Career future for the home health nurse

[JeanettePNP]

Hi, I'm a new nurse looking into home care opportunities, only because that's the only thing in my area that's rolling out the red carpet for new grads.

I never really thought of home care as an area I was interested in working in, but I believe in rollign with the punches and if a door opens, you take it. My question is career-wise, where can you go with home care experience. What does the future look like? What opportunities are there for a homecare nurse after a few years? My goal was to eventually go back for my masters/NP, although I'm not sure yet which specialty. Can anyone comment on how well home care prepares you for the independent practitioner role?

[carwin]

Well stated RubyRN. The statement regarding "starting at the bottom" was not offensive to me. It further supported my belief that new grads should get training with seasoned acute care nurses before encountering the autonomy of home health care. I think in the hospital you really see the responsibility you've taken on in becoming an RN to provide safe, quality, competent care. It then becomes a part of your core and it defines how you practice regardless of specialty. Starting out in home care can diminish that because you are doing more teaching, but you have to know your stuff.

EX: Pt was on 80 mg Lasix daily but no potassium. Asked the "seasoned" nurse, she

didn't see the problem. Told her to call the doc and ask the patient if he had ANYmore pills around the house. Doc said he just took over this patient's care and immediately called in potassium and ordered labs. You guys can see how this could have ended. You can't assume that the doctor knows everything about a patient. They see other docs, share meds with spouses, tuck away a prescription and forget about it, etc.

As a home care nurse you are saying I have a strong enough knowledge base to be the docs eyes and ears. The patient's house may be filthy but your care better be immaculate.

Home care agencies where I live can be pretty corrupt. I don't want to see any nurse but especially a new nurse encounter that. ADON friend of mind told me that a surveyor told her that they are questioning agencies that don't report nurses to their state boards of nursing because of competency issues.

Right now there are nurses, therapists and MDs who have lost a license or are sitting in federal pen right now who worked in home health. Google medicare fraud in home care.

Any specialty where I can lose a license AND/OR my freedom command me to be the best skilled, competent person I can be. Again be careful. You are the one and only caretaker of your hard-earned license.

[hospicerocks]

You MUST always protect your license. I am a HHA manager who is resigning tomorrow because my boss 1) forged my signature on a pts med list and 2) sees nothing wrong with changing the documentation on an OASIS once the Rn has submitted it for processing! IE: fixing it to upcode.

I am going to be giving up about $20,000 per year but I refuse to be a party to such practices! Management is difficult enough without being able to trust or respect your boss. The company keeps her around, even though I direct reported this information to a senior level manager, because her branch makes profit each month. This has CMS fraud and lawsuit all over it!

[caryrey02]

Caryrey02, you wrote " Eventually I wanna go to a hospital and get my masters degre but you gotta start from the bottom to get to the top ;-)"

I hope that you weren't implying that working in home health "is starting at the bottom." I have worked with and mentored many newer nurses who did a year or two in med surg and their feedback indicated their stints on the floor didn't necessarily prepare them well for the situations they would be facing on their own in patient's homes where people are on their turf. What I hear the more experienced home health nurses saying on this forum is home health requires nurses not only to have well hoaned assessment skills and critical thinking, but also the ability to creatively problem solve independently, understand transcultural differences, not to mention the horrendous paperwork requirement. I am relieved to hear that employers are offering very lengthy orientation and residency programs to new grads to help them adjust better to the unpredictable environment of home health vs. giving them a couple weeks and letting them hit the ground running and floundering around out there on their own. I am curious, how much exposure you had to home health in nursing in your schooling? Like OB, ICU, ER, etc. home health is it's own specialty.

Congratulations to all of you and I wish you the best of luck in your endeavors.

you are right, we dont have a rotation called "Home health", and I would love to go to an ICU to get that so talked about "trainig/experience", but after more than 200 applications no one hospital ever called so homehealth was the one oportunity around my area (the only 5 graduates from my class that have a job are doing home health).

It is not my dream job but I truly like my profession and I am learning, doing research, my coworkers support me and it is getting better everyday. Things are really bad in the job market right now and not always you can start the way you would like.

But thanks for your good wishes, it is appreciated

[Luv2care0907]

I was just in the same position three weeks ago. I am a new grad in miami area and I have applied to at least 200 positions, even far from miami...not being picky at all, applied to LTCs, nursing homes, even flu clinics...EVERYTHING....no one even called (and I was veledictorian of my class)...I ended up being called for a home health agency and without even thinking it i accepted, it is not my dream job and I wanna go for my masters and NP as well but that experience everyone wants have to be obtained somehow, in my case and 4 other classmates(the only ones from my class able to start working) home health was the only option. Good Luck!!

Thanks for sharing your experience. It is very educational for me.