Brand New Nurse in Home Health: Can you really gain experience?

caliotter3 · Jan 28, 2011

If you need to stay employed, then be glad to get hired in home health for both the experience and the paycheck. Home health has its advantages and limitations just like any other specialty. You have to keep things in perspective. You can't expect to maintain experiences across the spectrum. The best you can achieve is to get variety in the present job and/or try to maintain two part time (or full time) jobs in entirely different specialties. Many nurses work in hospitals and supplement their income by working part time in home health doing shift work. This works for many and does offer a little bit of a mix as far as experience goes. Get tired of it, then five years from now change jobs! That is the beauty of nursing, you can move around according to your desires and the opportunities out there.

bree* · Jan 28, 2011

Oh I'm not picky. I'm just wondering if someone like me can even survive in Home Health. I always thought that you learned your basic skills somewhere else (clinic, hospital, etc.) and THEN you had enough knowledge to work in home health, since it's a more independent setting.

OCNRN63, RN · Jan 28, 2011

As someone who worked in home health for several years, if you are, as you say, "clueless about so many things in nursing," then home health really isn't the place for you to start out. You need to have solid clinical skills and be able to work independently. There won't be anyone down the hall to answer your questions, help you with a procedure, etc.

Patients are going home much sicker than they used to. At the time I left home care, I was taking care of one patient who was on a continuous infusion of a cardiac med that a few years ago would have bought him a bed in ICU. The amount of documentation you have to do for home care can be daunting as well. Personally, I can't imagine being a brand-new nurse and taking that on.

I know people will say you have to do what you must to survive. I think about the possibility of doing potential damage to your license if you are not prepared to handle the responsibilities. If these agencies are that eager to hire you as a new grad, I would have hard questions for them about what kind of cases you'd be getting and what kind of orientation they will provide you.

Ayeloflo · Jan 28, 2011

For the paychech, go with the homehealth for now. As far as being clueless, you would be even in acute hospital, but you'd have the support of other nurses. In home health, you are on your own. The supervisor typically tells you abut the case, send you to meet the family, get orientation with the other nurse who is on the case, etc. Always have a way to reach DON for advice. Contact other classmates or resource person who can give you advice. I'd say you are VERY BOLD to step stepping into independent nursing straight from school. Never be uncomfortable about asking the family as many questions as you might have. Normally, the families (if it's pediatric) are trained in the procedures like chaning the GTube, reinsertiing the trach when it pops out, etc. Take advantage of the situation and tell the family you are new and would love the opportunity to do the procedure. Very soon you'll start to feel very comfortable. Some nurses have the same patient for a year or more in home health. Good luck.

Nothing beats acute med/surg as first year experience. You'll hate it but you'll learn sooooo much. Live for today. One day at a time. You'll do just fine

LTV950rn · Jan 28, 2011

As a brand new LPN, I started out doing peds private duty, so similar situation. I'd make sure you get a comprehensive orientation, as well as who to contact if you have a question or problem arise when you are out and about. I've found that a reputable agency will provide you with both a good orientation and ongoing support. This setting is great for honing your ability to work independently and learn new skills. Good luck to you!

netglow, ASN, RN · Jan 28, 2011

Bree*, if this thread is yours as well...

https://allnurses.com/general-nursing-discussion/new-nurse-graduate-529288.html

I would disagree with those that say to just go for it with home health. I think that unless you have had some, any, exposure to basic stuff homehealth would be at the very least dangerous.

grateful2010, LPN, LVN · Jan 28, 2011

Take the job-get as much training as possible. Know emergency contact numbers, if possible get the number of the 24 hour nurse hotline (where a nurse is available to answer any questions you may have at any time during the day). Call the doctor WHENEVER you deem necessary. In the process Look for a job at a hospital. Most importantly pray ever day that you deliver the best care to your patient. Best of luck.

OCNRN63, RN · Jan 28, 2011

Take the job-get as much training as possible. Know emergency contact numbers, if possible get the number of the 24 hour nurse hotline (where a nurse is available to answer any questions you may have at any time during the day). Call the doctor WHENEVER you deem necessary. In the process Look for a job at a hospital. Most importantly pray ever day that you deliver the best care to your patient. Best of luck.

I have to be honest: this post really frightens me. It comes across like, "Take the job and hope nothing goes wrong."

When you work in home care, you are the nurse. When I was on call, I would have been calling myself if I called the 24h number. I suppose I could have called my manager; I most likely would have been out of a job, as well. You are in that position because you are expected to function independently, not having to call nurses and doctors for back-up.

allnurses Guide · Jan 29, 2011

I've discovered that in home health, when problems occur, it's because the nurse couldn't react quickly enough to the unexpected. Most of what you do has a routine to it, but especially when you are taking care of patients on vents, an unexpected occurance means the patient does not have the A in the ABCs, a true emergency.

When you ask yourself if you should take on a case, don't ask "can I do all those routine feeding, suctioning, breathing tx, etc", because the answer to those questions is most likely yes. Ask yourself if your patient is safe in your care should the worst possible scenario occur. Your patient aspirates food, your patient has an obstructed trach, the ventilator malfunctions, it's alarms are going nuts. What do you do first?

I read a post here a couple of weeks ago in which a nurse had worked night shift with a child on a vent-- and everything was good until the night it wasn't - the child had no air - she didn't know what to do, and it turned out that the tubing was disconnected. A simple fix. You need to know when to do what and what to do first. I have worked with new people who can learn all of that, but mishaps do occur. Try asking yourself if you would want you as a nurse for your child (hypothetically of course).

It's worth pointing out that some agencies have backup only in the theoretical sense. There's a name, a phone number and oh no just a voice mail! Now what? I'm not saying no new grad should ever work in HH just trying to help your thought process out some - best wishes to you!

Up2nogood RN, RN · Jan 29, 2011

I started as a new LPN grad in private duty working with peds on vents. I don't think I would have felt competent enough to take on a home health job though. I did a clinical rotation with home health and hospice and realized you need to think quick on your feet without someone to bounce ideas off of. I did have extensive experience in passing meds and as a CNA so I was so chosen as a new grad to work private duty and I had a very thorough 2 night orientation on my case. Working HH though you won't get that type of orientation. Have you tried LTC and clinic too?

SlightlyMental_RN · Jan 29, 2011

Bree*, if this thread is yours as well...
https://allnurses.com/general-nursing-discussion/new-nurse-graduate-529288.html
I would disagree with those that say to just go for it with home health. I think that unless you have had some, any, exposure to basic stuff homehealth would be at the very least dangerous.

A post from bree* in that thread:

"Here's the problem..at my clinical rotations, we never did anything more than take vitals, help people move around, clean up, run around like maids, and read glucose/give insulin injections. I have never even done a tube feeding or wound care or anything. My program was a joke :("

I would be way too nervous to go into home health if that's really your background.