Advice for a new grad-Case Management vs. Private Duty

[KTSNurse2b]

hi all experienced home health nurses! i'm a new grad about to start my first job in home health and i'd like a little advice. to start, i am very aware that home health is not the best place for a new grad, but it is my only option right now and i have to take what i can get vs. being unemployed as i have been for the last 3 months. i am in minneapolis (just moved here after graduation in may) and i started applying for hospital positions back in march when i found out i'd be moving. once i had graduated and passed nclex, i took a day to hit up the hr offices at the four hospitals that seemed to have the greatest prospects for new grads. i had a nursing portfolio in hand (with letters of recommendation) and was hoping to be able to put a face to my name and stand out amongst all the other applications they get. no go-i was headed off by the receptionists (nicely, but firmly), told they won't take anything paper, all they want is the info on the online application, the nurse recruiter will call me if they are interested, they are getting 150 applications for each position that doesn't require experience and preference is going to those with experience first, then those already working for the institution, then those that did clinicals there, then, bsn's, then adns....

so, i finally starting checking craigslist and was surprised to see several agencies hiring for home health and extended care that were open to new grads. i applied and boom-after no one from the hospitals wanting to touch me for months i had 5 interviews within a week. most are extended care shifts with agencies, so i'd be working 1:1 with a trached/vented/gtube client. one position that i should find out on monday whether i got is actually a case management position where i would be doing skilled visits and some supervision of pca's. i'm not sure yet what that position would pay, but i've been offered $26/hr full time days with the private duty agency that i liked the best. should i actually be offered the case management position and the pay is equal or better to private duty, i think i will take that position because i will get to see a greater variety of pt.'s. however, from what i understand the skills will certainly not be as complex-i won't be getting any trach/vent experience and will more be doing dressing changes, med set ups, maybe a cath change every now and then. but the hours are better with the case management position: m-f office hours, flexibility in scheduling your week, and only having to take call on weekends occasionally.

would you all agree that this would be the best choice for me? it seems like i am having to make a choice between variety and using less of my skills, but then again the case management position will give me more career advancing opportunities...at least it seems. i'm also afraid i would get bored with the same thing day in and day out that would be encountered with extended care shifts. i worked 2+ years as a cna on a busy med/surg floor of the hospital while i was in nursing school, so that is the pace i'm used to. that said, having seen (but not experienced) the reality of hospital nursing, home health certainly sounds appealing. i wouldn't mind having more time to breathe than the chaos that i saw the hospital provides, but at the same time i don't want to be bored to tears either, like i'm afraid i might be with the extended shifts.

by the way, in the 5 interviews i've had so far, i saw quite the gamut of sketchiness and total professionalism with home health agencies. both the agency for the case management position and the extended care agency i've already been offered a position with seemed top notch and i feel pretty comfortable with the orientation they have described. especially in comparison with the other agencies i interviewed with.

so-any words of wisdom or insight as to how i should proceed if i am offered the case management position and end up having the opportunity to choose? if the case management position ends up being a pay cut from the extended care position, would you still recommend that i take it? thank you!!!

[KateRN1]

Please don't make the new grad mistake that "skills" are those procedures that you get checked-off on in school. There are a variety of other, more subtle skills that come into play in Medicare home health care. Case management is very complex and most new grads are not suited for it. My advice would be to take the shift-work position, you will get your feet wet as a nurse, learn how to set boundaries, learn when and when not to contact physicians, and you will learn a whole lot from vent kids and their parents. You really need to learn how to be a nurse before you learn how to be a case manager in any setting. Medicare/intermittent visit home care is extremely complex in terms of the subtle skills you need to manage a team of patients, there is a lot of teaching, Medicare rules and regulations, documentation issues, OASIS issues, and many, many more potential pitfalls. Even experienced nurses struggle when they first arrive in Medicare/intermittent visit home care, and they already have their basic nursing skills down pat. Read through some of the threads in this forum and you will see the struggle that both new grads and experienced nurses have faced.

[caliotter3]

Take the job that appeals to you the most. Being employed is important. Then when you get bored, look for another position. By that time, you will have experience that will help you get another job.