Advice for a young home health nurse. please :)

[wunzieRNBSN]

I graduated with my BSN last May 2010. I passed my NCLEX last September. I applied at hospitals around my area, but I never even got called back for an interview. I guess I did not apply hard enough. Although, I managed to land a job at a home health care agency. At first they hired me to do Q.A. (quality assurance for all the paperwork) and managed to familiarize myself with the OASIS and the RN notes and other documentations that go into the patient's chart... then they let me manage a group of 5 nurses to manage and receive reports. Documented our care coordinations about patient report/care updates/ manage the lab results/ md reports/ follow up with orders/ coumadin therapy/anything that would require a nurse/etc. We also underwent a survey with ACHC, so I played a big part to make sure our documentations are perfect, charts are complete, all the forms are completed, and that we followed all the guidelines. stressful experiences. but we PASSED! The RN that trained me recently quit, so now I am the only RN that is at the office at all times. the owners are RNs also but they come and go, so I'm the official "nurse supervisor" in the office. I also see patients after office hours because I find that having my own cases make me feel good inside, like a real nurse, not just one that talks to patients on the phone and manages their care through other nurses. I am also the On-call nurse.

I started this job in September, and it is surreal to me how I have acquired all this responsibility in the company. I've had MANY nervous breakdowns because it is a lot of responsibility, especially since I entered this job straight out of school. The learning is never ending. Managing other nurses that have been nurses for YEARS is very challenging. But the owners, administrator, and our DON have always complimented me on my work ethic.

From time to time, I can't help but think about how starting out in home health will affect my career as an RN. Am I limiting myself to just being a nurse supervisor/hhn? I know i should have started in a hospital so that I can develop my skills more... should I work at a hospital now while i am still only 23 yrs old? I do a lot of self study, and I utilize the other nurses if i ever have any clinical questions... I really enjoy what I do. I enjoy supervising and I enjoy the sense of independence as a home health nurse. I don't think i would enjoy being a floor nurse, I would only do it for the experience and to acquire skills. I plan to go back to school sometime in the future, i'm not sure if i want to be an NP, or go into administration... but i would appreciate some advice for my situation so that i can make sure that i am paving the right path to a successful career. Thank you!

[caliotter3]

Conceivably you could keep the job you have now for the rest of your working life, but that is not likely. You might want to get a part time hospital job on your days off or the weekend to get that hospital experience, but I would not be in a hurry to look for it. Do not quit this job before you have another one in hand, because you might find yourself out of work for a very long time. Just assume that in the course of things, you will progress to another job and another specialty in the future and take things as they come.

[penterbm]

I am a newer grad nurse as well and got a job in a hospital about a year ago, like you, the only reason I wanted this job was to improve my skills and then find something outside of the hospital. It may be helpful to get a part-time hospital job as suggested in the previous post. It wasn't until I started my job that I realized how much nursing school did not teach me! I would at least suggest doing online education, attending seminars, etc. to stay up on the latest in nursing skills. Nevertheless, any experience in nursing is great too have, I am sure now you would be much more marketable for a different job but I don't see the need to find a new job right away, as long as you enjoy your job now. hope this helps!

[abbie0]

I started off in the hospital, and then went to home health. I have to say that I developed more skill in home health than I ever did in the hospital. EKG, Home Infusion of Abx, Dobutamine, Lasix, IVIG, etc. Every kind of pump and tube, wound, & diagnosis imaginable. It always makes me laugh when I hear people talk about going to the hospital to keep up skills. Maybe in Med Surg, but mostly the care is so specialized that you do the same things over and over. I found the hospital monotonous when I worked the Cardiac Stepdown Unit, Psych was interesting, but even that is better in the home setting of a patient. Of course hospitals don't see it that way, they want assembly line speed, but even the patients in the hospital want quality care as well, and there is only so much quality available in 15 minutes.

[abbie0]

By the way KUDOS on the review!!

[wunzieRNBSN]

Thanks for the replies! you guys are right... I'm learning so much in home health. And it is exciting it its own way. getting to know pts in their home environment. everyone has different dx so it is never the same thing. I've done wounds, i've called out on CHF exacerbation and sent pt to the hospital... dehydration w altered mental status. etc.

but... again, from time to time, I don't want to limit myself in just home health. I recently attended the conference for NAHC to keep updated with the medicare regulations, etc. Any medical updates I really have to do on my own. But that's not so bad with the internet making learning very accessible.

[HealthyNurse]

Only you can decide what is the "right" career path for you. Did you start this job in Sept. 2010 or Sept. of this year? If you've been at it for over a year, I would say that you've already accomplished quite a bit within a short period of time in your career.

That being said, your post struck me as a bit naive, which is understandable considering how young you are. What exactly is a "real" nurse? I've been out of clinical practice for a few years, but I still consider myself a nurse and I always will be. There are many, many different ways of being a nurse. Some involve hands-on clinical care and others involve ensuring that patients are receiving the best hands-on care possible, through a variety of means. I haven't actually touched a patient in almost a year, but in my job now, I impact the lives of many more patients than I could ever reach by performing direct patient care. I'm not saying that my job is more important than that of a direct care nurse (I have the upmost respect for what staff nurses do), but my point is that you should consider broadening your understanding of what nursing practice encompasses.

If hospital nursing is what you really want to experience, by all means, go for it! Just don't quit your job until you have found another position. The other option is to get a part-time or per diem hospital job that will allow you to gain some experience while keeping your home health job.

I practiced in acute care for a year and a half and that was MORE than enough to realize that I don't enjoy that type of nursing. I can't imagine ever going back to the hospital, but I understand why you would want to experience it if you never had the opportunity. I do find that the hospital experience was very useful to my home health practice.

Regardless of the career decisions that you make, you should congratulate yourself on the success that you've had so far. You've already accomplished far more in your career than many nurses do after a lifetime of practicing as a nurse.

[wunzieRNBSN]

I started this job Sept. 2010.

Thank you for your post. I really needed that.

It's not that I am really wanting to experience being a hospital nurse. In fact, after starting out in home health, I don't think I can survive in a hospital setting. I've gotten used to actually having time w my pts.

I've discovered that I have such a soft spot for the geriatric population... I don't think I ever want to go too far away from that. Thank you. Thank you so much. Sometimes I forget to be proud of myself.