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Discussion

Getting into HH after a termination

My family is going to move to Seattle soon and I am looking into jobs there. I graduated in Dec. 07 and worked as a pediatric nurse for 4 months before I was terminated (long story). I dont really want to do hospital nursing as I found it difficult to contend with the cliques, politics, and multiple patient load and all in admits/discharges. I found it really hard to keep up and I was exhausted and depressed at the end of every work day. I know I love nursing though because of those few precious one on one moments I had with the children and their families that made it all worth it. Because of this I am thinking home health is my place to be.

There are a few positions through PSA Healthcare in the Seattle area and they say they have a training program if you dont have experience. So my questions are as follows:

1. What is the likelihood of a relatively new grad who has been out of school and the workforce for the past 8 months getting a job in home health?

2. Should I even tell them about my previous job experience. When I left I asked my boss at the time what kind of reference I would be getting from the hospital (not necassirly from her, just the hospital) - she told me not to even put the job down on my resume. I am torn on this account as I feel it was some experience, I dont want to lie about not having job experience but at the same time I dont want them to somehow get a hold of my previous boss and have her destroy my chances at ever getting another job. I am really unsure of how to explain that I got fired from my first nursing job. Can I really ever get a job again as a nurse - have I already ruined my career?

3. Should I just go ahead and take a hospital job for a year then go to home health?

4. How steady is the work in home health? If you dont have clients that means you dont work which means you dont get paid and that worries me that I may be out of work for periods of time - how common is this?

Thanks for any advice,

Megan

Featured Replies

the best advise i could give you at this point would be as you are a new nurse with minimal experience, i would recommend you getting some good med-surg under your belt, HH is a whole different world and you need to have a solid base to work from, see if there is a hospital that also has a HH dept that way you could start at the hospital and transition to HH, best of luck!!!

  • Author

My issue is that I feel like I have a lot of trouble handling the fast-paced environment of a hospital even if the actual patient care is good experience and I just feel like I cant keep up and I'm constantly behind. I dont feel I can adequately learn in an environment where I'm barely hanging on. I need a place that takes things at a slower pace until I catch on. On the floor I never had time to take a minute and think and that really bothered me and made me worry if I was making bad decisions because I was forced to make them too quickly.

My issue is that I feel like I have a lot of trouble handling the fast-paced environment of a hospital even if the actual patient care is good experience and I just feel like I cant keep up and I'm constantly behind. I dont feel I can adequately learn in an environment where I'm barely hanging on. I need a place that takes things at a slower pace until I catch on. On the floor I never had time to take a minute and think and that really bothered me and made me worry if I was making bad decisions because I was forced to make them too quickly.

Home Health is not a "slow pace" environment,,,here was my day today, 8 visits, 103 miles finished up with paperwork at 8pm, took approx 10 minutes to eat dinner...off to bed soon to start it all over in the morning...

i don't want to discourage you, but i also don't want you going into HH thinking it is something it isn't, also our agency is involved in a PAC study, which to all of us doing it means ----much more paperwork!!!

I agree that you really need some good med surg experience before going into HH. Most HH places where i live require a minimum of 2 years med-surg experience before they will even consider an interview. Granted, you do have 1 on 1 time with your patients, but you will also have to see 7-9 patients a day so you really need to keep moving. I can usually get all my visits in within 6-7 hours but then i have at least an hour of documenting to do at home. I LOVE HH, and hope i never have to go back to hospital or LTC nursing, BUT I'am thankful I had that experience under my belt before going into HH otherwise i think i would have been overwhelmed with the responsibility we are given as well as having a good knowledge base to be able to answer those sometimes difficult questions that patients ask. Good luck to you!!

To the OP you mentioned PSA. My understanding about PSA is they are primarily 1 to 1 in the home environment/private duty model as opposed to per visit home health. My two cents worth is go to the interview and see what they tell you about the work and ask detailed questions about their training program. I will grant it is not an optimum start to a nursing career to not have the standard med/surg or acute care experience. Perhaps though if a position with PSA is offered to you this will allow you some real time experience with patient care, help you build some of your work confidence and provide you with a solid work reference.

Having said that I would strongly advise you to consider also doing some type of part time work in a clinical setting also. Hunt around to see if there is a rehab hospital or smaller acute care hospital that offers a decent preceptor program even to their part time employees. Unless you are content for your career to only be in private duty you will need the acute care/clinical experience sooner or later. Granted all hospitals, rehabs and LTC facilities are incredibly busy but some of them do provide excellent preceptor programs.

  • Experts

All feedback that I have ever seen or heard about PSA has been negative. Be very careful when dealing with this company. They are known for putting nurses into pediatric cases who have little to no nursing experience at all. Not a good practice.

I was interviewed by a home health company after having been terminated from a job. No attention was given to the termination. I provided positive references. The company was eager to hire me and by the time I left the office I had a job. I think that you should be prepared to answer any questions, but don't bring up the subject or dwell on it. Instead concentrate on your strong points. If the employer needs employees, they might just gloss over the termination as long as your license is clear. Good luck.

I wasn't terminated, I left my last position due to physician abuse. I was hired over the phone by my HH agency after posting my resume on their website that I was interested in. I am now a case manager for my agency and I LOVE IT!!!!

Yes, you are busy, the paperwork is something else, but I love being able to spend time with my patients. I am primarily responsible for admits, re-certifications, discharges, and supervisory visits. Yes, I am on call, but can usually delegate the calls to the LVN.

If you want HH, then go for it!

I have a friend who was a psych nurse for many years- no med surg experience.

Her agency offered her a 1:1 peds home care case. She stayed 8-12 hour shifts with a young girl with many medical issues (frequent seizures, severe brain damage, paralysis, blind, tube feeder, trach).

This nurse had no experience w/ pts like this, but her agency arranged for her to orient for two weeks with a nurse who was very experienced with the case.

My friend cared for this pt regularly until the pt passed away.

She did well, enjoyed the experience, and gained confidence in herself.

Maybe you can find a situation like this.

I know it's not what you wanted to hear but I think you would be expected to have a minimum of 12 months experience, more than likely two years.

DON'T omit information, it's the same as lying and will just dig you deeper in a hole. Explain your situation to your prospective employer, but before you do look into your heart and figure out what your good at and what your weak points are. This is sometimes very hard to do...good luck.

I believe the only thing a former employer can do is "verify" your time of employment with them. I don't believe legally they can "expound" on reasons why you left. I've never been terminated from a nursing position, but in another field before nursing I was terminated. When asked for a reason I said "ethical conflict." I got hired.

Good luck to you. Confidence in yourself is the best sell for a position. "there are no difficult patients, just difficult situations..." Prospective employers want to know that you are worth the risk of hiring (it costs a company alot of money to hire a new employee and they have to know that you are worth the investment).

Routinely I offer information that they are not allowed to ask. I tell a prospective employer that I am happily married with a grown son who lives on his own (no small children to be sick and have me out of work), hobbies: I watch old movies and read (i'm a homebody that doesn't travel--I won't be out for weeks traveling)... I don't drink or smoke (wont be out with a hangover)... I've been offered nearly every position for which I have applied.

Good luck to you, you will do well if you are confident and project that well.

linda

I have enjoyed the last 2 years in HH with Maxim, I always have work, in fact overtime if I want it. However, I agree that a good foundation makes it easier. HH can be scary as you have no immediate support, like in a hospital setting. Best of luck! Hang in there!

  • Experts

Some things to consider when applying for a new job. Withholding information on an application is the same as falsifying a document. And this can get you stopped before you even start. Normally there is a place where you sign that the information being provided by you is complete and accurate to the best of your knowledge. Do not let this trip you up.

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When one take a home health case in many instances, one is expected to have a couple of years of experience under their belt. In no way does four months of peds prepare you to take care of these medically fragile kids at home. When you are in the hospital setting, you have staff all around if there is an emergency; but when the child is at home. It is only you. And if the parents happen to be in the home, that is one thing; but you are the one that is there to provide complete care to the child during that shift, and the parents should be able to be out of the house during your shift. That is one of the reasons that care is provided so that they can get time away. What would you do if the child had a trach and it slipped out? Have you ever replaced one before? What if the G-tube were to come out? Would you be able to insert another one? Have you done it before?

Remember also that it is usually the state or private insurance that is paying for you to care for the child during that shift, and they are paying for someone with experience. If you had four months of peds experience, how much of that was actual orientation and how much time were you actually on your own?

Just because an agency may offer a job, you need to watch out for your license first. When an agency is offering a fragile peds job to a newbie, they do not have the nurse's best interest at heart.

Or looking at it from the other side, if this were your child; would you want someone with your experience carrying for your child if you were to leave the house for the day? To work peds cases at home, you need good, solid work experience behind you. Do not let anyone try to tell you anything else.

You need to get your confidence built up again as well. This type of case is most definitely not slow paced.

Best of luck to you.

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