A couple (okay, a lot) of questions from someone interested in HH

kat7464 · Apr 14, 2011

Wow! So many questions. I won't answer them all, but also being somewhat new to nursing, can relate to where you are at. I graduated last May (LVN to RN) and was hired on as a home health nurse with no med surg experience. I have now been doing home health for nine months. It has been the hardest and most rewarding year of my life. The independence and autonomy are wonderful and yet very scary - you have no one to turn to in the field - you are the one making all the calls. Sure, I will sometimes call the case manager or my boss for an occasional question, but otherwise they are expecting me to know how to handle whatever comes up. Excellent assessment skills are a must. You are reimbursed for mileage - we get .50/mile and because we are union, maybe an increase will come our way down the line. Each agency has an area they work within - ours is a 30-mile radius. We frequently drive into the mountains to see patients; less so during the winter if the roads are unsafe. As far as just dropping in to do wound care, etc., it's never that simple. We always assess all systems, and most pts have multiple comorbities that require attention and teaching. Each visit is intended to be complete, following the care plan that has been established. We do a lot of home infusion for which there is no certification (however to hang chemo you have to be certified.) Anyway, that's about all I have to say. I love home health!

berube · Apr 14, 2011

Hi, all.
I've been a nurse for nine months. I'm 22 years old, fresh outta RN, BSN school. I currently work nights on a surgical (some med overflow) floor. I really dislike it for many reasons I won't get into. I am waiting to hear back from an MSN/NP program to become a geriatric nurse practitioner. It will take me three years to finish. My year's anniversary for this job is up in July and I want to pursue something else while I am in school.
I am interested in home health and have been for awhile - I applied when I graduated, but they wouldn't take new nurses. I think I would enjoy it and be good at it. I am intelligent, creative, critically thinking, have good instincts, and am confident in my assessment skills. I'm personable, flexible, and good at time-management. I think I would enjoy the flexibility, the variety, the hands-on nature, and the autonomy of home health nursing.
My questions:
1) Though I am confident in myself, surely - especially still being a baby-nurse - I will have questions. Is there some sort of resource for you when you're out in the field and have questions? Someone you can call?---there are always nurses in the office or your co-workers that you can run questions by
2) HH vs CM? I've seen this discussed here but I am unclear. Is there a toe)difference? My ideal home health job would be to drop in, do a dressing change, ostomy appliance change, phlebotomy, trach care, whateverwhatever....educate, chat, chart, in, out. Is it that simple, or is there dealing with insurance, case management, other not so fun aspects I should be prepared for?---HH visits consist of doing a full assessment on each patient, (head to toe), then there is the dressing change etc,,,simple in and out visits are a thing of the past
3) Is "home infusion" different? I tend to see HH jobs split up by "home health", "hospice", "and "home infusion", the latter of which seems to need certification. So does that mean I wouldn't be hanging any IV medications unless I applied specifically for a home infusion job?---HH can also do infusion, PICC, mediport, PIV
4) How is your role viewed differently by your patients than that of a hospital nurse? I think my biggest fear is being viewed as a sort of handmaiden and not being respected by my patients (as if that's any more possible given my current situation). At least in the hospital you can maintain some sense of control and authority, but I would be afraid of how that dynamic would change when you are in their home and vulnerable. Obviously I would treat them with humility and respect being in their home, but how do they treat you?---patients like the fact that you can spend more time with them, talking, teaching them, i have always been treated with respect by my patients
5) What is the training like? I keep reading on here that people get thrown into it with little or no training - was that your experience?--you have to remember that they agency is not training you to be a nurse, someone has already done that, they are teaching you the HH aspect
6) Another fear is the whole threaten-to-sue thing. I get it ALL the time where I am (granted, part of it could be the low-functioning population with which I work) and it's always over something menial just because they are frustrated, but it's not so scary when you're in the hospital with witnesses and a structure to back you up. Home health its your word against theirs. You are covered under the HH agency's malpractice insurance, right? Have you ever gotten involved in a lawsuit in a HH situation?---in any aspect of nursing you should carry your own malpractice insurance, the hospital, NH or HH agency is out to protect their interests
7) It is my understanding that you are compensated for mileage. With gas prices rising like never before (we are $3.89/gal here which is outrageous for this area), does it even out at all?---most agencies pay mileage money, they type of vehicle you drive makes a difference, a large SUV you may not even out,,,
---
8) Do you get any control as to how far you travel?---not if you want to work,,if you keep saying NO they are not going to call you
9) What are your hours like? 8s? 12s? I'd really like a three 12 hour set-up like I work now so I can go to school. Are you paid by the visit or the hour? Which do you think is better?----my usual day is starting at 8am, finishing up (paperwork, phone calls, getting ready for the next day, 6pm,,,paid by the visit , doing anywhere from 6-9 visits a day
10) Do you like your job?! =]---i have been a nurse for 37 yrs, HH for 25 of those years,,,will retire from HH,,,for the most part i do like my job,,some days can't win for loosing :)
I think that is all my questions for now. Thank you very much.

best of luck with everything!!

cathrn64 · Apr 15, 2011

OK I won't be able to answer all of these but I'll try!

Depending on your agency, there should be help available on the phone from your sup. I know I have co-workers calling me with questions (esp the newer ones!) I/we encourage new hires to call their preceptors with questions. I have even had nurses that I have never met call me, because they were told I would help them.

At each visit you will be expected to do a head to toe assessment, teach, and do interventions. They are usually expected to be at least 30minutes. (usually longer)

At my agency we do get mileage reimbursement. It varies, at times, if the gas prices are high.

The agency covers a very large territory. We each have our own area. I am asked to go out of my territory at times, but mostly I stay in my area.

The agency I work for strongly discourages us from carrying our own malpractice insurance. They say that their lawyer will not be able to represent us if we have our own insurance. (that being said, I've heard of lawsuits in homecare, but never been involved or even heard a pt threaten one)

I see my first pt around 9 (I have a hard time finding pt's that don't think 9 is too early!) I see aprox 6 pt's a day I finish between 4-5 depending on how many and what I had to do. I do aprox 1-2 paperwork hrs afterwards

The pt's do respect you. You have a lot more time to get to know them. They can really come to like you and you them. Sometimes too much!

Yes I love home care and would not go back to the hospital!

lou12 · Apr 17, 2011

I am new to home health but not to nursing (about 25 years). I enjoy the patients, they respect those who truly care about them and for the most part, like to learn more about how to take care of themselves.

My biggest complaint is the lack of orientation. I had never seen an OASIS before but really had no orientation but was told that (after two months of working there) I wasn't productive enough-even though I was seeing 4-5 patients a day which were a combination of RCT, SOC, DC which are given 'higher points'. I am now prn just because I don't care to be given no support, no help (the other RN quit after I had been there a month so I was on my own-branch manager had quit one week after I started)...it was a nightmare.

I hope other home health agencies are not this way, good luck!

caliotter3 · Apr 17, 2011

You can find a lot of input by taking the time to do some reading in the home health forum. The biggest letdown in the beginning will be the fact that you probably will not receive a lot of orientation or training. Most agencies do not put much effort into training new employees, as you can see by reading a lot of posts here. The agency that trains you well will be one of the one in a hundred good places to work. Usually those places never seem to have openings!

RN1263 · Apr 17, 2011

Home Health is a huge learning curve, but was worth it for me, because I hated working in the hospital. So, I did a lot of reading about how to answer Oasis questions, etc on my own time. Now that we are in the midst of switching over to different computer software I feel like I've started a new job because of the learning curve...again....this will be the 3rd system I've used. They are talking about hiring a new nurse, because we're swamped, but can't right now, because the office is up in arms with this new program and no one would have any time to spend with someone new to train them.

ChristineAdrianaRN, BSN, RN · Apr 17, 2011

Thank you all so much for your replies. I do think Home Health would be something I'd want to pursue more seriously. :yeah:

What is Oasis? A (Medicaid/care regulated?) system of charting, I'm gathering? I saw the sticky on it, but it didn't exactly explain what it *is*...dumb it down for me in 10 words or less, hehe. Is there some sort of reading material (online or in print) that you all could recommend that would help orient me to this system? I *do* have a Barnes and Noble gift card I need to use...:)

Do you get to know any other nurses in your agency? I think I'd like being on my own on the job for the most part, but I do like my coworkers, and I think I'd miss the interaction. Envisioning meeting for lunch with another coworker do get some other nurse interaction during work days if that's possible... :cool:

RN1263 · Apr 17, 2011

Thank you all so much for your replies. I do think Home Health would be something I'd want to pursue more seriously.
What is Oasis? A (Medicaid/care regulated?) system of charting, I'm gathering? I saw the sticky on it, but it didn't exactly explain what it *is*...dumb it down for me in 10 words or less, hehe. Is there some sort of reading material (online or in print) that you all could recommend that would help orient me to this system? I *do* have a Barnes and Noble gift card I need to use...:)

You can go to: https://www.cms.gov/OASIS

The Outcome and Assessment Information Set (OASIS) is a group of data elements that:

Represent core items of a comprehensive assessment for an adult home care patient; and

Form the basis for measuring patient outcomes for purposes of outcome-based quality improvement (OBQI).

The OASIS is a key component of Medicare's partnership with the home care industry to foster and monitor improved home health care outcomes and is proposed to be an integral part of the revised Conditions of Participation for Medicare-certified home health agencies (HHAs).

Anyways...Essentially.... you would need an "Oasis user manual" to become fully knowledgeable regarding answering the questions properly. I have one from my company, however you may be able to request one from the website listed above. The questions aren't hard, but you need to interpret them well and answer appropriately. They refer to assessment data- SOB, incontinence, cognition, wounds, ADL/IADL ability with safety in mind, etc.

For example- A patient who is unsteady tells you "I shower myself with no assist". You would NOT mark on Oasis that they were independent with showering, BECAUSE they are not "safe" when performing that task if they are unsteady with ambulation. So, I would mark on Oasis- Patient requires assist/supervision with showering, so on and so forth.

The Oasis is a pain in the butt, because it is so long, but once you get use to the questions and how to answer them it goes faster. In the world of HH your documentation is just as important as the care you provide, because it ultimately decides how well the agency will be paid for their Medicare patients. Now Medicaid requires Oasis, but it does not decide payment for those patients, because Medicaid pays a flat rate per visits, where Medicare pays the agency a lump sum for the most part, unless it's a LUPA patient (I won't get into what that means....LOL).

Good Luck