First day on my own and feel like a failure!

Specialties Home Health


Specializes in LTC, HH, Psych, Med-Surg.

I have worked LTC for 3 1/2 years and decided to get out of the rat race and try some HH. I love the idea of spending one on on time with my pts and actually being able to talk to them instead of the crazy rush of LTC. I was given some training, and they are slowing weaning me into the process a few pts at a time. Working in LTC, I have great time management skills and am used to thorough documention. We are on Kinnser, which is new to me. This HH only takes MCR pts. Today I saw my first two pts on my own. First, let me say I am a perfectionist. I asked my DON for feedback, and when given feed back beat myself up for feeling like I should have done it. I feel overwhelmed, then I feel like an a failure for being overwhelmed by this as I can work a LTC floor with 25 MCR pts but stressed at 2 HH pt's! I feel like I am a bit lost and have to call the DON multiple times to ask questions. Is this normal for a HH newbie, I hope?

Well, what feedback did you get? And how can the DON give you any unless she's with you?

Specializes in Med/Surg, Tele, Dialysis, Hospice.

This in normal for a newbie in any job, especially a perfectionist newbie! It was your first day on your own...if another nurse came to you crying and told you that it was her first day on a new job and she was beating herself up for not being perfect at it the first day, what would you do? Like most of us, you would put your arm around her and tell her that it's okay, that no one is perfect, especially on the first day of a new job. You are learning all kinds of new things, of course you're not going to know exactly how to do everything and of course you are going to be slow at it until you get your "sea legs".

Picture your first med pass in LTC. If you are like me when I started a LTC job, it was slow, unorganized, and took forever--and I started my LTC job when I had been an RN for 21 years! But bit by bit, that med pass got easier and more streamlined as you developed a routine and a system for doing it, and so will it be in home health. If you don't let your perfectionist tendancies convince you that you have to be perfect every time, ALL the time, and allow yourself to go through the learning curve and growing pains of learning a whole new type of nursing with all new charting, time management requirements, etc. then in a couple of months you will look back on this and say, "What was I thinking? I can do this, and I do it well!"

I have done LTC and, while I haven't done HH yet (I may be starting a HH job very soon, though), I have been an after hours on-call hospice nurse who covered seven counties alone for twelve hour night shifts, so I do know a little bit about field nursing and charting on the go. At first I felt overwhelmed in that hospice job, but as time went by, I got proficient at it and I grew to love the freedom of being on the road instead of on a clinical unit and the autonomy of being one on one with my patients and their families. For me, LTC was horrific, and if you can do that, then IMHO, you can be a field nurse in HH. Just give yourself a chance and STOP beating yourself up. Even the best nurse in your company was once a newbie who didn't have a clue. We've all been there, it's just the ones who don't give up and cut themselves some slack who make it and become the "super nurses" that everyone else envies. :)

Specializes in COS-C, Risk Management.

And Kinnser is absolutely tedious in terms of documentation, which does not help with your time management.

Part of being new to home health is learning to be independent with what you're doing. Coming from a facility, you're used to having someone immediately accessible for questions, concerns, or to confirm your assessment. As a home health nurse, you will need to learn to function without that immediate gratification, unless it's really important to the immediate care of your patient. You will need to learn when and why to call your supervisor, the physician, the patient's family, etc. It takes time and experience. Keep asking for feedback and try not to get upset when people tell you that you need to be more independent. You'll get there.

Specializes in LTC, HH, Psych, Med-Surg.

The feedback was asking DON to review my submitted documentation.

Specializes in LTC, HH, Psych, Med-Surg.

Thanks for the comments....I guess it's hard feeling lost and feeling like I don't have the answers so often. I am so used to be "in my element" that now I am definitely out of my comfort zone. I love learning new skills, but it's challenging not knowing answers and not having the answers and having to call a DON to get one. Kind swear is a I forgot (part of my feedback) that while I did the NN of giving Lantus that you also chart under the med section. I just have to trust myself that with time it will come :)

Hang in there! It'll take a few months before you're feeling completely comfortable, so give yourself a break. Just the documentation alone is daunting when first starting in hh. For many of us, the variety of patients/conditions we're dealing with is new, too, since there are so many different things. Add the expectation of autonomy into it, and that's a lot to handle.

Specializes in LTC, HH, Psych, Med-Surg.

"kind swear is a challenge". Meant Kinnser.....darn that auto

Specializes in ICU.

I was an ICU nurse for almost 5 years. Had a year of a hiatus and trying some new non-clinical positions and then ended up in Home hospice 4 months ago. The company is also a regular HH company. While I thought I was doing mostly hopsice, with only "a few" palliatives (which are basically Medicare Home care admissions, just worse because they are so sick) they stick me with all of them.

Let me tell you, I have never felt so stupid and dependent in my life. I was an ICU nurse who was often charge nurse, pretty much never asked questions (maybe some feedback on my patients who were circling the drain) but I had everything on lockdown. Now as a homecare nurse I am asking more questions than I ever imagined, can't seem to get all my work done in my 8 hours at all and the documentation is all on paper.

We lost many nurses because of this. I am trying to stick it out and they want me to stick it out, so I have gotten a few pep talks from the supervisors. They tell me despite being a "seasoned" nurse already, it's going to take a year to feel comfortable. And while you may be a perfectionist, well, no one is perfect. We aren't born knowing everything.

I wish you the best of luck, because I am struggling now too. And I am no longer a newbie in the profession.

Are you being "criticized" on your documentation, or are you simply being taught the right way and where you can improve things? because if that's the case, they are simply helping you because the documentation is very important for Medicare patients. So they want you to do it the best you can and it takes a long time and a lot of practice to come anywhere close to "perfection" So don't be too harsh on yourself.

Specializes in LTC, HH, Psych, Med-Surg.

thanks MomRN0913,

I asked the DON to review my documentation as I have done LTC documentation but this is different system. I asked and wanted the input to ensure i was documenting correcting instead of going on for a month and finding out that I wasn't doing it the right way. She was not critical or mean at all, I just took it personal because what she pointed out was like "remember I showed you that you have to click on the MAR in the middle of the page to document the insulin?" I do....oops! I had forgot and you pull the template box down in the notes box which has you document the amount, site, it is like double charting to me and while I have use multiple systems, never Kinnser. Other feedback that made me feel dumb was just , "you should have documented this/that" and realizing that she was right, I should have. I guess I wanted to impress her and instead felt like I appeared like I don't know much. It is hard when in LTC I was praised for my thorough documentation, and now I have been knocked off my In in LTC I can ask a fellow floor nurse for help if I have a question, I try to not bother the DON (possibly avoid is the right but this is a small agency and I feel awkward having to contact her every time I have a question as she is the go-to person. There are a few other nurses, but not able to contact them for questions. During training when I was able to speak to another nurse who works there I picked her brain as much as I could. I do love the one on one time with the pt' that aspect it was exactly what I expected :)

Specializes in kids.

You will be fine...she is the boss and ultimately responsible for care given.

Remember this..

The one dumb question is the one that goes unasked!

You will figure it out! HH is a great way to really hone your independent and critical thinking skills. Good Luck!!!

It took me over a year to feel comfortable in the ICU,1and1/2 years to reach comfort level in ER,6 months in cvicu and only 3 years before being totally comfortable in HHIts not as easy as all think,hang in there cause its harder to learn than above mentioned and dont quit asking questions,thats when ya screw up!!!

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