Considering Home Care....

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Specializes in infection control, peds, home infusion.

Hi everyone! I am a new RN grad who is interested in home care nursing. I did shift work with a local agency a few years back as a LPN, and I really enjoyed it. Because I have three children (the oldest being 3), it seems as if home care nursing is really the only specialty that affords me the degree of flexibility that I need. The local hospitals require a f/t orientation for several months that I just cannot swing. My question is, do those of you in home care nursing feel as if you have lost anything skills wise over time? What are some of the drawbacks to home care nursing (besides Oasis)? How about some of the perks? Thanks so much!

Jenn:balloons:

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Hi Jenn,

Don't know if I'm the best person to answer this question because I have only been doing home health for 6wks. But I'll tell you how I feel and I'll be interested in how others respond as well.

First: My experience prior to this is: Surgery, Dialysis and Emeregency medicine. My most recent job was in the ER, which was HELL. So HH is a god send compared to that. But I do have some things so far that are bothering me.

1. On Call-They never hid it from me, I knew it when I started, but I still don't like it. I have 1 child at home, and to be told that if I receive a call at night that warrants a visit, I have to go. That could mean I have to travel over an hour to get there. Your time is not your own on these days. It averages to be about 1-2 times per week that we are on call. Weekend call is for 24 hours.

2. Weekends: don't mind them, only 1 wkend every 3 wks. Would have to work wkends at a hospital anyways and every other at that.

3. Flexability: Yes it is flexible to an extent. You are given a group of patients to see, and you make it work. But you have to make the pt happy as well. Not only that but admissions take about 1.5-2 hours, offholds 1-1.5 hours. Wound vac changes 45-1 hour. Travel time can be up to an hour where I live. Also, some pts will require after hours visits. I see a guy every monday at 4:30pm for chemo hook-up. On call starts at 5pm, so I don't get home until late these days.

4. Holidays: oncall and work. Sucks.

So thats my book. HH is so much better than floor nursing. I feel that a lot of the time I don't do much nursing though. Vitals, sometimes give meds, a lot of wound care. But thats about it.

I'm trying to weight the pros and cons.

Maybe try per diem, that way you don't have to work weekends, holidays and on call. but you don't get insurance and bennies either.

Good luck!

Chrissy

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Specializes in critical care; community health; psych.

What skills would you be losing? I do general med surg stuff; foleys, blood draws, wound care, wound vacs. No IVs and I haven't done a tube feed on our service. No vents either. Assessment skills have to be on target since you're out there on your own so you hone those using the simple tools God gave you.

Good luck! With the right agency you might be able to make it work. Beware of the paperwork monster. He'll steal your life away from you. I do have one suggestion. Try to go with an agency that uses laptops. It makes life easier in the long run.

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Specializes in infection control, peds, home infusion.

Thank you so much the both of you. I am seriously leaning towards home care, and the info is very much appreciated. I just interviewed at an agency that I very much have a good feeling about. I will post a bit more when I hear back from them (crosses fingers).

Jenn:balloons:

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There are many threads and posts about hh nursing where you can get info and read nurses venting about the downside. I love hh, primarily because I can give all my attention to one client at a time. I would suggest to you though, that you do as many RNs I have met: insist on patient care shift work rather than intermittent visits. You will only have the paperwork for the one client you are working with for each shift. Cuts down on your workload and you won't be driving all over creation in one day. HTH

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Specializes in LTC/hospital, home health (VNA).

I believe that HH nursing is the best kept secret of nursing! While on-call is NOT fun, it more than makes up for it in other ways. I love the flexibility and autonomy that it gives you. Teaching is key if course - but skills are important as well. I do wound care, vents, blood draws, IVs, wound VACs, ostomies, catheters, medications, feeding tubes, TPN, etc. And the best part is that each patient throughout the day needs different things so your day is definitely not boring. I like being able to start from home and finish at home so that I get to spend more time with my family ( we use laptops) And there is no other job where you can stop at the bank, run to the pharmacy and pick up a few groceries all within the course of the work day, because (being salary )as long as I see my patients it does not matter exactly how I "get er done" You'll love it! Good luck!

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I believe that HH nursing is the best kept secret of nursing! While on-call is NOT fun, it more than makes up for it in other ways. I love the flexibility and autonomy that it gives you. Teaching is key if course - but skills are important as well. I do wound care, vents, blood draws, IVs, wound VACs, ostomies, catheters, medications, feeding tubes, TPN, etc. And the best part is that each patient throughout the day needs different things so your day is definitely not boring. I like being able to start from home and finish at home so that I get to spend more time with my family ( we use laptops) And there is no other job where you can stop at the bank, run to the pharmacy and pick up a few groceries all within the course of the work day, because (being salary )as long as I see my patients it does not matter exactly how I "get er done" You'll love it! Good luck!

A happy HH customer who does visits rather than shift work. Lots of us are happy in home health!

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Specializes in Hemodialysis, Home Health.

I, too, prefer to do my 6-7 visits than to do shiftwork. Our agency doesn't even DO shiftwork. Strictly visits.

We have our pts. "zoned" according to where we live. I start out in town (as I need to check in with the agency first anyway to pull info from charts, etc.) and gradaully work my way back toward home.

I rarely drive more than 15 miles to any pt's home.. most are anywhere from2-10 miles apart. When I'm on call, I might have to drive farther, as the patient needing assistance can be one in another nurse's "zone", not one I would have seen before.. but that is the exception, not the rule.

And weekend call (Fri. noc through Mon. a.m.) I put in more miles as well, as two nurses cover ALL areas for scheduled wound care patients, plus any new admits or emergency visits. But that's only once every 6-7 weekends, so not too much of a problem.

I don't think I've EVER driven an hour to get to ANY patient's home.

Laptops would DEFINATELY be ideal. We have been promised them, but we are still waiting. *sigh* Hope it's sooner and not later.

And we don't do case management, either, which reduces the paperwork tremendously. I would never want to do case management. Far too timeconsuming.

Other than that, I agree.. HH is truly nursing's bestkept secret. :)

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