Always "on".

[twokidsmom,rn]

I have been a home health nurse since July. I became a RN 7/08, I am 46yrs old. I see an average of 5-8pts a day. I have been feeling like I am "on" 24/7. I think about my pts all the time, I have lost sleep over some. I am thinking maybe being a nurse is not for me. I do care about my pts and like my freedom with home health but when a wound is not healing, or if I keep seeing someone with no changes and my clinical manager says keep seeing a little longer I wonder if I am doing anything wrong. I did not get much of a orientation, 1 week with a nurse. My friend who started part time with a different home health agency went out with a nurse for 4 weeks. I am always doubting myself. Not sure if I should try something new or stick it out. My clinical manager says I am doing fine but still having doubts.

[RN1263]

If a wound is not healing it's time to call the doc and/or case conference and change the wound care- NOT quit nursing. I too have had patients I think about a lot, but I came to realize that there's only so much I can do and if I didn't stop doing that, then I would burn out. So, I make a game plan for the difficult cases and do my best...if they are non-compliant or should be in a nursing home, then AGAIN, there's only so much I can do if they're alert and oriented. Patients have the right to refuse to take care of themselves, it's hard to except, but true. Usually, I call APS and they get discharged for non-compliance...eventually. Home health has it's advantages, but is also challenging.

I bet you're a great nurse, you just need to learn not to take it home with you so much. Your patients are not in a facility, therefore they need to be able to care for themselves or with a caregiver. You can't be there 24/7- if they need that type of care, then they should be in a facility, but have chosen not to be. I had an older couple as patients that belonged in a nursing home, they knew it and I knew it, but they didn't want to give up their savings of $6,000 so they could get on Medicaid. I worried about them all the time, eventually they both became so ill that they gave up the money and went to a nursing home, after that I said no more worrying about patients that hold the cards in their hands and there's nothing I can do, but watch the train wreck happen.

Just my 2 cents!

[cathrn64]

I definitely agree with RN 1263! The key is to remember that the home health pt, or family, is able to make decisions. You may not agree with them, but they have that right. I know I have had many pt's who should not be at home, or belong in Hospice. I can encourage them to make the "right" decision, but it is their choice. As long as it does not endanger the pt, they can choose. Sometimes I don't agree with their choice, but it's theirs to make. Also, remember that your day ends and you cannot control Everything!!

[BSNin2008]

Yes, I love the patient or family who tells me, "well, that's your job", whether it is getting them on the commode, cleaning their dirty diapers, calling the pharmacy for their refills, etc., etc. Or, "well, you are supposed to come every day to xyz, you're the nurse!". What they are not getting is exactly what RN1263 said, they are choosing NOT to be in a facility and along with that comes responsibility to self-care. Our job is to teach, monitor, reassess, and change POC PRN. Unfortunately, many people think we are going to come and do hospital care in the home. If you need hospital care, then go to the hospital, your home is not set up for that.

[caliotter3]

You need to learn to find activities and worries in your home life to occupy yourself when thoughts of the job creep into your mental space. This is true for any occupation you are in, not just nursing. Work is work and it should stay at work. You may have to be very proactive to turn this bad habit around, but your family deserves all of you, not just your body at home, but your mind at work.