From PACU to Home Health

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Hello all! I've been stalking this forum for months now as I have been preparing to start my new position as a home care nurse. I graduated nursing school in 2008 and was very fortunate to start in the PACU as a new grad. I work at a large teaching hospital and have learned so much over the years.

I applied for a home care job because I moved and now have a 1 hr drive to work (hospital) I am also getting tired of 12hr shifts and not seeing my kids for days at a time some weeks :( I am also very much into holistic health and feel that the hospital isn't really the best place to practice holistically.

Anywho, i am starting this thread to share my journey. The home care company I am working for is a small company, there's only 4 rn's 1 Lpn, and 1 aide. I will be working per diem as I am not quite ready to leave my hospital job.

already I have learned that home care is a completely different world than hospital nursing. Even though I have been a nurse for a few years and take care of critically ill patients in the PACU, I feel like I don't know anything when it comes to home care. I'm so used to another nurse or md being available to offer a second opinion or answer a question,but in homecare you Are one your own... I must say I for once feel like a professional however in homecare as there's no time clocks, or managers breathing down my neck. My first visits alone i couldn't believe I was getting paid for what I thought was not a lot of work. I went to see a patient to teach him about Zantac! Now of course he had a whole lot of other things going on, but my assignment for the visit was to assess him and provide education.

i almost wish I still had care plans from nursing school, because in homecare we rely heavily on creating care plans. The nurse makes out the care plan which again, I find impressive and makes me feel like a valued professional .

i think I've blabbed enough for now, but again i wanted to create this thread to share my journey and hope to get advice on how to succeed in homecare. :) thanks for reading

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Glad to hear of your new and enjoyable transition to home health.There are many nurses struggling with the 12 hrs shifts in hectic hospital situations and like you would benefit with the breath of fresh air that home health work can bring to one.About 15 years ago I did 3 years of home visits as a RN in Dallas and loved every minute of it,never seemed like work as in the hospitals,of course that was before the new and more time consuming paper/computer work came into being.I found the patient and family

members appreciated the one to one undivided attention I could give them which was almost impossible in the hospital where I was juggling admissions,discharges and the myriad of things that kept me away from better patient care and education.Wishing you as many happy visits as I enjoyed.

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My first admission

Yesterday I finally did it! I did my first start of care (SOC). My day started with our required care conferences where we discuss all of our patients, and then we had a staff meeting. I was annoyed because the meeting was almost 2 hrs ! I wanted to see my patient as early as possible because I knew it would take me a couple hours to do the full admission. After the meeting I scheduled my patient who said I could come at 12, this gave me over an hour to make sure I had all the paperwork and enough back ground info on her to do a good job.

I arrive at her house and she and her family were lovely and inviting. Unfortunately, this patient was pretty young and had a recent craniotomy (procedure involving the brain) to remove a mass. She was left with some physical limitations after the procedure which made her home bound.

I started the admission with making sure she understood what our company offers. Sometimes patients think they are receiving around the clock nursing care, maid services and all kind of crazy stuff. Lucky for me she was well informed and knew exactly what we were offering, so we went ahead and signed consents. After the "business" part was complete I went ahead with collecting her medical history. This conversation tool a good 30-40 minutes and discussing her medications took just as long. Lucky for me, she wasn't on a ton of meds, because I have to document every single med she takes. Once I gathered all my information, I started my assessment which didn't take more than 5 minutes. I Tried my best to chart as much as I could while I was in her home, but I'm not familiar with the paperwork so it would have taken way too long to do it in the home. The total visit ended up being 1hr 40minutes. We are paid a flat rate and admissions are supposed to only take 1 hr.... Lol

Now the hard part was waiting for me. I had to get all the paperwork completed and be out of the office by 3:30 to meet my daughter at the bus stop. I get back to the office and no one was available to help me because one of the nurses went home sick and my preceptor had to take her patients. My DON (manager or director of nursing) couldn't help because she was in a meeting. I was left to figure it out on my own. Most of the OASIS wasn't bad at all, I just had to simply fill in my assessment. I notice questions were asked over and over, and that was annoying. But I know it's made that way to make sure we are being consistent and honest... I guess that's why. Finally at 3pm my manager was available to help, so she was able to help me with some of the documenting. But it was now 320 and I had to get ready to leave. Before I left the offic I called the patients DR and made sure she would sign our home care orders. I spoke with the secretary and was told they would call me back with an answer.

I make in home by 340 and just sat in my car until my daughter arrived. I was just about done the chart! After my daughter arrived we went to pick up my son. Once we were all home it was 4pm and I had to take the chart back by 5 for payroll!!!! I was really stressed now, because I knew I had to finish and my kids were being normal kids harassing me lol. I had to keep telling myself to get it done and if something is wrong I can always fix it later ( that's what my manager told me) this eased my anxiety and stress levels . By 440 we were leaving the house to drop off the chart. I made it back In perfect timing and handed the chart in and again my manager assured me that it was my first admission and I shouldn't worry. She said we would go over it together next week :)

Now that I think about it, I had a pretty stressful day but in the end I was able to pick my kids up and take them to the office with me. I still got my work done. I'm pretty sure it gets a little easier too. I spent the whole day working on this admission,but I'm glad I finally got to do one. I'm sure the next time I do one I will be much more comfortable.

I'm so excited to learn to be a proficient home care nurse. Right now I'm in the phase where I don't trust my assessment or anything I do. I think I'm doing an awful job and question whether I am really helping my patients. I haven't received and negative feedback so I guess I'm doing ok,but I know I have so much to learn. For the first time in my nursing career,I really want to take my own time to invest in educating myself on my new role. I'm thinking of ordering a home care reference book to help with documenting. I may had said it before that this home health company teaches just by doing and doesn't t really rely on polices or written guidelines. It worries me a little bit, but I also look at it like there's room for improvement and I would like to help with that :)

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Specializes in CCU, Cardiothoracic care.

How has the home care job been going since your last post? I too am a newer nurse (3 years) and got lucky when I started in Telemetry and then 6 months later cross-trained to CCU, recovering open heart patients post-anesthesia. So how is the new gig going?

I have been interested in home care for awhile. I'm working night shift (for 3 years now!) and it's just awful. I just got an interview for Home care with a hospital that is a teaching hospital, magnet, all that good stuff and is closer to me! The interview is next week. So going from critical care to home care would feel like a big step but I feel like I need it! I am a newlywed, we want to start a family and I have been begging for day shift for a few years now to no avail. I feel like this may be the best move for me. I have such anxiety and stress that I bring home with me from work.

Please tell me you are still loving home care! It will help to hear it from someone who worked PACU since I am critical care. :)

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My first admission

Yesterday I finally did it! I did my first start of care (SOC). My day started with our required care conferences where we discuss all of our patients, and then we had a staff meeting. I was annoyed because the meeting was almost 2 hrs ! I wanted to see my patient as early as possible because I knew it would take me a couple hours to do the full admission. After the meeting I scheduled my patient who said I could come at 12, this gave me over an hour to make sure I had all the paperwork and enough back ground info on her to do a good job.

I arrive at her house and she and her family were lovely and inviting. Unfortunately, this patient was pretty young and had a recent craniotomy (procedure involving the brain) to remove a mass. She was left with some physical limitations after the procedure which made her home bound.

I started the admission with making sure she understood what our company offers. Sometimes patients think they are receiving around the clock nursing care, maid services and all kind of crazy stuff. Lucky for me she was well informed and knew exactly what we were offering, so we went ahead and signed consents. After the "business" part was complete I went ahead with collecting her medical history. This conversation tool a good 30-40 minutes and discussing her medications took just as long. Lucky for me, she wasn't on a ton of meds, because I have to document every single med she takes. Once I gathered all my information, I started my assessment which didn't take more than 5 minutes. I Tried my best to chart as much as I could while I was in her home, but I'm not familiar with the paperwork so it would have taken way too long to do it in the home. The total visit ended up being 1hr 40minutes. We are paid a flat rate and admissions are supposed to only take 1 hr.... Lol

Now the hard part was waiting for me. I had to get all the paperwork completed and be out of the office by 3:30 to meet my daughter at the bus stop. I get back to the office and no one was available to help me because one of the nurses went home sick and my preceptor had to take her patients. My DON (manager or director of nursing) couldn't help because she was in a meeting. I was left to figure it out on my own. Most of the OASIS wasn't bad at all, I just had to simply fill in my assessment. I notice questions were asked over and over, and that was annoying. But I know it's made that way to make sure we are being consistent and honest... I guess that's why. Finally at 3pm my manager was available to help, so she was able to help me with some of the documenting. But it was now 320 and I had to get ready to leave. Before I left the offic I called the patients DR and made sure she would sign our home care orders. I spoke with the secretary and was told they would call me back with an answer.

I make in home by 340 and just sat in my car until my daughter arrived. I was just about done the chart! After my daughter arrived we went to pick up my son. Once we were all home it was 4pm and I had to take the chart back by 5 for payroll!!!! I was really stressed now, because I knew I had to finish and my kids were being normal kids harassing me lol. I had to keep telling myself to get it done and if something is wrong I can always fix it later ( that's what my manager told me) this eased my anxiety and stress levels . By 440 we were leaving the house to drop off the chart. I made it back In perfect timing and handed the chart in and again my manager assured me that it was my first admission and I shouldn't worry. She said we would go over it together next week :)

Now that I think about it, I had a pretty stressful day but in the end I was able to pick my kids up and take them to the office with me. I still got my work done. I'm pretty sure it gets a little easier too. I spent the whole day working on this admission,but I'm glad I finally got to do one. I'm sure the next time I do one I will be much more comfortable.

I'm so excited to learn to be a proficient home care nurse. Right now I'm in the phase where I don't trust my assessment or anything I do. I think I'm doing an awful job and question whether I am really helping my patients. I haven't received and negative feedback so I guess I'm doing ok,but I know I have so much to learn. For the first time in my nursing career,I really want to take my own time to invest in educating myself on my new role. I'm thinking of ordering a home care reference book to help with documenting. I may had said it before that this home health company teaches just by doing and doesn't t really rely on polices or written guidelines. It worries me a little bit, but I also look at it like there's room for improvement and I would like to help with that :)

So glad its working out! Any update?

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Hi, I'm still working home health. Ive experienced very good days and some bad days. Im getting much better at admissions because thats pretty much all i have been doing. I love the patient/family interaction, most days when I work i feel like I'm just hanging out with nice people when I do visits. I feel much more respected and appreciated by patient and families in home health. the charting can be a little much but its getting better. Im learning to do the most of my charting in the home. I have a few other post about my bad days on the board in case you wanted to know more :)

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Hi! I've been a nurse working in the hospital for 15 years. I've done labor and delivery MedSurg and now I am in psych.. I love Psych but the hectic pace of the hospital is really getting to me. Have been thinking about home health for quite some time. My question is do you regret leaving the hospital to go into home health? Which do you like better and do you find home health less stressful? Thank you for your answer!!!

Wendy

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