Discouraged

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I started home health nursing last November. Prior to that I had 10 years hospital-based med / surg experience. There are many things that I truly enjoy about home care, but I am getting really discouraged at this point. Mounds of paperwork, less free time...seems like all I do is work, work, work. I am about to attend class to learn the laptop charting system, and I am hoping that this will alleviate some of the paperwork. The fifth month of my new job I was literally in tears and told my supervisor that if things did not get better by June I was looking for a new job. I thought it only fair to give myself a little more time in the job, but I feel like I've hit another low point where I just want to chuck it all. When I worked in the hospital, after my shift was done that was it--no phone calls to make, no labs to track down, no paperwork to finish, no schedules to do, etc., etc. Does anyone have any advice, any words of wisdom? How do you manage to do a good job without sacrificing so much of your personal life?

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Specializes in Lie detection.

Great thing about HH- flexible hrs, time off, less taxing physical work.

Bad thing- Lots and lots of charting!!! We also went to laptops and that makes the charting lengthier. I often finish my day earlier than 5 but then end up doing my notes later at night.

If I did them when I finished my actual visits then I'd probably be done at 5. So it's a toss up. I like getting done early sometimes and then I'll chart while watching TV. I figure it all works out in the end.

I'm now really trying hard to finish the note before I leave my pt's house!!!

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Specializes in Gerontology, Med surg, Home Health.

I,too, find it difficult and sometimes annoying to be chasing docs down for orders and having my phone and my beeper going off all the time. Then I learned that most of the nurses have a message asking whoever is calling them back with orders, lab results, or something crucial to speak to a Team Leader. They can take verbal orders and straighten out a mess from the office. They call of course and leave a message but at least you're not the one dealing with an emergent situation from your car.

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Is it possible that you might be able to cut down on your work schedule so that you can find a number of shifts/days per week that will allow you to retain your sanity? Like instead of 5 days per week, maybe only 3? I remember I had a job one time where I was being pushed to the limit on a daily basis (institutional harassment). I had accrued leave time, so every so often I scheduled myself a mental health day when the pressure came on. I did this until I left and managed to survive it. Maybe you could cope better with work cut down into smaller chunks. Also, if it really looks like a losing proposition, you could use the off time for your job hunt. Just an idea. Good luck to you.

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Having been where you are describing, I'm going to go on a hunch and say, maybe home health isn't for you. I know it sure wasn't for me. I lasted 8 months before I went under and when I finally admitted defeat I felt like I had a ton of weight lifted off my shoulders. My cell phone stopped ringing off the hook, suddenly I didn't dread waking up knowing people were "waiting" on me, my gas bill was almost nonexistent compared to when I was on the road all the time. I was able to clean all the papers and junk out of my car. I didn't have to sit on the phone calling doctor's for orders. I don't miss home health at all, not even a little. I'm not knocking home health but it really does take a certain personality to do it and enjoy it.

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Thank you all for your comments and suggestions. There are many things I truly enjoy about home health: flexible schedule, spending one-on-one time with patients, actually being appreciated for your work, among a few, so I'm not quite ready to throw in the towel just yet. I started computer training Monday, so that will cut down on some of the paperwork. Also just today I got two snaps up from my team leader: during a recent survey, one of my patients gave me high marks, and UM brought one of my recerts to my TL and held it out as an example for others to follow. I really needed that little boost to my ego! During one of the breaks in class today, my fellow classmates and I were discussing the pros and cons of home health but overwhelmingly agreed that is was much better than working in the hospital. I suppose everyone goes through these phases while adjusting to the new position, so I know I'm not alone. I've just decided to give it more time and see where it leads me. Thanks again!

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Hello,

I am an old nurse new to home health 1 year ago. Skillbuilding has been quite a year. My experience strength and hope program:

I find myself in the same position as Discouraged at times, every few weeks. Factors: I live far from the office (about 1 hour, 50 mi). Some patients are in my area so I can see them on the way home, or on the way in. I have a huge territory (3-4 counties because the other psych certified home nurse is out sick). Driving isn't too unpleasant, because I talk on the phone to patients, families, doctor's offices, the office, and of course my friends... and I always have an audio book to listen to. That is a must.

However, being a psych nurse, even with my non psych patients, I tend to talk (and mostly listen) too much. I do a ton of teaching each visit. I spend too much time at each visit. Our agency says 30 minutes in the house, 15 min. charting is a good goal for a regular visit, 1-2 hours for an admission (ha ha) or a resume. and an hour for a recert.

Well, admissions take me 2-3 hours plus HOURS of paperwork and looking up codes. (codes are going much faster now than they did). A regular visit for wound care or teaching usually takes me 1 hour plus the charting. Sometimes, several non-visit discharges can get added to me. Looking up new patients in the office, pulling patient ed material from the files, hunting for proper supplies, and being nice to everyone in the office add to my time tribulations. I know these are not optional!!

I have gotten behind in handing in paperwork when I have complicated admissions and have been in some trouble about it. Everyone says, "Oh, your charting is so good" but my efficiency factor in getting it done and in is poor so I am not pleased nor is anyone else.

I have tried a timer (just for my counseling psych patients) but I lost it and didn't really like it. Ding!

This is what I am trying. I must set better priorities before the visit:

-determine in advance which subject or subjects to cover in teaching (or counseling) and don't let the patient derail this too far.

-make out a route and try to stick to a schedule for each visit early in the day (I have been off by as much as 4 hours when trying to predict my day) and use a timer or my watch to announce "I must wrap this up".

-tell each patient about how long the visit will take including the vitals and the teaching, and then stick to it.

-Not try to be super home health nurse by perfectly teaching each person all that they need on the day of admission. (They need their meds straight, not memorized on day one).

That is really it. Being supernurse. I think my Codependency is really the center of this. Like many in the helping professions, I achieve a lot of my self esteem at work. The more I do, the better I must be! But this has thrown me out of balance in life in the past, and it is doing it again.

:monkeydance:So, with my peers out there, I am resolving "one day at a time" to abstain from supernursing, and take care of myself and not burn out on the schedule. I will do the above resolutions and be just fine anyway!

Thanks for listening. JensiS in Tennessee

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Specializes in icu.

I'm starting in home health next week. I've heard the paperwork can be overwhelming - but that you can do it at home which is a plus. In the past I working in critical care - lots of charting there too, sometimes two hours after the shift change - at least one hour on average.

The worst part of working in the hospital, for me, was dealing with a handful of obnoxious, pretenious, miserable doctors. Hands down, dealing directly with mean and nasty doctors was the worst. It was my main reason for changing to home health - plus being out of the hospital - some days, with our 12.5 hours shifts, there was not a break - at all. At least, in your car from patient to patient - that is a break. To eat a snack, to think or not think for a few minutes.

I have two small children at home - I'm hoping home health will be better than the feeling of going into a prison for 12.5 hours at a minimum.

Any comments? Much appreciated.

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Specializes in OB, M/S, HH, Medical Imaging RN.
I'm starting in home health next week. I've heard the paperwork can be overwhelming - but that you can do it at home which is a plus.

At least, in your car from patient to patient - that is a break. To eat a snack, to think or not think for a few minutes.

I have two small children at home - I'm hoping home health will be better than the feeling of going into a prison for 12.5 hours at a minimum.

Any comments? Much appreciated.

Been there, done that! I loved home health. I didn't think the paperwork was overwhelming and I did do it at home. We had computers and I did as much as possible in the patients home, vitals, assessment, etc...then charted the teaching, narrative notes, Oasis... etc at home.

Driving from patient to patient was relaxing for me. You can stop when you want to, run errands, etc...I believe home health is nursing best kept secret. My fantasy job all came to an end after 6 months when a mixture of poor management and a change from per hour to per visit hit all at once and I ended up giving my 2 weeks notice. I live in a rural area and visits that are 40 miles away are not worth $37 which included my driving time, visit time and charting time. I would have been making about $7 an hour.

I would not go back to the 12 hour floor job for all the tea in china. I work 11 hour shifts 3 days a week in radiology. I've been with the hospital since 1981 minus the time with home health.

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i think the biggest thing to remember in home health is that if you get even one day behind on paperwork you will feel like you are drowning...always stay organized , remember there are many other disciplines that can help manage a case, many nurses feel they need to "solve all the problems" themselves, i say bring in MSW....after about 45 minutes the patient isn't going to absorb/learn any more, so make sure they are safe, have the meds straight for the rest of that day, and visit again tomorrow...you will feel better, the patient will be happy to know you are coming back tomorrow....we front load all our admissions and see them 3 days in a row (regardless of the day of the week), it helps knowing they will be seen the next day, as we all know that admission visit can be a killer.....just remember, stay organized and utilize all your disciplines.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

I worked in homecare for 13 years as a visiting nurse, and as a supervisor.

It's great having the independence, the autonomy, the one to one patient contact.

Of course the downside is the paperwork, and the fact that there is no incoming staff coming in on the next shift to take over any unfinished business.

It was a love-hate relationship. Sometimes it takes awhile to successfully transition into the very different routine. The job is quite different than the hospital routine, and the formal & informal support systems available in the hospital just aren't there.

Organization is critical.

The laptops really can make a difference. If you otherwise like the job, I'd suggest seeing how it works once you mastered the computer documentation. Do you think hanging in there for a year is a possibility.

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Specializes in icu.

Thanks for your advice. I am making a list of your suggestions to refer to probably often, as I start on Tuesday!

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