Disenlightened

[JentheRN05, RN]

I thought home health was where I wanted to be. After working a little over a month, I have developed an ulcer, been on antidepressants for 10 years, yet for the first time in my life, I became suicidal. I have never been that type of person.

I have been run ragged, never see my family. All and all a very depressing situation. I'm seriously considering going into LTC because I have burnt so many bridges in the last 2.5 years that I don't have much options left. I just haven't found anything I like.

I should be starting a NP program this coming month, I am praying that it gets me where I belong. I love to educate, love taking care of patients.

My issues through out my entire career (a whole 2.5 years) have been:

1. Hospitals = no time for patients patient:nurse ratio unreasonable.

2. Office pay sucks, and even though I loved doing it, there's never any openings.

3. Home health, I am constantly getting the runaround, literally. I get a company car, company gas card was paid reasonably well, but not for the hours I put in.

Current situation is, generally I do between 4-8 visits a day. Usually minimum of 30-1 hour drive between, so I usually leave around 7-9am (depending on patient need) not get home until 8-9pm. Spend 2 hours doing paperwork (setting up for the next day, and CYA stuff (scanning so I never get accused of not doing a visit - I was warned to do this - of course it's in a locked file).

I was so sick last week that I missed two days. I was supposed to be on call. Ended up working the whole weekend. I am fairly certain I had a nervous breakdown on Friday because I had seen 8 patients and was exhausted when they faxed me 5 SOC and a discharge with 4 visits for the entire weekend. I only went back to work on Friday because I am new to this job and felt obligated to get back to work. However I was still very sick, yet I did it, and paid the price that night. That's when I started thinking of what a failure I've been, and how desperately I wanted out of this constant running (driving) atmosphere. My mom (also a nurse) calls it windshield time. I spend more 'windshield' time than I do seeing patients.

Last week i received a note saying we were going to 'pay per visit per payer source' so I am guessing that means I will no longer get salary. I'll end up doing more work for less pay (which I don't think is possible to take on more patients the way they have me spread out) They say they pay for drive time, but only if it's 2hrs between visits. The amount of time I spend in the car between patients compared to how much I see patients is a good 3:1 if not 4:1.

I really am just venting. I am sick of not finding a position I like, sick of running away from job after job, and mostly I'm sick of being miserable.

Can someone please tell me that it will be better when I'm a NP or have my masters? Because I need something to hold onto. Anything at this point.

I've already started sending out resumes (after only being at this job a month) I'd quit on the spot if it weren't for the fact my car broke down on the way home from the interview for this job. I haven't had the money, much less the time, to get it fixed since.

I just wish there was some magical sign, something to point me in the right direction, because anymore I just feel like a failure and feel like I wasted 3 years of my life learning to take care of patients. Yet as much as I love to take care of the patients, either there isn't the time to do it properly (hospital) or there isn't time for ME.

Welcoming any and all suggestions. Should I just get out of the field? I LOVE taking care of the patients, and again, I love teaching the patients. Am I going in the right direction?

HELP!

[traumaRUs, MSN, APRN]

Hi Jen - sorry your career has been so full of potholes. Changing jobs is stressful - no doubt about it. To have had three jobs in 2.5 years might not allow you the time to fully acclimate to each situation.

My first piece of advice is to get yourself to a physician or psychiatrist - get your meds and stress level dealt with first. The fact that you have not been doing well at any of these jobs leads me to believe that it might be that you need a med tweak.

As to whether it will be better as an NP - I doubt it. You will then have full responsiblity to make decisions (and possible mistakes) for your patients. And...you really are under the microscope here too. You have more responsibility as well as more accountability.

Best advice - stick with home care for now for at least six months. If you need to go part-time due to your mental health status, then so be it.

[JentheRN05, RN]

I would but lack of health insurance detours that. I have been on every antidepressant over the last 10 years. The one I'm currently on is the only one that worked. At least until recently.

I can't go part time until I get my car fixed, I can't get my car fixed until we have the money/time to do it. So I'm pretty much stuck right now anyway. I just feel so stretched to the limits it's not funny.

[cookie102]

not all HH agencies are like the one you described,,,do you have other HH agencies in your area??? how about teaching? you can teach LPN's with a BSN and from what i hear as long as you are going towards your masters you can teach RN"S hope you feel better

[pnurseuwm]

Whatever you do, don't go into LTC. There you will have between 30-40 patients with each patient being on like 10-15 meds. You may have to do treatments. Have to deal with angry/ ignorant families, constantly missing meds, and the games the patients play with you. You will be running around like a chicken with no head and burn out fast!

[tennesseeRN]

I would have to agree with Traumarus in that perhaps in your search for the "perfect fit" maybe you haven't given each area enough time. Or perhaps if you have difficulty managing stress or are easily burnt out, then maybe bedside nursing/home health isn't your fit either. BUT!!! That's what so great about nursing. There are soooooo many options to choose from. Maybe your skills lean more towards the teaching aspect--perhaps in a nursing program or maybe a diabetes educator.

Nursing is NOT a family friendly career, nor wealth, nor fame, ect. ect. Most all we nurses have sacrificed time with our families, time to ourselves, time in church. Something else to think about--Looks like your fresh out of school. That is a big adjustment. How many of us nurses started school with lofty ambitions and know exactly which nursing career path we are going to take. Then by the end of school we have taken an entirely different direction, or we have been shown so many choices that when school is over and we have that big RN by our names--BAM. Reality sets in. This doesn't mean your a failure. Your human. Sounds like your too hard on yourself.

But--As a veteran home health nurse, I don't think home health is the place to be for you. Not right now.Not only do you have to learn how to be a nurse (school IS different than real life) but also how to be a home health nurse, case management, IV's at 2am, wounds and someone forgot to leave supplies, demanding directors, little oversight, outcomes and PPS.

Good luck in your search. Sometimes it takes a little time to find our way.

[JentheRN05, RN]

Well, I made the decision, putting in my resignation tomorrow. A job opened up locally that I hope and pray will be my niche. Because I am darned tired of changing jobs. I only for see 2 problems. Shift 3-11 (won't see kids or hubby much), and having 33 patients. Any guesses as to the job I'll be doing? At least I'll be home, have set hours, no call, no BS at work, and NO AUDITS (at least not like the ones in Home health - which their gearing up for one in October - glad I won't be there).

Anyway - please keep me in your thoughts, I need a job I will love, and need it desperately. Mostly to prove to myself, that I AM in the right field. I LOVE patient care, specifically teaching. But there's no opening for anything like that around here, So gotta take what is available to get out of this rut I'm in. (ya know, the ulcer and all).

Thanks for your advice, sorry I can't give it longer, I was told, that since I'm so organized, I would do good at this job. You have no idea what it's like when you are organized very well, and someone throws a proverbial wrench in the organization, or they aren't organized. I cannot deal with, 'oh I thought I told you you needed to do a stat PT/INR lab draw on so and so', or 'by the way, did you visit so and so last week?' Um... NO I didn't know anything about them. Someone started a case, and then somehow it slipped through the cracks that they needed to be visited 2x last week. So it makes ME look like the bad guy, but how in the heck am I supposed to know I have a new patient unless you TELL ME.

K - done now. I will NEVER do home health again, UNLESS I am running the show, because this BS lack of organization and last minute throw together admits is for the birds.

[HealthyRN]

Well, I made the decision, putting in my resignation tomorrow. A job opened up locally that I hope and pray will be my niche. Because I am darned tired of changing jobs. I only for see 2 problems. Shift 3-11 (won't see kids or hubby much), and having 33 patients. Any guesses as to the job I'll be doing? At least I'll be home, have set hours, no call, no BS at work, and NO AUDITS (at least not like the ones in Home health - which their gearing up for one in October - glad I won't be there).

Anyway - please keep me in your thoughts, I need a job I will love, and need it desperately. Mostly to prove to myself, that I AM in the right field. I LOVE patient care, specifically teaching. But there's no opening for anything like that around here, So gotta take what is available to get out of this rut I'm in. (ya know, the ulcer and all).

Thanks for your advice, sorry I can't give it longer, I was told, that since I'm so organized, I would do good at this job. You have no idea what it's like when you are organized very well, and someone throws a proverbial wrench in the organization, or they aren't organized. I cannot deal with, 'oh I thought I told you you needed to do a stat PT/INR lab draw on so and so', or 'by the way, did you visit so and so last week?' Um... NO I didn't know anything about them. Someone started a case, and then somehow it slipped through the cracks that they needed to be visited 2x last week. So it makes ME look like the bad guy, but how in the heck am I supposed to know I have a new patient unless you TELL ME.

K - done now. I will NEVER do home health again, UNLESS I am running the show, because this BS lack of organization and last minute throw together admits is for the birds.

I'm glad to hear that you made a decision and I wish you luck in your new job. I found your post today as I was trying to find answers to my own problems. I'm feeling really depressed today about my own situation. I've been a nurse for about a year and a half and I'm on my third job. I started out in med-surg, left after about a month, and then went to the ER where I stayed for 10 months. I'm now working as a "community educator" for a home health agency. Ha ha. Community education is the front for the real job which is being responsible for bringing in referrals. I have quotas to meet and the area that I cover is overwhelmed with competing agencies. I am very concerned that if I don't find another job soon, I may be fired. I was considering asking for a transfer into patient care, but I just don't know.

I'm also supposed to be starting an NP program in less than a month. I went into nursing because I wanted to be a FNP. However, I am so unhappy with my career decision thus far that I don't want to make another mistake. I've really struggled with the decision to continue with the program, but I think that I'm going to. Having a master's degree will open up many more opportunities and working conditions seem to be much better for advanced practice nurses.