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Contemplating a job in HH

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kelnich1 kelnich1 (New) New

Hi everyone,

I am currently contemplating a job as a HH nurse. The position would be per diem and paid per visit. They said I can do anything from 1 pt to week to practically a full time schedule.

I am a little worried as I have been out of the field (nursing in general) for 2 years to raise children and the 3.5 yrs before that I was a telephone triage nurse (no clinical).

My background is ED nursing so I am hoping even though it's been 5+ years out of a clinical setting my skills will come back to me. What do you think? Is this a terrible specialty to reenter into the nursing field after a 2 year hiatus?

I am also worried about going into people's homes. I mean the ED was not a pretty place at times and I LOVED it but going into people's homes are a whole different ball game. Have you ever felt unsafe?

Just looking for some advice or input as well as some encouragement. I love the idea of home health as well as the flexibility it will provide BUT I know it's not a glamorous job.

Thanks!

Yosemite, RN, ASN, EMT-I

Specializes in Med./Surg., Diabetes, Med. ICU, home hea. Has 34 years experience.

Kelnich: you'd be well advise to brush up on modern wound care, "moist wound healing" protocols and basic materials for the various types of wounds. OASIS documentation will also be a must and takes some time to become proficient; some agencies will train you, many want prior experience. Documentation is a tedious and time consuming process and often takes longer than the visit/intervention; the hourly pay for "per visit" reimbursement is low. Many of us "full time" HHC nurses have little personal life after all that is involved: visits, driving time, documentation, organizing visit schedules, communication with physicians, communication with team members involved in the case, recertification if beyond 60 days, resumption of care if hospitalized, discharging documentation, plans of care, etc.

It can get complicated; examples: working around board & care home and assisted living facility's meal times, lab draws & organizing to make sure you get to the lab before it closes, testing INR with a Hemosense in time to report it to the provider calculating the warfarin doses before they close/are gone for the day, traffic flow around "bottlenecks" and rush hours all while minimizing drive times/distances to meet all the needs and daily visits.

Make sure you interview the agency(s) to find out how they document, i.e., paper vs. electronic. You may be expected to provide your own tablet/laptop and may have to provide your own cell phone and carrier plans with little or no reimbursement. Find out what the agency(s) provide; you will likely have to provide your own basic diagnostic tools, possibly your own gloves and environmental barriers. Insist on a proper orientation and, even though you're an experienced nurse, don't get suckered into getting thrown to the wolves without it!

Best wishes and good luck!

I<3H2O, BSN, RN

Specializes in Home Health.

Yosemite has some excellent points!! Because this is the only thing I think Yosemite didn't cover, I think going in to patient's homes are really the least of your worries. Of course, I live in a relatively safe area. I have been scared. I have coworkers who have been scared. I call someone before I go into "iffy" situations and give them the instruction to call me in 10 minutes or so. Good luck with your decision.

Yosemite, RN, ASN, EMT-I

Specializes in Med./Surg., Diabetes, Med. ICU, home hea. Has 34 years experience.

I always do a "drive by" in Google, then in person just prior to the visit. If I see unsafe situations, I call my agency and report it, then call the patient and explain I will not be making the visit/taking the case. For me, this rarely happens. I worry more about dogs that are reportedly "friendly" and "Oh, he never bites." I've been bitten twice.

Thanks for the input! I really appreciate it. $70 for an initial visit with $60 for follow ups doesn't sound as much with the paperwork involved. I didn't even think about the amount of time for documentation. Hmm... I never even thought about dogs. I have an appt/interview on Tuesday. I think I will get a better feel for the agency at that time. They sound pretty desperate for nurses which worries me some, although they say it's because their caseload is growing. They did say I can take as little as one pt a week to a full time schedule. My initial phone interview went fantastic but I have to check them out and decide whether they are a good company to work for.

I<3H2O, BSN, RN

Specializes in Home Health.

You could also look on Medicare's website at Home Health Compare. See what kind of scoring they have. That may give you some idea of the kind of company. Find out if they are CHAP, Joint Commission, State certified. How the last survey went. Why has the census grown so much in such a short amount of time?

Yosemite, RN, ASN, EMT-I

Specializes in Med./Surg., Diabetes, Med. ICU, home hea. Has 34 years experience.

$70 for an OASIS evaluation/assessment, initiating the Plan of Care, getting additional orders, etc. is a RIPP off!

They did mention there is a $20 incentive to get the paperwork in for SOC early so I guess potential for $90 for a SOC. I think I will go in on Tuesday to get a better feel for the company and ask more questions about training and documentation, etc. They did say I can do ride alongs and such... Thank you for this information as now I feel like I will be going in there with my eyes wide open. I actually have a second interview for another job on Thursday and initially I was leaning towards this home health position but now with the amount of time documentation may take it doesn't sound like it would be worth my time. There is no reimbursement for gas, but they try to minimize your drive time.