Any tips or advice for a new grad/new HH nurse?

[otterbeinbed, BSN, RN]

I graduated with my BSN in December, passed boards in January, and accepted a job offer from a reputable home care organization. I worked as a CNA in home health for several years, and loved nearly every minute of it. During school, I did a short clinical with a local home health nurse and was thrilled that education and advocacy play a huge role in the position.

I start the new job tomorrow and will be training with another nurse for roughly 6 weeks. Despite reading many threads and articles covering home health nursing, I still feel vastly unprepared and am not sure what to expect. The manager is very open about how difficult the first 6 months can be, but that it's quite rewarding once I get into a rhythm. When I start going out on my own, I'll see a handful of clients then go back to the main office so they can check my charting and help me with any questions or concerns I have, which sounds nice.

I know it won't all be sunshine and roses, patients can be difficult, home environments are sometimes sub-optimal, but is there anything I need to prepare myself for in advance? Is it normal to feel apprehensive and excited at the same time? Do work laptops allow you to use Excel or Word to keep track of your schedule?

[BarrelOfMonkeys, BSN, RN]

One thing that I wasn’t exactly prepared for when going in to HH was the scheduling. I started out part time and slowly picked up more and more clients so the case load wasn’t a problem. Scheduling in advance was a challenge with psych clients. I work with adult/pedi psych and some medical adult/psych. Psych clients are not always the most reliable (forgetting they had an existing appointment, forgetting all about yours, outright refusing, etc). It took me a while to get a routine down and to be able to manage my daily schedules with sometimes changing them by the hour. If I missed a client on Monday and had to reschedule them then I’d have to fit them in another day that week which changes my schedule for that coming day. So I’d tell you to be flexible with schedules (again this is from a psych client perspective) and to realize it will take time to find your groove. That’s been the biggest challenge for me going from a facility to HH. It was the last place I ever wanted to work when I was in school and now I have never been happier in my career.

[recruitern]

For new grads entering HH, I would advise them to document, document and document. I am a HH Liason Auditor for Homecare Agencies and from my audits, I can tell you that DOH is very strict with RN's documentation. I would ask the Director of Nursing to orient you extensively on that specific Agencies policies, and procedures, and their paperwork if they use paper charts. If they use software to chart, make sure you are trained on that before going out in the field. I often see many Rns get shoved into the field, have no idea what they are walking to, no orientation on a proper nursing bag, no idea on what to look for when they enter the home. I would shadow a nurse for one or two home visits, Revisits/ and Start of Cares as well. It will only help you, especially as a new grad in HH, you will learn a lot.

[DallasRN]

4 hours ago, recruitern said:

For new grads entering HH, I would advise them to document, document and document. I am a HH Liason Auditor for Homecare Agencies and from my audits, I can tell you that DOH is very strict with RN's documentation. I would ask the Director of Nursing to orient you extensively on that specific Agencies policies, and procedures, and their paperwork if they use paper charts. If they use software to chart, make sure you are trained on that before going out in the field. I often see many Rns get shoved into the field, have no idea what they are walking to, no orientation on a proper nursing bag, no idea on what to look for when they enter the home. I would shadow a nurse for one or two home visits, Revisits/ and Start of Cares as well. It will only help you, especially as a new grad in HH, you will learn a lot.

Read this. Over and over and over. The part on policies/procedures. The part about not allowing yourself to get shoved into the field. No real orientation. All of it.

I hope your new agency is wonderful and proves to be the exception to much of what I've experienced. It seems many of the agencies around here hire a nurse today, give her a caseload tomorrow. You can quickly become overwhelmed with the visits and the documentation. You're running 90 mph during the day, trying to get your visits done in spite of patients cancelling at the last minute, forgetting (even tho' you called the evening before), trying to get in touch with doctors who don't call you back, running into office for car stock...then you end up spending your evenings trying to get documentation done.

Again, demand a decent orientation that will meet your needs. It will serve you and the agency in the long run.

Best of luck and congrats on your BSN