about the challenge. How marketable am I? I have the desire to transition but cannot afford to go back to acute med-surg at new-grad pay.

    I know I have special gifts; we all do. I do not consider myself at square one after 25 years; any advice for me? Is there a special something to say to the folks at HH? Is there a grin-and-bear it somewhere in here I can't afford?

    Thank you Hoolahan, or Scavenger, wherever this goes.
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    I don't see any reason why you should expect new grad pay. You have 25 years experience. You only need to be honest and say it's been X years since I have inserted a foley, and they will send you out with a nurse to watch one, then again to see you do one, at a minimum.

    I am not sure where you live, but my agency covers only one county, so, on a rare occassion, we could call each other for support. Since I had the cardiac experience, a nurse called me one day because she couldn't get a BP on a pt. He was AA&O, she just had a problem because he had a dialysis fistula in the left arm, and a PICC line in the other, and she could get anything in his one leg, the other amputated above the knee. I wasn't too far away, so I met her at the place and showed her how to palpate a BP in the forarm below the PICC line.

    Just be up front and ask to see a procedure done before trying it yourself. If you don't get everything on orientation, don't worry, you can find your oppotunities afterwards. I imagine you would have the most trouble with wound care and ostomies. It is hard to teach pt's about that when you don't feel knowledgable about it yourself. Ask to spend time with the wound/ostomy nurse, or the first time you have an ostomy change for someone to come with you. That was my weakest area, my bags would fall off, but I just kept reading about it, practcing on dummies, going to inservices, and then I was like an expert.

    It will come together if you are motivated. Your agency will also have to be motivated to invest the time to get you up to speed.

    Good luck.
    AnnZan likes this.
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    Hi guys and gals..... Whew is it just me or is the cenus booming lately?? Seems like I have done about 20 OASIS visits in the last 5 days. I went out with our hospice nurse Friday night for a hospice admit who came home with IV antibiotic, had a PICC line, but she wasnt comfortable with them, so I went with her to help her out. Son watched me Fri night, he did it all Sat AM and Sat PM. I just stood there and watched. Amazing how some people are willing to help their parent, while others absolutely refuse to have anything to do with them. I have driven no less than 130 miles/day in the last month. whewwwwwwww, guess thats life in home care.
    AnnZan likes this.
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    Ok who said that "BOOM" word outloud...as bad as the "Q" (quiet) word in the hospital.

    Since last Monday we have DOUBLED the amount of referrals through my office to the point we are unable to staff about 30 therapy cases at each office = 120 patients not able to receive therapy yet this week. VP of nursing informed me to turn down all referral sources except for our own facilities on Friday and we needed to tell our own facilites that a therapy delay of 3-5 days may occur. Yesterday we had 17 Mom-Baby referrals in one day--usual is 5-8.

    Of course, one hospital emailed the agency admin team that Intake informing them of therapy delay so giving business to competitor. Email was forwarded to me in AM by my boss, the Chief Financial Officer "Are your staff REALLY saying this and who said they could". Thankfully, my staff keeping me updated re all branches inudated 48 hrs for new starts of care. I reviewed intake stats, called and confirmed with therapy Mgrs outstanding cases, jotted info down re unstaffed cases, that VP of nursing aware and discussed with me etc.

    3PM today, I spoke with CFO who was number crunching to see if they could raise therapy salaries as unable to recruit new staff.....

    Yep, 500 referrals in one week will do that to you!
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    OMG Karen!! 500 referrals!!!!

    You know what, let them go ahead and refer to a competitor, when one agency is like this, they all are, and I bet they will also have a delay, but they may not have the courtesy of being told so up front.

    I have seen this happen several times at different agencies, that occassional PT overload, or OT. Of course all cases then get triaged, with post-op hips and knees at the top of the list.

    Have you considered using another contractor to help you out when it is so overloaded? We had a PT vendor we could refer to when that happened, but like I said, they could get just as backed up, and it is usually all agencies at the same time.

    I used to laugh when they would threaten to call another agency, nine times out of ten, they called me back eating a slice of humble pie.
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    Quote from curleysue
    I thought I would give you my typical day as a home health aide. Which I think is quite interesting.

    Anyways, that is my typical day. I hope I didn't break any confidentiality rules, I didn't name any names and I didn't say the town or state so hopefully I am okay.

    Thanks for listening. CS
    Thanks CurlySue, your day is indeed very intersting. I look forward to more of your posts. I don't think you broke any confidentiality any more than any of us have. One thing I do often, is change the sex of the pt too, unless you are talking about a prostate or mastectomy concern. Just so long as no one can read this and identify a person, but w/o names or locales, that is pretty hard to do. I have seen a few nurses be identified by their employers though, so if you want to rant about them, do it, but carefully.


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