Considering home health nursing

Traveler · May 24, 2005

You have some experience in med-surg and that is a good thing for home health. Many home health agencies want 5 years minimum nursing experience and one year hh experience. The only problem is, it's hard to get that experience if you have to have that to get hired! I am in Tennessee so I don't know about your area. Some nurses love hh and some hate it. You are on your own- literally. You are the only one in the home and it is a lot of responsibility. The paperwork is horrendous. After 6 mos to one year it takes less time to get it done, but there is more paperwork in hh than in any other area of nursing. My agency requires the nurses to do the coding and it's just something that you learn best by doing it. My paperwork and follow-up phone calls, etc. take much longer than the actual visit. As far as pay is concerned, I think much depends upon the agency you work for and your productivity. It is just something that you have to try for yourself and see if you like it. I can't imagine ever doing anything else again. I love the freedom, getting to explore new places, the intimate interaction with the patients and families and not being stuck in a building all day. You need to be able to be very flexible and adaptable. You also need to learn to take safety precautions depending upon what type of area your service area is in. I work in a very rural area in the mountains. Cell phone coverage is iffy at best and meth is a huge problem here. You need to be able to use your gut instincts about situations.

cydney7 · May 24, 2005

Thanks so much for responding! Most of what you said sounds great to me. I know that you said the paperwork is horrendous, but I think that with time (like anything) you learn how to do it quickly while still being efficient, you know? I've learned pretty good time management skills so far.......they're not where I'd like them to be, but they'll get better. I live in a pretty big city, and crime is a big problem here, so I don't really know where they'd put me. I do know that there is a job opening in some of the more rural counties, which I think I would like better. And, I wouldn't mind driving to those areas.

You know what the best thing you said was? The part about the patient interaction, it being so intimate.....exploring new places......that all sounds right up my alley. I work in the NICU, as I know I've mentioned before, but I really don't like it. The main reason? No interaction with patients. I mean, they're babies. And Mom and Dad usually want to just be with their baby---not really talk to the nurses. It's hard. It's so claustrophobic in that unit.......ugh, I just don't like it like I thought I would. And even though my med-surg work was difficult, I loved my patients. I loved talking to them, building relationships, all the stuff you get when working with adults, you know? I never had any complaints from any patients, always got along with them......it was great, for the most part. So I'm definitely leaning in a different direction, right? Anyway, I'm rambling on and on here. Thanks so much again for the response---hope to hear from you soon. Oh, one more question---what is your typical daily schedule like? Just curious.

You have some experience in med-surg and that is a good thing for home health. Many home health agencies want 5 years minimum nursing experience and one year hh experience. The only problem is, it's hard to get that experience if you have to have that to get hired! I am in Tennessee so I don't know about your area. Some nurses love hh and some hate it. You are on your own- literally. You are the only one in the home and it is a lot of responsibility. The paperwork is horrendous. After 6 mos to one year it takes less time to get it done, but there is more paperwork in hh than in any other area of nursing. My agency requires the nurses to do the coding and it's just something that you learn best by doing it. My paperwork and follow-up phone calls, etc. take much longer than the actual visit. As far as pay is concerned, I think much depends upon the agency you work for and your productivity. It is just something that you have to try for yourself and see if you like it. I can't imagine ever doing anything else again. I love the freedom, getting to explore new places, the intimate interaction with the patients and families and not being stuck in a building all day. You need to be able to be very flexible and adaptable. You also need to learn to take safety precautions depending upon what type of area your service area is in. I work in a very rural area in the mountains. Cell phone coverage is iffy at best and meth is a huge problem here. You need to be able to use your gut instincts about situations.

Traveler · May 24, 2005

It sounds like you would love home health if you like interacting with the patients. You really use everything in nursing in home health. You are assessing not only meds, diseases, etc., but the whole family process and environment. There is no typical day in home health. Today was a relatively "normal" day. I left my house a 6:30. Got to the office at 7:15 to finish up updating some charts, paperwork, etc. Had a case conference from 8-9am. Went by the pharmacy to pick up some IV meds, supplies for a patient. Saw that patient first- ran the IV in. The visit was about an hour long. I then went to see a patient who had just gotten out of the hospital and did a post hospital (COPD, CHF, etc.). Next patient was not home when I got there. Next was stasis ulcer and supervisory visit on a little lady. I then did another stasis ulcer, cardiac teaching on another elderly lady. Went to lunch with my boss. Saw a patient in a bad home environment with a stage III pressure ulcer. It was not healing so I changed the orders for the dressing to try to "shock" the wound. Went to discharge a man but found some more problems so I recerted him. Then I went to see a patient and do a monthly B12 injection and supervisory visit. Last patient was a man who is a new diabetic, lives alone, long history of etoh abuse and psych diagnosis. Teaching him to check sugars and diet. From the office to last patient house was 57 miles. Left last patient's house at 3pm. Total driving with commute is 120 miles and I have about 2 hours of paperwork to do at home tonight.

Mijourney · May 25, 2005

Traveler gave you a good example of a day in the life of a HH nurse. That's a pretty good day to me. Some days as in the institutional environment are not so good. Those are the days you need to be mentally prepared for because as previously indicated, it's just you. Sometimes you do not even have a doctor readily available. As indicated, HH nursing takes alot of ingenuity, creativity, and wits. You can improve this with practice and time. In non-traditional settings, employers like nurses with home health experience. So, you may have to spend more time working in your current environment before you're qualified for home health but don't give up. HH is a rewarding career choice I think.

cydney7 · May 27, 2005

I love interacting with the patients......that's the most important thing to me, and it's the thing that I miss most since I've been working in the NICU. One thing that worries me, though---what kind of safety precautions do you have to take to be a home health nurse? I mean, are we talking pepper spray, or a car alarm, or what? I live in Mississippi, and I don't know where the agency would choose to send me........it could be anywhere, really. I'm a pretty trusting person, I suppose......wouldn't want to get into a dangerous situation, you know?

Does your schedule allow you to have a life? Do you ever work weekends or holidays?

Everything you described sounds great to me. I would have a lot to learn. But, another good thing about home health (at least it seems so) is that you know so much about different areas.........various diseases, meds, and so on. It's kind of well-rounded in that way. In Mississippi I would probably be seeing a lot of diabetics........but that's an area that interests me a lot. I've even thought about become a certified diabetic educator. Anyway....I'm going on and on here.

I guess I'm just on a search. I think I know what I like and don't like........but I want to make sure that I find my place, you know? I'd hate to start another job and hate it. I'm going to just call a couple of places and see what there is to offer.

Thanks for your reply again. I appreciate it. I'd love to keep writing.

It sounds like you would love home health if you like interacting with the patients. You really use everything in nursing in home health. You are assessing not only meds, diseases, etc., but the whole family process and environment. There is no typical day in home health. Today was a relatively "normal" day. I left my house a 6:30. Got to the office at 7:15 to finish up updating some charts, paperwork, etc. Had a case conference from 8-9am. Went by the pharmacy to pick up some IV meds, supplies for a patient. Saw that patient first- ran the IV in. The visit was about an hour long. I then went to see a patient who had just gotten out of the hospital and did a post hospital (COPD, CHF, etc.). Next patient was not home when I got there. Next was stasis ulcer and supervisory visit on a little lady. I then did another stasis ulcer, cardiac teaching on another elderly lady. Went to lunch with my boss. Saw a patient in a bad home environment with a stage III pressure ulcer. It was not healing so I changed the orders for the dressing to try to "shock" the wound. Went to discharge a man but found some more problems so I recerted him. Then I went to see a patient and do a monthly B12 injection and supervisory visit. Last patient was a man who is a new diabetic, lives alone, long history of etoh abuse and psych diagnosis. Teaching him to check sugars and diet. From the office to last patient house was 57 miles. Left last patient's house at 3pm. Total driving with commute is 120 miles and I have about 2 hours of paperwork to do at home tonight.

cydney7 · May 27, 2005

Hi. Thanks for your response! Like I told Traveler, I'm just on a search right now.........trying to find what makes me happy. I know the NICU doesn't. I miss the interaction with patients most of all. I've only been a nurse for a year now, and even though my med-surg experience was stressful, I've really realized how much I loved it (even though at the time I hated it occasionally). There are good things and bad things about every job, though. I know some days are stressful and others are a breeze. There are always challenges, and I'm sure it has to be scary to be so independent.......having to make so many decisions on your own. It intrigues me, though. I'm going to check out a couple of agencies around town and see what's out there. Where do you work? Just curious. Do you enjoy what you're doing? I'd love for you to tell me more.

Maybe I can get one of the home health nurses around here to let me ride around with them one day. We'll see. Again, thanks, and I hope to hear from you again soon.

Traveler gave you a good example of a day in the life of a HH nurse. That's a pretty good day to me. Some days as in the institutional environment are not so good. Those are the days you need to be mentally prepared for because as previously indicated, it's just you. Sometimes you do not even have a doctor readily available. As indicated, HH nursing takes alot of ingenuity, creativity, and wits. You can improve this with practice and time. In non-traditional settings, employers like nurses with home health experience. So, you may have to spend more time working in your current environment before you're qualified for home health but don't give up. HH is a rewarding career choice I think.

CardioTrans, BSN, RN · May 27, 2005

Hi there, I just wanted to chime in on this one. I have been doing home care for 15 yrs. The autonomy is great, but always expect the unexpected. When you think you will have your day planned out to finish early, it never happens.

You have to have excellent assessment skills. You are, after all, the eyes of the doctor. You have to know a wealth of information, from CHF, DM, HTN, CVA, COPD, wound care, IV administration with different access lines, and pumps, TPN, tube feedings, IM injections, and learn how to do everything alone, without being able to call down the hall for help........... just about everything you find on a med surg floor, and then some.

Patients today are coming home sicker. Home care has changed alot in the 15 yrs that I have been in it. The patient care is great, the paperwork and Medicare guidelines, and deadlines can be absolutely horrible. Even though I have been in home care for so long, it still takes me at least 1-1/2 hr to do an admission and 45 min to do a recert (paperwork only), not counting the visit time.

The neighborhoods can be less than desireable. Even if you are in the most upscale neighborhood, the homes themselves can be bad.

Everyone that I know that is in or has tried homecare........ its either love it or hate it. I have never seen someone in between. Then you have to deal with some people thinking that home care isnt real nursing. Some people think that you just go in and everything is status quo, you spend your 30 min visiting and you go to the next one. The last 4 people that I have orientated all said "I never knew that you actually did nursing in home care"............ wonder what they thought we were doing........ :rolleyes:

As for the hours......... I bring work home some nights, some nights I dont. My particular agency...... the nurses rotate call every 6 wks, and are the 2nd in line on call the weekend prior to their week of call. I have worked at agencies where we rotated it one night at a time. I personally like the week at a time, because once your week is over, you dont have to worry about it for 6 wks. Now granted some weeks of call are worse than others and I may go out everynight...... but we try to arrange it where if Im out all night, then I get to go home early the next day, or come in late. Some weeks I actually work 50+ hrs then have paperwork to do, then there are some weeks that paperwork included I only work 40. Im salary, so it evens out.

There are days that I drive 200+ miles and see 4 patients, then there are days that I only drive 20 miles and see 7 patients. Some days Im knee deep in wounds, IVs and injections, others that I only do teaching of a disease and its management.

Its never the same thing, and once you get used to doing it one way, Medicare decides they want something different.

Didnt mean to be so long winded (spelled long typed)......... but hope this helped. Good luck to you!

cydney7 · Jun 6, 2005

Hey there---

I'm finally getting around to posting a reply. Thanks to you, and the others, for all the info. It's such a wealth of good information, and it will serve me well if I ever decide to do home health. I'm still interested in it, but I think that I need to concentrate on hospital work for the time being.........

It never hurts to try out new things, though. So I will keep checking this website for info........and would still love to keep in touch with all of you. Thanks again.

Cydney

Hi there, I just wanted to chime in on this one. I have been doing home care for 15 yrs. The autonomy is great, but always expect the unexpected. When you think you will have your day planned out to finish early, it never happens.
You have to have excellent assessment skills. You are, after all, the eyes of the doctor. You have to know a wealth of information, from CHF, DM, HTN, CVA, COPD, wound care, IV administration with different access lines, and pumps, TPN, tube feedings, IM injections, and learn how to do everything alone, without being able to call down the hall for help........... just about everything you find on a med surg floor, and then some.
Patients today are coming home sicker. Home care has changed alot in the 15 yrs that I have been in it. The patient care is great, the paperwork and Medicare guidelines, and deadlines can be absolutely horrible. Even though I have been in home care for so long, it still takes me at least 1-1/2 hr to do an admission and 45 min to do a recert (paperwork only), not counting the visit time.
The neighborhoods can be less than desireable. Even if you are in the most upscale neighborhood, the homes themselves can be bad.
Everyone that I know that is in or has tried homecare........ its either love it or hate it. I have never seen someone in between. Then you have to deal with some people thinking that home care isnt real nursing. Some people think that you just go in and everything is status quo, you spend your 30 min visiting and you go to the next one. The last 4 people that I have orientated all said "I never knew that you actually did nursing in home care"............ wonder what they thought we were doing........
As for the hours......... I bring work home some nights, some nights I dont. My particular agency...... the nurses rotate call every 6 wks, and are the 2nd in line on call the weekend prior to their week of call. I have worked at agencies where we rotated it one night at a time. I personally like the week at a time, because once your week is over, you dont have to worry about it for 6 wks. Now granted some weeks of call are worse than others and I may go out everynight...... but we try to arrange it where if Im out all night, then I get to go home early the next day, or come in late. Some weeks I actually work 50+ hrs then have paperwork to do, then there are some weeks that paperwork included I only work 40. Im salary, so it evens out.
There are days that I drive 200+ miles and see 4 patients, then there are days that I only drive 20 miles and see 7 patients. Some days Im knee deep in wounds, IVs and injections, others that I only do teaching of a disease and its management.
Its never the same thing, and once you get used to doing it one way, Medicare decides they want something different.
Didnt mean to be so long winded (spelled long typed)......... but hope this helped. Good luck to you!

mcorrao77 · Jun 12, 2005

I'm still a nursing student and I went out with a home health nurse last Friday and LOVED IT!!!!! I never thought I would. I graduate in August and I'm going to apply at a hospital that has a home health agency, but first I want to get my med/surg in and gain experience!! I can't wait until I graduate and finally a RN!! The nurse I went out with wonderful!! She had a great bond with her patients and the families. They really looked forward to her visits. I feel I can really give back to my community by becoming a HH nurse!! I can't wait! I'm going out with her again on Thurs and Friday and I'm so excited.

renerian, BSN, RN · Jun 13, 2005

I saw several really good points posted. You need to be flexible as this is true, if you don't mind your schedule changing mostly every day, you will be fine. I have seen so many people come to home health and get frustrated by the movement of people/client's on their schedule created by patients having changes in their health care status, or gee your squeezing an admit in between visits, etc.

The other is paperwork. I would say this is a huge reason we lose nurses in home health. There are computerized agencies though.

Last and not least home health nurses go way beyond what other nurses do/no offense. I have gotten sheets for people with no sheets, I was always buying food, running errards, and oh yes, I "donated" a ton of hours. Depending on how your pay scale defines your job you more than likely will be doing some work without being compensated......that loses people who are very money driven.

renerian

Traveler · Jun 16, 2005

As evidenced by my last two days, you never know what your day will bring in hh. Yesterday I saw ten patients (8 RV, 1 RC, 1 SOC), drove 75 miles and worked a total of 9 hours. Today I had 8 visits (all regular visits), drove 45 miles and had a 12 hour day. I am paid per visit and so yesterday I made out really well, today not as well. It works out in the end though.