Future in Home Health?

anh06005, MSN, APRN, NP · Jan 27, 2012

I have only been working home health since September 2011. I previously worked on a very busy cardiac/step-down unit. After they increased the ratio on our unit to 1:5 things got even more hectic and I stayed late charting almost every night. I needed a change! I had a few contacts in home health (who also left my unit) and began asking them about it. I miss acute care in many ways (fast pace, acutely ill patients, life or death situations, adrenal rushes, etc.). Overall, though, I love home health for the more manageable and predictable pace and the autonomy.

I believe the nurse's experience depends on the nurse's attitude and also the home health agency (I have been reading this forum since before I switched...some stories are crazy!).

My agency is the best in our area. Even a manager for our biggest competition called to ask how our rehospitalizations are so low. Weird...I know

I'll tell you a bit about my experience (and how our agency is laid out)

With our agency we have a few nurses who do mostly evals (the start of care for home health) during which the nurses decide if we pick them up as a patient and for what). They also do post hospital visits (self-explanatory) often. The other nurses have a group of patients in their 'area' of our coverage (30 miles from our office) and based on any special needs of patients (we have a couple of nurses who are awesome with wounds, CHF patients typically go to nurses with heart background like myself, only a few nurses are comfortable with peds, etc.). For regular visits and a 10-hour day we typically see between 5-7 patients (typically 5 or 6. 7 only on a BUSY day). And you're expected to spend about 30 minutes or so with each patient (more if necessary). If you're an eval nurse you typically do 2 evals (these are much more intensive and have a lot of paperwork!). They try to keep our patients on our schedules so we can know them in and out. Sometimes it is necessary to send another nurse out, though, like if the patients needs a PRN visit r/t dyspnea or if the regular nurse is off. I really love this fact about my agency...I get to know my patients so well!

Once we get our list of patients for the day we make our own schedules. You have to take into account if one needs lab work drawn, has other obligations, etc. so it can get tricky! You have to be VERY flexible in scheduling.

You also have to be able to adapt to multiple environments. Most of the houses I go into are like my grandparents homes. Likely no major remodel since 70's or 80's, wood paneling, older furniture, possible smell of moth balls. I have been in some, though, that you wonder how someone can live in it due to pets, hoarding tendencies, and/or the smell of bodily fluids from humans or some other species.

We all rotate taking call and there are enough of us we take call probably 2-3 nights per month and 1 weekend every 4-6 weeks. Not too horrible. If we get called out at night, though, we get paid time and a half. We also get 0.51 per mile driven in our personal vehicles and I average probably 200-250 miles per week. It's a nice perk. My agency pays per hour rather than per visit which is actually fine by me....that way I don't feel the need to rush :)

I know I'm kind of rambling so I'll stop here. I really don't think it hurts to try home health but I recommend having some floor experience first so you can see patients in truly acute phases of disease processes, treatment options, things to look for, etc.

AnnemRN · Jan 29, 2012

It really does depend on the agency you work for so, you need to keep that in mind. I've been expected to see 7 patients in an 8 hour day. There are many times when 2 of those patients required wound vac changes and the remaining patients were recertification and discharges. The days entailed tons of computer documentation and ended up being 10 hrs days or more.

We are expected to take call 2 to 3 times/week with a travel area of 50 to 110 miles/day and work 1 weekend a month. We also rotate the role of charge nurse on the weekend, which means in addition to carrying your heavy workload you are expected to toubleshoot any immediate problems or phone calls from agency patients including our private pay homecare section. So, you see there can be a big difference in what each particular agencies expections are and how doable your assignment is.

I've been in home health since 1994 and it keeps getting more and more difficult.

Home Health Columnist / Guide · Jan 30, 2012

see our sticky threads at bottom of forum:

typical day for a hh nurse...

pinkfluffybunny · Feb 3, 2012

It is the only job I have had as a nurse, I don't do visits, I have just one patient. It's alright some days but mostly I am so over it. I work odds so I continually have to deal with no compliant parents. Even though I am here for a certain amount of hours per day its like I am responsible for all the other hours of the day. It's so frustrating when my pt gets sick to watch them blame everything on other people. Not to mention I'm my experience there are a lot of nurses that don't really want to work very hatd to the point of compromising pt care.