Considering move to HH, unsure if I have enough experience

Libby1987 · Feb 11, 2016

Can't speak to MA, but you have relevant nursing skills experience. It would be your assessment and decision making knowledge and experience to consider. Do you recognize the symptoms and implications of changes in status and how to best respond? If you've only been working in a task oriented capacity, you may be lacking in disease management which is a major aspect of home health.

Farawyn · Feb 11, 2016

Welcome back.

I agree with Libby. It sounds like you have good recent acute experience.

Have you been charge? Have you precepted anyone? How are your communication and assessment skills?

HH is autonomous. You do have a team, but you are the eyes, ears and voice of the patient.

I'm in NY, and I'm PV (FFS). I get paid well, 120 for a SOC and 90 per visit.

The transition you may find difficult is not having another nurse to bounce things off of. That's what I miss most about the floors.

Libby1987 · Feb 12, 2016

Welcome back.
I agree with Libby. It sounds like you have good recent acute experience.
Have you been charge? Have you precepted anyone? How are your communication and assessment skills?
HH is autonomous. You do have a team, but you are the eyes, ears and voice of the patient.
I'm in NY, and I'm PV (FFS). I get paid well, 120 for a SOC and 90 per visit.
The transition you may find difficult is not having another nurse to bounce things off of. That's what I miss most about the floors.

$90 for a revisit? That's seems to be a premium. How many visits are you reasonably able to perform daily? Are you traversing a large area or otherwise excessive drive time?

On the other hand, the SOC rate is proportionately low. How many SOCs do you perform on a daily basis?

With my set up I'd be doing 1 SOC and 4-5 revisits finishing in 8-9 hrs and that would be pretty lucrative at your rates.

Farawyn · Feb 12, 2016

$90 for a revisit? That's seems to be a premium. How many visits are you reasonably able to perform daily? Are you traversing a large area or otherwise excessive drive time?
On the other hand, the SOC rate is proportionately low. How many SOCs do you perform on a daily basis?
With my set up I'd be doing 1 SOC and 4-5 revisits finishing in 8-9 hrs and that would be pretty lucrative at your rates.

I'm working tomorrow and I expect 2 SOC and a visit.

Or 3 visits and 1 SOC.

After school I can see as many visits as I want. I usually only see 1 or 2 wounds. When I tell them I can work on a Tuesday, I say, Hi, I am available for 2 visits.

Libby1987 · Feb 12, 2016

I'm working tomorrow and I expect 2 SOC and a visit.
Or 3 visits and 1 SOC.
After school I can see as many visits as I want. I usually only see 1 or 2 wounds. When I tell them I can work on a Tuesday, I say, Hi, I am available for 2 visits.

Perdiem is a different animal than case mgmt where we follow our own patients and revisits are predictable and often routine.

Hoosier_RN, MSN · Feb 12, 2016

Perdiem is a different animal than case mgmt where we follow our own patients and revisits are predictable and often routine.

I get about the same $ it's because I don't get any other benefits other than the visit and mileage.

Farawyn · Feb 12, 2016

I tend to see the same wounds when I do the after school gig. Easy peasy.

On the weekends I make more.

jdl1982 · Feb 12, 2016

Farawyn, Ive been charge before, At my facility charge doesnt do much more than lead the scramble when admissions are coming in and making the assignment honestly. I havent precepted anyone either, that is something generally given to the staff nurses who have been at the facility at least 10 years as far as Ive seen.

I feel my assessment skills are strong, though time to time I will bring situations other nurses or the docs when something seems "off" and I cant put my finger on it. Communication is good, documentation is also pretty good. I was hoping that there would be other resources at least reachable by phone that I can bounce things off of or describe the situation you know? So as you said the possibility of not having that at all does give me pause.

Libby, I am comfortable with many of the more common chronic conditions. Your question makes me stop and think. Many of the interventions I know and commonly do now are mostly medical, things I call the doc, get an order and go to the pyxis to implement. Maybe a stupid question but in the home setting I wouldnt have the pyxis as an option obviously, so if I am in a situation where I need the lasix or the IV cardizem, would my only option at that time be to send them to the ER? When you say how best to respond, do you mean what is emergent vs monitor vs this can wait till the patients appointment next week?

And thank you guys for taking the time to respond and helping me out. I dont want to put myself in a position where I am unable to provide the best care for my patients and jeopardize them you know?

Farawyn · Feb 12, 2016

Your last sentence alone tells me you will be good in HH.

It's not for everyone. I like it, Libby likes it.

The patients are for the most part extremely appreciative. The HH RN is usually a huge comfort to them.

Libby1987 · Feb 13, 2016

Farawyn, Ive been charge before, At my facility charge doesnt do much more than lead the scramble when admissions are coming in and making the assignment honestly. I havent precepted anyone either, that is something generally given to the staff nurses who have been at the facility at least 10 years as far as Ive seen.
I feel my assessment skills are strong, though time to time I will bring situations other nurses or the docs when something seems "off" and I cant put my finger on it. Communication is good, documentation is also pretty good. I was hoping that there would be other resources at least reachable by phone that I can bounce things off of or describe the situation you know? So as you said the possibility of not having that at all does give me pause.
Libby, I am comfortable with many of the more common chronic conditions. Your question makes me stop and think. Many of the interventions I know and commonly do now are mostly medical, things I call the doc, get an order and go to the pyxis to implement. Maybe a stupid question but in the home setting I wouldnt have the pyxis as an option obviously, so if I am in a situation where I need the lasix or the IV cardizem, would my only option at that time be to send them to the ER? When you say how best to respond, do you mean what is emergent vs monitor vs this can wait till the patients appointment next week?
And thank you guys for taking the time to respond and helping me out. I dont want to put myself in a position where I am unable to provide the best care for my patients and jeopardize them you know?

Yes, that's pretty much what I mean.

No matter what you know or don't, there's still an adjustment to how we react and what measures we have. The most experienced nurses can be surprised at what we manage at home and don't send to the ER but they at least recognize the significant but not so obvious changes in condition and are able to respond and communicate effectively with the physicians, or walk in and see sepsis/osteo/CVR exac from across the room and send them.

And having a good working knowledge of out patient meds. Some of those you might be surprised at, but even just the garden variety. Inpatient nurses don't always take an active part in medication mgmt, in home care you're looking for problems and sorting them out.

And then there's the gazillion little details that just take time to learn, like patients discharging from a SNF with a few days worth of new meds in blister packs that were started during their hospital course and they need an immdiate follow up appt with their PCP or other out patient provider to obtain written prescriptions before they run out. And that we're the ones who have to assess for that need on the first visit and get that appt made before the weekend even if the schedule is full or we're not hanging up until they will accept our records as adequate for calling in rx's for conditions the PCP hasn't seen the patient for.. Even nurses that have come from SNF's don't always realize that.

That sort of thing takes me a few minutes to recognize and take care of but not when you're new. Especially not when you're new and green. It does help you learn it all faster and easier if you're naturally detailed oriented and organized with strong problem solving skills.

All that said, it sounds like you do have some working knowledge to build off of.

ETA the part I like most about HH is all of the satisfying accomplishments I can make in a day, everyday. Many are small but I've never gone home thinking I didn't have impact. Using the example above, preventing a patient from naively running out of their new amiodarone is a little thing that keeps the train on its tracks.