Exhausted!

[Lee Franklin]

This is a long email, so I apologize.

Here is my problem. My wife is a VP at an Home Health Care (HHC) company, and the recruiting team cannot find nurses in SOCAL. She is at her wits-end and asked me to TRY to figure this out, so my thought was go to the experts...you, the nurses. Here is my assessment (through the eyes of an HHC nurse, who was a 15-year hospital and ICU nurse) and I would love to hear your thoughts.

"I think that when it comes to ER, OR and ICU nurses, they do procedures in the hospital that HHC nurses typically don’t do in the home environment, so it would make sense if that set of nurses might have concerns about doing high-acuity procedures in the home environment.

OR is obvious, but in the ER or ICU, they are definitely going to do things like A-Lines, new vents, gunshot wounds etc. that need to be stabilized in-patient... but ultimately, those patients come home. So, for nurses who truly have an aptitude and craving for that high acuity bedside nursing, they may need to work in a highly controlled hospital environment to continue to have that exposure. They may think that is their only option.

However, outside of that small clinical window, it is a misconception that you will lose skills in HHC. In fact, the opposite is true. In HHC, we are exposed to a little bit of everything and must have a vast array of clinical expertise in our tool bag, typically “on our own” in the home environment and off of whatever MD order we have, which is often in need of updating once we evaluate the patient. The MD typically takes our suggestions, so we need to know what we’re doing for sure, which is why in CA, it’s a law that an HHC nurses has to have a year of experience to even work in the field. We see everything; but here is a short list of the most common.

• Post op or post hospitalized patients. Cardiac, Pulmonary, Trauma, etc.
• Bowel and Bladder Ostomies
• PICC, IV, Chest port access etc., peripheral line, blood draw etc. Lots of IV antibiotics
• Peg tube, TPN, G tube etc.
• Foley’s
• Plurex, LVAD, Milrinone
• Neb, infection training
• Medication administration, IV, I'm, PO
• Compression wraps, Diabetic ulcers, Stasis Ulcers.
• Post op care, drain tubes, staple removal, incisional care

All the wounds you can imagine, from small bed sores to huge trauma wounds that need dressings, vacuums, packing, and teaching for the caregivers. Then just all of the basic nursing care, teaching, training, family support for every possible disease or combination of diseases you can imagine. We truly do a little bit of everything.

It might be helpful to know in particular the type of skills they’re referring to, there are so many misconceptions about HHC because it’s not an avenue typically taught in nursing schools.”

I can tell you that the comp. is the same, you have the autonomy to manage your caseload, which is far less that in the hospital, you do your admin. on your own time, etc, but I would love to here your thoughts.

Thanks,

Lee

[LibraNurse27, BSN, RN]

Hi Lee,

I hope this is not discouraging, I want to offer honest feedback about why I have never considered going into home health. I am getting burnt out on the stress of bedside nursing, but when I leave bedside I want to go to a clinic or surgery center. I like going to one place and seeing coworkers. I don't like driving a lot and driving to multiple locations in one day. I know most people are great but I would be nervous as a small female going into unknown environments alone. In a hospital if a patient attacks you there is security. In someone's home there is not.

I also think about not knowing how to do something and having no one there to ask or back me up. What if I don't know how to do a procedure, orders are unclear, I can't get the IV, etc. I do like the sound of long-term relationships with patients throughout the course of their treatment and the lack of multi-tasking, being able to focus on one patient at a time. Maybe those are good aspects to advertise? I have never seen a home health company that pays the same as the hospital, so if your wife's company does that's great!

I know home health is a super important aspect of nursing and I hope there are people out there willing to work. Just wanted to share my fears so maybe your wife's company can address those issues when talking to potential hires. ?

[Lee Franklin]

Thank you Libra, this is honest and helpful feedback! ?

[Daisy4RN]

Is that what you are hearing from potential candidates, that they are afraid of losing skills? If so maybe you can explain what you have written here to them, or put something like that in your want ad. I have worked HH at two different times in my nursing career with the latest being a few years ago. For me the breaking point (with the last job) was the insane amount of work/responsibility and paper/computer work involved. I also did HH about 20 years ago and can tell you the work was much less back then. The work now includes numerous calls to MD, pharmacy, companies making deliveries of O2/medical equipment etc and of course endless calls to/from pt/family. Maybe it was just the agency I worked for (the first time) but I was not expected to do many of the things which now seem to be the norm (they had actual case managers, not just calling the field RN a case manager and dumping all the work on them). Plus more and more regulations (med req required at every visit etc). These are all things to consider when trying to recruit. Maybe find a way to have office personel do some of these tasks that are very time consuming, for instance it is much faster for the nurse to text someone that pt needs to find out where the O2 is and someone in the office can make that call (and sit on hold!) and text the nurse and pt that it will be delivered at such and such time. Problem is most agencies don't want to pay for office help and think that the nurse should do it (in order to save money). Also, I would emphasize that you have ample training and also a Nursing director (or whatever title) available for questions the nurse might have while in the field as well as other available staff for issues/procedures that may be new to that nurse. Also, not sure what the on-call procedure is but most nurses do not like too much of that. Hire an on-call person if you are able, at least part-time or what you can so there is not too much for already busy nurses. It is a lot of work as I am guessing you already know!

[Lee Franklin]

Thank you Daisy, I really appreciate your perspective.

Sincerely,

Lee