Acute care vs. Home health

caliotter3 · Nov 13, 2011

I suggest you take a good vacation, and I mean a good one, before making any moves. Extended care home health is typically less stressful than intermittent visits and can be done a little or a lot, as you wish. Try out a shift or two on the side while keeping your hospital job. That is what many hospital nurses do for extra money and to try out hh, before jumping ship. Good luck.

ErinS, BSN, RN · Nov 13, 2011

I get palpitations from the moment I step onto the floor until the moment I leave. I've been looking for openings within the hospital and outside of the hospital in lower-stress environments to no avail. I realize home health has it's issues too (don't all jobs?), but from what I hear, "the worst day in home health is still better than the best day on the floor".
Any advice/suggestions/stories/experiences would be greatly appreciated!!!

Well, I work hospice so it is a little different, but the part where you said you get palpitations until you leave, you don't really get to leave. It is exceedingly difficult to leave your work at work. You often have problems with patients during the day so you worry about them at night, because no one is there taking over the work. Now, I can honestly say that as much as I truly love my job and will never go back to the hospital, my worst day in hospice is a million times worse than my worst day in the hospital. Because I am alone, there is no pharmacy to bring me meds, no RT to help my pt breathe, no aide to clean up the diarrhea, no security to restrain the psychotic family member, and no supply closet to get the catheter I need.

Again, my viewpoint is from hospice, but I can't imagine the issues are that different in home health. Again, I love my job. I like the problem solving and autonomy, but it certainly has big challenges. And my best day in hospice IS a million times better than my best day in the hospital.

PalliativeNurse · Nov 13, 2011

I worked on a med/surge unit and I hated it. I"ve been doing home health care ever since as a palliative care nurse. I still feel my pt"s are challenging as they are mostly cancer pts and are complex. Yet there's a balance with home health. Yes you chart after your done with your shift, but that's if you choose. If you wrap up your last pt at 2:30-3:00pm you can chart at home. You always have the option of stopping at the office or anywhere finishing your work and heading home. I don't have to wait for anyone to come in and relieve me, and I LOVE the autonomy of home care. I feel home care is amazing. You get the whole picture of someone being in their home environment. You can help them long term in managing their disease, as opposed to making them stable enough to ship them out, which sometimes they need much more care. I couldn't get out of bed to do anything else.

justanothernurse3 · Nov 13, 2011

I have done both. Personally I prefer the hospital because I hate Hate hate all the paperwork. You spend 30 minutes-45 minutes a week with a ill patient that needs you there 3 times a week, but u can't get approval from the main office, because medicare won't cover it. Houses are unsafe and smell frequently. You have to take call. Yes you will get phone calls in the middle of the night for very very silly things. The hours are good though. I love the hospital because when I leave I leave.

PalliativeNurse · Nov 14, 2011

"paperwork" is done via lap top supplied and I suppose varies from company to company via there policy. We are taught to chart mostly in the home so minimal is expected outside. We have " escorts" off- duty cops available 24/7 for questionable/unsafe environments. They can drive you, sit outside or be right side you depending on the the "threat.". As you seem q huge home care advocate, and coming from a Med surge where we turned out aprox 750 Pts a month, I LOVE home care and the care I can provide.

StrwbryblndRN · Nov 14, 2011

I work med-surg now and left for a short time to try something new, home health. I liked my night job and left on good terms. It was just to expand my horizons.

Boy I hated HH. I cried every day. I loved the pt's but the computer work was excessive and cumbersome. I brought work home and it greatly effected my family life.

I went back to the hospital and am very happy. When I leave, I leave. Lucky for me pt's do not rack my brain at home.

I know many nurses who hated HH and came back to the hospital. But these same people do not seem to stress in the hospital setting like others do.

It is just a matter of finding what works best. You will never know till you try.

PalliativeNurse · Nov 14, 2011

I give my pt"s continuity and know them on a personal level. I'm a guest in their home and it's a privledge. I spend a solid hour - three a week on these people in visits alone to them. I leave my " shift" too, that's what evenings and weekends are for. We have nurses on call 24/7 . I do one week of NOC, pet year. I work one holiday pet year. LOVE IT.

PalliativeNurse · Nov 14, 2011

Sorry guys you will never win this battle. Love it.

R*Star*RN, BSN, RN · Nov 14, 2011

I left the "never-ending stress" of the hospital to go into home care. It is the worst decision I have ever made. Now, all home care agencies are not created equal but in my case there is nothing that parallels the hell I am in.

I juggle a caseload of 30 patients. I am responsible for their needs 24 hours a day. I end up working 10-12 hours a day and only get paid for 8 because it has been hinted to me that if I charge too much overtime my job will go bye-bye. I sit in traffic for hours and if you think you don't get a bathroom break at the hospital well try getting a bathroom break in your car when you're running behind all day. Don't get me wrong there are some good things about home health but it is an all-consuming job. At least at the hospital your work stays when you leave.

I am getting the heck out of this job as fast as I can get a new one. Getting back into the hospital will be tough since now I am labled as a "long term care" nurse.

Mijourney · Nov 15, 2011

I notice that our newer generation of nurses are burning out quicker than us old guard. It sounds like providing direct care has become more challenging then in previous times or perhaps nursing students are not assessing what works best for them before they go live. I worked direct care for many years and found that I enjoyed home health more than hospital-based care because as a previous poster pointed out, I get to work on a personal level with a client without the type of influence from others that one would experience in the hospital setting. I got to actually educate, instruct, teach and learn as well as provide real support to that client and family. You have to be a project manager of sorts to work in home care ensuring that you plan your day well for yourself and your clients realizing that you will not be in a controlled environment like a faciity. Home care is not for everyone and neither is acute care.

wannabecnl · Nov 16, 2011

Still in school and getting ready to start an acute care job, but in one of my clinicals, I saw a great use of home care that might be a good transition for you.

In my maternal/child health clinical, the hospital had nurses who did home care follow-up with the new moms. I went on a home visit with one of the nurses (it happened to be with a patient I had seen the previous week in the hospital when she had the baby!). We assessed mom and baby, weighed the baby (made mom's day), played with her other child to assess how the situation was for her, assessed mom for PPD, made recommendations for stress management, nutrition, and family relationships, watched mom breastfeed the baby (no problems, but if there had been, we would have helped with that and/or arranged for the lactation nurse to visit the home or see the mom/baby in the lactation clinic), etc. We stayed probably 2.5 hours in total, and that was the only visit we did together.

That may have been the only home visit this mom got, but it was a good one! I imagine if there were problems, the nurse might have scheduled another follow-up. I did not have this when I had my babies, and I'll tell you, I wish I had.

I mention this because this nurse worked for the hospital and spent some time there, but the bulk of her actual patient time was in the patients' homes. It happened to be all obstetrical patients, but you might be able to find something like this. It's almost transitional nursing; you are going to the home at the right time to catch problems that could arise, and you provide more follow-up as needed. It's not a long-term relationship with a client, but it was obvious that it was rewarding for the nurse and very beneficial for mom and baby.

Just an idea!