Age-old question... Should I leave the hospital for home care?

Specialties Home Health

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I know this is a personal decision but I am looking for input from nurses who have taken the leap of faith?

So I work on a psychiatric unit. It is just toxic and I am burnt out. Since our strike last winter, the hospital I work is getting worse all the time. Morale is at an all-time low. Are all facilities

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Wendy

Specializes in Med./Surg., Diabetes, Med. ICU, home hea.

Do NOT leave the hospital. There is NO return (unless you're hospital based and unionized). The pay for the hours worked is abominable. Take my word for it, kid, the grass is always greener on the other side of the fence.

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It would be a huge transition to go from inpatient to today's home health, more so if you aren't already performing many hands on skills. Decades ago when I left the hospital home health was relatively simple, today the patients are much more acute and the documentation load is significant. Like entering any other speciality it will take approx 6 mos to achieve a working knowledge and develop a comfortable organization and a year or more to feel confident and competent.

OTOH it is extreme fulfilling and you can see the impact you make on a daily basis.

Our census went went down this summer but my overall average wages have remained fairly level.

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I picked up a per diem job last year and worked per diem home care for almost a year. I kept my full-time job at the hospital. As almost everyone has said, its tough and risky to give up the stability of hospital nursing. I resigned from home care because I just didnt have enough time to meet their minimal requirements, I wish I would have kept the position because I loved home care. If you are in search of a different type of nursing, I say go for it and as you are planning go per diem at your hospital job

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The acute stress is much less, I came from the er and have been doing it 6 months in hhc but once I started doing admits (I work per visit) what I'm making per hour plummeted. I'm making 19 dollars or less an hour and it's not just because I'm new, I've got it down to a science and from start to finish with coding, charting, getting orders, notes and all a start takes me from 3 hours and 15 min to 4 hours. I only get paid 76 dollars for each one. Is the stress worth the drastic pay cut? At the hospital I made 32 Ann hour plus 3$ an hour in cert pay per hour, but I dreaded going to work every day. I think if the pay in home health was slightly higher, like let's say 26$ an hour when you worked it out, what they pay clinic nurses around here in Florida, it would be worth it. We get a pay raise in December so I'm holding out before I switch companies, but I think I'll stick with home health.keep in mind though that I'm per diem and our full timers are salaried. From what I hear, hhc is one of the few areas in nursing where you can negotiate your salary, and you'd better, because they work the salaried nurses to death. They work from 8 am to 10 or 11 at night 5 days a week and take call on nights and have to take some weekends. I don't think it's worth doing full-time, they own you, and when the nurses complain they get, "that's the nature of home health"

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Thank you everyone for your replies!! The company I'm looking at (Masonicare) has a good rep. They pay mileage, have a cell phone stipend, good benefits, but it would be $10 less an hour maybe a little more. This is a significant pay cut! However if I feel more fulfilled in my work and it is less stressful it might be worth it. It's just making the decision to do it and wrap my brain around making less money. The cons such as charting into the night time hours seem to be about 50-50. Seems that some nurses are able to complete it during their regular hours and some are not. Is this to do with the company you work for? Or more time management? Appreciate is charting during the visit helpful? I am pretty savvy on computers so I'm thinking I might be okay. I get my charting done at work in the hospital in a timely manner, while others stay overtime quite a bit to finish up. the company I'm looking out uses oasis. Thoughts?

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Wendy

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I used to have my hospital charting done on time in the hospital, too. And if we're talking regular revisits, my charting is done by the time I leave the home, but for admissions, there is no way.even if you get your oasis and assessment charted in the home three is still the notes, orders, 485, need reconciliation, Dr phone calls, profile, etc... I have made a form for patient's to fill out that ask all the basic symptom and demographic information while I'm filling out they're consent forms and what not to cut down on time in the home and also have written a computer program that fills out the oasis and assessment for what a standard patient looks like so all I have to do is chart by exception and change what's different for this patient and it still takes me 3- 3.5 hours to do everything on 1 start. If you have like one start/oasis (not including discharges, those are quick) and the rest are revisits it balances out and pay odd still good but if you have all oasis, which if you are an RN they can load you up with those, you'd make more money working half as much time I the hospital, but again, the stress level is much less in home health. It's just a matter of working 16 hours and getting paid for 6-8.

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Thank you that was extremely helpful!

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Wendy

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I just started at a home health agency and still do per diem in the hospital (ER, ICU). I'll tell you in a month what I think. People at the hospital are always like 'why would you want to do that' about anything that's not inpatient work (clinics, school nursing, hospice, etc). But I think we all know that as you mentioned hospitals can be 'toxic' environments. And this is even in good, well run places. Honestly, I can't embrace the idea that in 10 years when I'm 50 that I'll be ok with doing 12 hour shifts, working a mix of holidays, weekends, evenings, nights, call, days, etc. I think you see what toll 12 hour shift work takes on people. Go to your nearest inpatient floor and see what a nurse looks like after 20 years of service. Sure there are some healthy ones, but it takes extra effort to stay sane and healthy in an inpatient environment. I routinely hear nurses with seniority and 10+ years experience complaining about their schedules. To me trying home health wasn't because I wanted to be a HH nurse, it was because I want a normal life!

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I just started at a home health agency and still do per diem in the hospital (ER, ICU). I'll tell you in a month what I think. People at the hospital are always like 'why would you want to do that' about anything that's not inpatient work (clinics, school nursing, hospice, etc). But I think we all know that as you mentioned hospitals can be 'toxic' environments. And this is even in good, well run places. Honestly, I can't embrace the idea that in 10 years when I'm 50 that I'll be ok with doing 12 hour shifts, working a mix of holidays, weekends, evenings, nights, call, days, etc. I think you see what toll 12 hour shift work takes on people. Go to your nearest inpatient floor and see what a nurse looks like after 20 years of service. Sure there are some healthy ones, but it takes extra effort to stay sane and healthy in an inpatient environment. I routinely hear nurses with seniority and 10+ years experience complaining about their schedules. To me trying home health wasn't because I wanted to be a HH nurse, it was because I want a normal life!

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Wendy

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Foggnm,

Thank you so much for your reply! I would love to hear back from you once you get your feet wet in home health!! :)

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Wendy

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Specializes in emergency, vascular surgery/telemetry, med-surg.

foggnm,

I feel exactly the way you do. I have been in the med/surg/tele arena for 3 years now, and I am just growing tired of it. Besides the stress, I hate that I miss out on so many moments with my family and friends. The thought of being 'normal' and working mon-fri (mostly) is so enticing. I interviewed with the VNS in my area and shadowed, it seems like something I could enjoy. I also interviewed and shadowed at an ambulatory surgery center. I liked this also except that it seemed like a lot of the work was assisting the doc. I like the autonomy that comes with visiting nursing. I think either way I will do a per diem hospital job just in case. I also thought that if I really wanted to get back into the hospital after leaving that I could go through an agency, since the hospitals here do hire their travel nurses if they want permanent placement. I would love to hear more about your transition from full time hospital to full time home care!

:)

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Well, where should i start? I was a hospital nurse for 10 years, relocated to another state, and now im in HC. Its been 1.5 years in homecare, and I still havent grasp the case management part. It gets crazy with scheduling, and with calling of doctors. I do remember calling doctors in the hospital, but it was my Unit secretary that would make the actual call. But i did get an extra 10,000 to my salary when i relocated, so thats one of my upsides. And i love working alone. I love the flexibility. I love leaving my home after my children, and being home when they get home from school. If i get a better documentation system down, i think I would totally enjoy homecare more. Hope this helps!

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