Calling all HH nurses with 1:1 assignments

LaJollalove · May 17, 2019

Hi! I’ve done this for years, mostly with children. Whether or not you will like it depends on the patient, family members or other caregivers and your employer and of course your personal preferences. I’m an LVN and I’ve also worked in facilities and have done some other kinds of nursing as well. The pay in 1:1 home health is generally lower than other areas of nursing, however generally it is much less stressful and tiring. I’ve mainly worked nights so I get some down time as long as my patients were sleeping and stable of course. If your patient becomes unstable it can be very stressful even with well trained loving family members. It’s definitely harder than having other nurses and medical staff around you if there is an emergency. I wanted to be an RN in the ER since nursing school and working in home health has made me wish I was at least trained more in emergency nursing. Many home health nurses working solely with 1:1 patients feel that they “lose skills”. You hopefully become an expert on your patient but you don’t get exposed to a variety of patients and various health challenges. Make sure to bring lots of water, your lunch, extra layers of clothing and even your own toilet paper and paper towels. At facilities I’ve always stayed on the clock while I’m charting even when a DON asked me to make corrections or fill out any forms I had forgotten or not had time to complete during previous shifts. However in home health you will be expected to go into the office to finish charting on your own time and will not be paid.

caliotter3 · May 17, 2019

Don't feel bad if the family rejects you. Spend any length of time in extended care home health and you will get sent back to the agency sooner or later. It is almost always on the client, not on you. Problem comes up when you get with an agency that eats up what all the clients say and never backs up their nurses. Hard to avoid that kind of agency because most of them act that way. Nurses are expendable, customers are a never-ending source of revenue so the nurse never rates consideration. Just the way it is.

wanderlusthomebody · Sep 16, 2019

Hello!

I've done almost 2 years with complex ped clients, doing 8 and 12 hours shifts. They are trached, vented, GT/GJ, any combo of other things for very handicapped kids with MS, CP, MD, etc. I was VERY nervous at first because I had zero experience with kids in a nursing capacity and zero experience with most of those above listed things that come along with these types of clients. I was lucky to start with a kiddo of a person in my RN class, and she was AMAZING at answering any and all of my questions (and I had a lot) and being patient with me while I took 2-3x longer to do cares than she did). Haha!

I work FT nights and I do like it, though there are pros and cons just like any other job.

PROS - You get to really know your client's condition and baseline so it's easier to detect changes. You really get to know the care plan so you have a much better idea of not only info like their hx, meds, etc but it also should walk you thru the steps of what to do in case of different emergency situations (our company includes that anyway). You also have LOTS of time on nights to really get familiar quickly with the care plan, so you can at least mentally know these steps if the situation ever arises. HH clients are generally more stable than pts in other nursing setttings - not to say they still don't get sick or have declines that come up rapidly sometimes. Kids compensate amazing until they can't anymore, so they can go from baseline (or close to) at the beginning of your shift to the ER by the end of it so you have to be diligent to detect changes as they occur. You can more or less set a schedule that doesn't really vary too much from shift to shift (which I LOVE). You also know what to expect for the most part and you'll learn with time what interventions to do immediately when you start noticing changes in their condition to help prevent it from declining. My company uses online charting for 80% of the charting, so that's always a nice perk! I have never needed to go into the office. Depending on the client/family, you may luck out and have a family that really and truly appreciates you and lets you know that they do - which is ALWAYS nice to hear. ?

CONS - in my case, all of my cases are very similar cares so I don't use a wide range of skills and 1:1 HH uses a much smaller range of skills than other areas do because you see the same people all the time. This may be viewed as a pro in the way that you get REALLY good at assessments (to detect those fine changes in lungs or bowel sounds, for example) and the skills you DO use. I can't help but feel sometimes that I am losing more skills than I use though. You may not have the latest and greatest equipment to use, and sometimes you may run out of supplies (in my houses, the moms both are in charge of buying and ordering, so things get overlooked on occasion). It can be difficult in the house to retain professional boundaries as you "get comfortable" with the client and/or family and they with you. It may be a household that is not a stable, healthy environment all the time - family dynamics are complicated things and not always sunshine and rainbows. As previously mentioned, the client is always right and in many cases, a nurse will be replaced if the family/client complains. The positive side here is that (at least in my area), the demand for HH nurses with my skill set far outweigh the supply so even if I were to be removed from a house, I'd be placed in another really quickly. Another con to some can be the monotony of your job. For the most part, it really is the same thing every shift, the same routine. I love that part but I know plenty of people who wouldn't. Another con - you are on your own if an emergency arises. There is no team to call in, no code button. If you're lucky enough, you may be in a home that happens to have a willing parent or other family member there to help out.

I hope this helps a little anyway. It's hard to really sum it up because every client is unique with their own set of challenges and rewards. Just make sure that you are given adequate training - because whatever happens on your shift happens to your license.