a new grad (sorta) opinion of HH.

Specialties Private Duty

Published

I suppose I am writing this to vent, express my opinion, generate comments and opinions, and maybe even help others who may relate and find a solace in reading my post.

I say sorta new grad because I was an LPN at a nursing home for a year (RN there for a couple months before I left ... more pay but same duties). So I'm a new grad RN with a previous nursing job but still pretty much a baby. Haha.

I took the first job I got offered so I could make the move to VT. Bayada home health. It's only my second week. Caring for a young man in his 20s with a trach and g tube .... brain damage is present so there's really no verbal communication.... I'm overnight 10-8. I have a little experience with g tubes from LTC but only touched on trachs in clinical. So I was nervous.

At first I was overworked and completely physically being affected... the other nurse who cares for him is out so I've had to pick up the load. Luckily, the agency is very understanding and supportive and have reduced me to 4 ten hr overnights instead of 5 in a row and worked out a pretty flexible schedule for me and it seems like it's able to be tweaked if I find something doesn't work for me or works better for me. So you gotta give a little of course but they are flexible here if you voice your concerns or requests. (Which I'm learning to do ... depending on when the other nurse comes back I'm supposed to do every other weekend so I can have full weekends off sometimes soon ... I'm just pulling the weight right now doing them every week right now however it's temp plus I did request sat off and they were super flexible about it!)

oriented for 2 1/2 nights which at first felt like not enough but turns out I actually felt more at ease when my preceptor left because I was able to go by my own routine and schedule.

I've been checked off on skills and now just have to turn in a written exam and I am "adult trach certified" which they said I can carry with me into future jobs. I honestly don't feel very certified in trachs.... I can suction and I know the protocols if the trach comes out and luckily if his did he's pretty stable without it .... I don't know what I'd do with a mmore dependent patient if complications arose. I'm still having trouble changing trach ties .... it's so difficult to fit them in the slots!

I never wanted to get into HH. I want to be in the hospital as soon as I can be. I want to do hospital skills. Work with IVs. Experience different patients. Work alongside other colleagues. I guess the trach and g tube skills will help? While this is not my thing ... I at least feel like it's more bearable than I did a few days ago. And I know it's thst way with any new job. Especially since I had started the night of the day I moved into my new apt so I got no rest for several days straight ha.

Emotionally: you'd think I'd feel more compassionate working with this patient ... his poor mom slaves away caring for him when we're not here and others his age have much better quality of life. I'm a very sweet and caring person so I was surprised I didn't feel much. Made me feel guilty. After Talking with some people and reading an article I realized this is normal sometimes... as nurses we may sometimes block feelings without realizing it as a defense mechanism.... this doesn't make us bad people. And sometimes one patient gets to us more than another and that's just human. And it's okay if when I go home I don't worry about my patient because work and personal life are separate. And naturally, if this isn't my niche, I may feel a little differently but it doesn't mean I won't give quality care to my patient.

Let me tell you ... I'd be totally fine doing three 12 hr night shifts in the hospital ... four (at least not 5 now ...4 is manageable) 10 hr shifts overnight in a row are just different when you're alone and only have one patient to care for. Also, know what my biggest issue is?? Not the high tech care but TURNING AND CHANG ING BRIEFS! I am tiny and it's very straining on me when my patient is dead weight ... at least in LTC I could get help from the CNAs if needed. I'm completely alone here. I've been shown techniques to help me so I'm gonna try those but the fact of the matter is it is still more difficult.

I feel that as a new grad HH is not the most optimal place to start out. Both in LTC and now HH, I have virtually been on my own when I feel like I need coworkers and mentors around to help me learn and perfect my skills. With both jobs I have the same patients/residents and I feel it's hard to learn new things that way. I do feel lucky to work for a decent HH agency though, they're supportive and flexible and I feel welcome to call if I have questions on my shift. I am also the only nurse right now for this patient while the other nurse is out and even then it seems there are no PRN nurses?! (I used to get full time hours if i desired at LTC when i went prn!) So it's pressuring to fulfill shifts knowing if I'm not here his mother is slaving away . But that's where I'm learning to take care of myself and say no if I'm over exerted and maintain my own life outside of work .... being flexible to the family's preferences when and if I can. Do I want to do this forever? No. Actually waiting to hear back from a new grad hospital nurse residency program. Will I be flexible and generous with my time and notice when I leave this agency because they've been good to me? Definitely.

They know that I'm very intent on working with peds patients but they didn't have any upon hire but told me I could transition to them if they come up. Will I be here long enough for that? Idk but if so I'll be happy to take on peds patients. Is my heart still yearning for the hospital? Yes. I'd love to do NICU, or at least peds, or oncology. I will take any floor in the hospital to just get my foot in the door and start doing hospital skills though haha.

Do I think new grads should start out in HH? if hospital work is what you want, it's probably not ideal BUT, like with me, it might just work out that you started in HH first and then hospital instead of the other way around and any experience is good experience as a new grad. And I know the g tube but especially trach experience and cert will look good for hospital work. If HH is where you want to go and stay,even though I'm sure hospital experience would be helpful, then I say jump right in if you don't plan on doing anything else because if you don't ever plan to work in acute care then might as well jump in and learn in the area you plan on sticking with!

So in conclusion.... honestly? I don't really like my job that much .... it's not the patients fault of course, just not my niche. I don't hate it though like I did the first few days! (Stress relief, sleep, and eating helped me hate it less haha). Some people love HH.... I don't and that's ok. I feel neutral about it now which is better than hating it and crying before i go in like i did before. Do i still give quality care? Indeed. Do I feel important and respected for my job? Yes. Will I end up at the hospital? Definitely. Who knows if in the future I won't want to do this .... but for now I am and looking for hospital work. Hoping that if I get into the new grad program, I think they have different start dates for different units so it's possible I wouldn't start for a few months after hire so I can put in plenty of notice at the HH agency and work with them just like they've worked with me to give my services as long as I can before they have to find someone else.

The end! My thoughts. Any comments or opinions of your own are welcome!

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Specializes in acute care, LTC, currently home health.

Perfectly ok to not like HH, it's not everyone's cup of tea.

Good luck on your search for a hospital job.

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Can I vent that it drives a little crazy to have private duty called home health? We don't call ICU the ER.

No one would criticize you for not liking the job or that PDN is not the best place for a new grad to start. And 5 10's on nights would be more than I could ever handle.

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Can I vent that it drives a little crazy to have private duty called home health? We don't call ICU the ER.

No one would criticize you for not liking the job or that PDN is not the best place for a new grad to start. And 5 10's on nights would be more than I could ever handle.

Yeah, I can see why you'd refer to my line of work as private duty. My agency is called a home health agency though! Haha. I can see the point you're trying to make though. I guess people have different ideas of what home health are maybe ..... I too feel it's more private duty work than HH considering the majority of patients are longterm as opposed to in the need of nursing care at home temporarily after hospital discharge.

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For all I know that is the name used in other areas, it was really just a silly vent.

I think you might like intermittent visits where you would have a more varied experience.

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While the hospital is still where I want to be, I do have to agree that I'd definitely enjoy intermittent visits better than this when it comes to HH / PD. I am at "work" now. I'm basically an overnight baby sitter. I'm here to give mom a break from caring for her adult son ... I give a couple meds. I give g tube feedings and flushes. Change the g tube dressing and trach ties. Suction as needed. Basically an overnight baby sitter with a license to make it legal for me to touch the trach and gtube and give meds. Changing briefs and moving alone ...which usually works fine lately but if i need the extra help no colleagues around. Watching a movie though and surfing my phone! I am allowed to do that! Haha. I can see why people transition from hospital to home health cases like these. it's more flexible and chill and you do kinda just get to be a nurse babysitter with a license and make good money. But I'm kinda sitting here wishing I were experiencing more! I'll prob take that back when I'm busy in a hospital haha! But oh well ... it is what it is for now! Trying to be proactive about getting a hospital job and be patient on the new grad residency hiring process there! (It's kinda drawn out). I am making great money for what I'm doing overnight though. And sometimes I deserve it for my exertion trying to simply change a brief or move him up in bed alone as dead weight! Haha. But money isn't what drives me in nursing ..I just wanna enjoy my job... sure it's a factor but I don't mind taking a small cut in pay as a new grad in a hospital ... it's still decent pay!! I just make all the more here... And I think the raises add up pretty quickly after each 6 months or year of experience in the hospital. But for now I'll enjoy making what I'm making just chilling here .... morning care soon ...*snores* but don't get me wrong, it does get busy at certain times of the night when all his care is ordered at the same time slot ... and then needs suctioning and moving when Im trying to carry out other orders and next thing you know it's 30 mins later ...and when it's 4 in the morning your brain gets a little slow! But that's nurse life ... gotta power through those AM hours of the night and work your brain and check those meds etc cause we have an important job!

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

I can't say your feelings are unusual for a new grad. I have to be honest though, I would not use the term babysitting when talking about an adult. I only bring it up to remove the possibility of letting it slip at the wrong time. Families are extremely sensitive about terminology though I'm sure you didn't mean it that way.

Usually a client qualifies for skilled nursing for his/her assessment skills, not because they can care for patients with trachs and g-tubes. I would usually delve into the patient's Plan of Care, and read all the manuals for their Durable Medical Equipment and diagnosis when the time goes by slowly, but yes there is a lot of downtime in Private Duty Nursing.

It sounds like you've got a handle on saying "no" to too many exhausting shifts. Remember it is the agency's responsibility to cover shifts. The fastest way to burn out in this field is to let them guilt trip you into working so much you have a nervous breakdown.

Anyway, you seem to be adapting well and wishing all the best for getting that job that challenges you as a new nurse!

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@libby1987:

At my agency, what you are calling "private duty" is called home health high tech, bc it is paid for by medicaid. Private duty is self pay, and we do not provide that service. At least, that is my experience with quite a few years of high tech in my past (also as a new grad, and yes, I lost skills that I am now rebuilding).

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Also, I agree that OP may prefer intermittent visits. That is what I am doing now, and I love it! The flexibility is perfect for my family situation, I am learning unbelievable amounts (nursing AND paperwork, lol!), and I thoroughly enjoy the connections built with patients. Huge amounts of growth for me, and I feel like a nurse. :)

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The down time sounds like a great opportunity for studying if you're advancing your degree.

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I had to go and look it up. From an insurer's POV, re licensed reimbursible nursing care, Home Health is intermittent skilled nursing services and Private Duty is hourly skilled nursing services. Either includes other skilled services as well.

OOP/non skilled/non licensed is entirely different and I guess can be called whatever it wants. Ours is called personal care and includes personal and homemaking services.

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I do home health high tech paid by medicaid. And of course I would never use the term babysitting. Was just drawing a point on this board.

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