help! i need advice on becoming a home health nurse

tablefor9, RN · May 11, 2010

Is is best to work for a hospitals hhc or agency?
If I work hhc will I lose some skills?
I want to get my masters in 2011, will this hinder my experience for school?
If you have been in hhc, is it ever scary to be going to someones home alone?
Do you have any other advice or comments?

Good for you, getting experience prior to making the jump! That's only going to help you.

Hospital based might be better, if you could pick up shifts in the hosp if visits were down in the hhc area, and in the way-back when I was doing hhc, it paid better that way. YMMV.

I don't think you'd lose skills--you'd still be doing IVs, labs, dsg changes, what skills are you afraid of losing? And, when I did hhc, I was still PRN in my ICU.

Don't see how it could hurt to have various experience when applying for a master's. What do you want to specialize in? I just don't see a bad way to spin this.

And, LBNL, Yes! in 2 years, there were exactly 3 times I was a little itchy on the inside going to someone's home alone. In one instance, it was a chronic ETOH spouse, who though he might like to play slap and tickle with the nurses, we ended up sending a letter to that home.

#2 was a crack house, and we did "fire" that pt.

#3 was in a very, hmmm...weird community.

Granted, I did a 4 county office, in a very rural area. So, again, YMMV.

Good luck to you!

cb_rn · May 11, 2010

yes, it can be scary to go into someone's home by yourself. They will tell you at your agency that you don't have to go somewhere you don't want to but the truth is that (at least my agency) never had anyone turn down going to someone's home, make of that what you will. I have gone in known drug dealer's homes, worked in the middle of a very high crime area, taken care of people that leave their family member lying around in filth, and often adult protective services is called but nothing can be done for any variety of reasons. I have been afraid I was going to be assaulted, had crude sexual comments aimed at me, once thought I was going to have to climb out of a window when two male family members started a fist fight that was rapidly escalating

you will become an expert at wound care and you will have to make many, many clinical decisions on wound care on your own. the physician more often than not sends you orders to evaluate and recommend and he will sign off on your recommendations. if you are not comfortable with wound care, this is not the field for you.

you will face ungrateful families that expect you to go above and beyond what you are allowed to do

you will also have great patients and families that are very caring and become almost like family

I had a schedule where I managed my own patients and when I was done for the day, I went home. Sometimes I would be done by 11am, sometimes I was still making visits at 6 in the evening

Depending on your agency, you will probably do IV infusions and teaching

Lose your skills? There are some you won't use as often but once you have mastered skills, you will find that going back into a hospital setting you may be rusty but you will remember them like riding a bike

Home care has the disadvantage of you being the only professional in the house at a time and it will be difficult at times to clean a patient or do wound care by yourself because some families are not able or refuse to help you

you must have a very strong clinical background, you are the eyes and ears of the physician and must make judgements about when to call him because something doesn't look or seem right while balancing the fact that as a home health professional, your job is to keep patients in their homes unless the situation truly is in need of physician assessment. your answer to every little thing that comes up cannot be "Make an appt to see your doc." However you must be able to recognize subtle signs that things are going south and make sure the patient gets the appropriate interventions.

HH is often looked down upon but the truth is I have also done progressive care and ICU as well as med surg and tele and home health was by far the most challenging because i was the one using my own clinical skills and intuition and judgement with nobody else's input in between their MD visits. It is an enormous responsibility.

Be prepared to see humanity at its worst and filthy living conditions and also be prepared to have rewarding experiences you will remember forever.

Hospital or private agency doesn't really matter as long as the agency doesn't have a high turnover rate. Do your homework about benefits and hours because you want to know how often you will be on call, what your rate will be, what you make for after hour visits, and keep in mind smaller agencies often have less desirable holiday, vacation, and sick time and higher insurance premiums. hope this helps, message me if you have further questions.