There is a thread somewhere where nurses have posted their day-to-day activities for examples of what to expect. If I find it I will try to post it!
I graduated 2.5 years ago, worked 1.5 years on a cardiac/step-down unit. When I started to DREAD going to work everyday due to the stress, changes in staff and rules, an increase in patient ratio I decided it was time for a change. I have been with home health a little over a year now.
Your experience will vary depending on your agency. With mine we have a newly appointed 'heart team' who will be taking the CHF and cardiac patients...also pneumonia patients are going to be thrown into our load as well. Most of our nurses are RN's so each of us basically do what needs to be done with our patients (LPN's cannot do an OASIS which is required for Medicare patients at certain intervals).
I was afraid I might lose my skills when switching to home health. I may not be up to date on coding a patient, fresh chest tubes, etc. but I still do PLENTY in home health. If anything it can be more challenging because you have to be prepared for all situations and think ahead. You are also much more autonomous and a doctor is not just right down the hallway if something goes wrong.
My day today:
Meeting 0800-930. Ugh.
Saw a diabetic patient who is recovering from a fractured toe and cellulitis of his foot. He was doing fine today. Foot is getting better. Am trying to get ahold of our diabetes coordinator for a new lancet since I took his apart and could not get it back together
Next went to see a COPD patient I have had for a while since she exacerbates often. She is becoming independent in her care and calling the doctor with issues. C/O thick creamy sputum, crackles in lungs, SpO2 normal for her. She also has a migraine and her regular pharmacy doesn't have the med ordered for her so I checked with other local pharmacies. No luck. They will order it and she will get it tomorrow. She understands and is fine. I put in a call to her pulmonologist r/t sputum and lungs and to check on if she should continue her prednisone (she has been off and on ALLLLLL summer). I discharge planned her today as well. Will call to check on her later this week (she is good at calling with issues) and will see her next week.
Next is a a-fib patient who is now likely back to NSR who also is recovering from lyme disease. He is doing great. We will likely discharge soon.
Last patient for the day (one patient requested I not visit since he was tired from company being over) was a pneumonia, CHF, diabetes patient. I had called MD Friday r/t drop in SpO2 and crackles, got order for z-pack. Today pt has dropped another 2 points in SpO2, coughed up thick yellow sputum this AM only, low grade fever last night. He finished z-pack today. Called MD again who order another z-pack. Pt will have chest x-ray later this week.
When I got back to the office I talked with our telemonitoring nurse about a couple of these patients so she knows more of what is going on when she calls to check on them tomorrow. Then I follow up on a s/p CABG patient who has had HTN issues since coming home. FINALLY receive new orders for BP meds. Caregiver also tells me she is having issues this afternoon (chest pressure, 8/10, dyspnea, BP elevated). I take report and talk with my clinical coordinator. He then calls back and says the pt had not taken her ativan this afternoon as scheduled...oops
He gives it and is told to call with any issues.
After talking with office staff and telling then what I needed to, sending faxes, and ensuring one of my other post-MI patients went to rehab (which I helped coordinate the day before) I left the office around 1700.
So that was my day! Some days aren't as busy. Some are even more busy. Especially when you have issues that aren't as easily solved as they are in the hospital (like when you can't get the lab draw or realize you don't have the supplies you need).
As far as the future I am halfway through my MSN program and will be a FNP. I have talked with my bosses and we are trying to decide if an FNP could be utilized well in our home health agency. We all know there are patients who would benefit greatly from it but as of right now there is not a budget for it and I am unsure of how the logistics would work since APNs cannot currently write home health orders. I am sure there is a way but some of our doctors are VERY particular anyway and I am not sure if they would agree like everyone else