New Home Care Nurse-Is This For Me?

[New_NurseD]

Hello, everyone!

I am a new nurse in Oregon (graduated in April 2016) and recently started my first nursing job in home care. I enjoy this area of nursing and have been highly motivated to perform to the best of my abilities.

With that being said, I constantly feel as if I am putting my brand new license on the line. This position requires quite a bit of knowledge about delegations, which let's be honest...many new nurses don't have. There have been several instances in which I have gone out to a client's home to train caregivers on medication administration, but have not had the correct orders. When I attempt to get in touch with physicians, they almost never get back to me...which is frustrating. This happens so often that I feel as if I never have the tools necessary to do my job. I am constantly confused about what requires delegation as well.

I am the type to ask a TON of questions, but the other nurse and people in the office rarely get back to me in a timely manner. It makes it difficult to get the help I need when I need it. I often feel that I am entirely alone in the field and this is very hard as a new nurse who is just now learning the ropes of actual practice. Also, keep in mind that there was no real training program for me. There was only one other nurse when I started a couple of months ago; therefore, my time spent with her was minimal.

Although I love home care nursing, I am finding it to be a huge gray area...and I am scared that this is not appropriate for me as a new nurse. Has anyone else felt this way? Does anyone have any tips to be successful in this setting? Any specific advice for new nurses who feel a bit overwhelmed? Thank you all for your time!

[roser13, ASN, RN]

I firmly believe that home health nurses should have at least a couple of years' experience before venturing out to practice on their own. The problems that you're facing, particularly no one to bounce ideas off of/ask questions of, are inherent in being a new grad. Home health patients are only getting sicker these days and I for one would not be willing to be on my own without experience.

[New_NurseD]

I absolutely agree. I am not doing home health exactly. Home care is a little different in that I am not directly providing patient care-mostly ensuring that caregivers are providing safe and helpful services. I appreciate your commentary!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

As for the doctor's orders, you can always go by the office to pick up the orders directly. Explain to the office staff who you are and on whose behalf. (It would be great to call ahead a day prior to, just so you can hopefully walk in the next day, grab the orders/prescription, and walk out).

Find out what it is you need for your patients that you are unclear about, make a list, and take that list to your office to discuss it. As always, be professional with your patients, tell them that you have to go and clarify few things about the order, and you'll be back or call back to discuss the plan.

Just try not to panic. Your patients are at home and are stable. Just realize that things that you need to do for your patients may actually take a couple of days for the results that you need. Then it should all flow pretty easily.

[Been there,done that, ASN, RN]

Home care is NOT for new grads. A reputable company will not hire nurses without at least one year of experience. You do not have the skills to be the only set of eyes on a home care patient.

The company you work for is USING you to make money for THEM. You are probably making per visit rates ( $35?) and they are pocketing the rest of the Medicare/ Insurance allowed payment. The company does not care about YOU, your license, or the patient. There are HUNDREDS of home care companies that exist only to make a profit.

I would not make one more visit for them. Been there, did that with 25 years of experience and found it hard to manage. I figured it out PDQ, stopped filling their coffers after 5 "visits".

[Been there,done that, ASN, RN]

I absolutely agree. I am not doing home health exactly. Home care is a little different in that I am not directly providing patient care-mostly ensuring that caregivers are providing safe and helpful services. I appreciate your commentary!

Even worse, as a new nurse, how can you evaluate care provided by others?