Autonomy as a home health nurse

[RN416]

I am having trouble with the autonomy as a home health nurse. Particularly, if a patient has a problem, knowing whether to educate/monitor or call the doctor or send to ER. It seems like I have to make a lot of decisions because I'm the only one seeing the patient on a regular basis and I can't go down the hall to ask someone what they would do. I have only been a nurse for 2 years so the limited experience isn't in my favor either. Does anyone have any tips?

[Daisy4RN]

There must be a nurse in the office you can call for an opinion and I would do that. But just remember that even after you obtain a second opinion its still your responsibility and license. If the patient is having new s/s that are not urgent then you should notify the MD and obtain new orders if needed. If the patient is in distress, respiratory, chest pain etc then you should probably call 911 (I called 911 once because a pt had extremely high BP and s/s of a stoke/TIA) . It just depends on the individual patient and their condition, prior s/s etc, pt plan etc. There is not a one size fits all. You will get better at this with time and experience. In the meantime, if you are not sure I would call your RN manager or call the MD in order to cover yourself and to make sure the patient is OK.

[Doberman1]

Are you comfortable with any other nurses in the field? You could ask for their opinion. I've been in HH for 2 years and when in doubt I call the MD. I've called MDs and told them that the patient needs to go to the hospital on a few occasions and the patient has been admitted. Don't feel that it's all on you; good health care is a team effort.