Help-Freaking out- seeing patients on my own!!

icuRNmaggie, BSN, RN · Feb 3, 2015

The pressured balls for IV Vanco are a great invention. Flush the PICC, prime the tubing hook up, when it's infused, disconnect and flush. Easy peasy. Don't stress over that. I know a guy who self administered his vanco that way while flying a commercial cargo jet for a major airline.

Mommytracknurse · Feb 3, 2015

Thank you for your post!! I feel like I've lost a lot of confidence in having been off for a few years- some skills have definitely returned with ease- I forgot I'm actually pretty good with starting IV's and lab draws- woohoo:). But some things you just don't see in the hospital or a dr's office- and out in the field- rural area- I'm gonna be on my own!! No cell service in a lot of areas!! Thank you for your post!! Keep the tips coming!!:)

icuRNmaggie, BSN, RN · Feb 3, 2015

Better review how to access a port with sterile technique.

Know the codes for your CADD pumps and PCAs. Carry a penny to open them to change the cassette. Know how to troubleshoot a leaky vac dressing.

I did it back in the days of paper charting and before GPS. It's all about teaching someone in the home to do a task like administer the Vanco via the pressurized ball, give Lovenox, do a NSS wet to dry dressing.

If the place feels unsafe, or if they have an aggressive dog, or if they are in any way disrespectful, just leave. Your safety come first.

Always do your charting in the home or you will be working on it at home until late at night. You should be able to do a dressing change VS and chart in a half an hour or less. It's mostly common sense.

IVRUS, BSN, RN · Feb 3, 2015

So this week I'm going to start seeing patients on my own- and I'm freaking out!! There are skills I've yet to do- for example- I've never seen a patient get set up with at home IV meds- or how to do them- the company that supplies most of our patients- uses this ball thing that then hooks to the patients picc line, port, etc- but why I'm freaking out- is what does the schedule look like for a new home health nurse? I'm coming back into nursing after 3 years off with my small children. I am super nervous about being kicked out of the nest- so any helpful info or tips that will make this less scary would be great!! Do you think I'll be expected to see routine visits, or will I be thrown in sink or swim style? Thanks in advance!!

I would be concerned too if I were just coming back into the nursing field. Three years may not seem like a lot of time, but in Healthcare, the only thing constant is change! You really need to have a good preceptor and plenty of time to get to know the equipment, their supplies and paperwork.

Orientation should be at least a couple of weeks, with the first week you doing nothing but observation, the second week, they observe, and assist you. As the other poster indicated, you will be doing tons of education, and of course, tons of paperwork. The elastomeric devices that you are speaking of, are really simple to use, and yes, are great for home care patients, but again, someone should be precepting you, which includes giving you the right terminiology about supplies.

Libby1987 · Feb 3, 2015

The elastomeric device is the easy part of the home health job amd you can learn IV mgmt in the home after successfully performing routine visits.

But why don't you know the plan? Your mgr hasn't told you how they will start you out?

KelRN215, BSN, RN · Feb 3, 2015

The antibiotic balls are literally the easiest thing ever to use. You flush the line, hook it up, unclamp and it infuses itself. Those things are designed for lay people to learn how to use. Other than in very rare circumstances we don't do visits to administer these antibiotics. We do the initial visit to teach the patient/caregiver how to administer it and flush the line then do follow-up visits for labs and line care only.

There is no set schedule for a "new home health nurse." Only your manager can tell you what your schedule will look like.

Mommytracknurse · Feb 4, 2015

I was riding with an awesome preceptor- she was really showing me the ropes and she's a great teacher- loves home health and was really going over skills well- and I thought I'd be with her throughout this week- seeing patients under her guidance- doing the charting- tons I paperwork- but then today that changed and I was told I was going out in the field on my own- with one Routine visit, one discharge, and one SOC. I did well with the routine visit- discharge pt didn't answer- and totally flubbed up my SOC bc my computer wasn't working in the field- and I missed asking OAsis questions. Then tomorrow I'm supposed to see four PTs-and I'm just feeling like it's sink or swim bc they've lost three rn's in the last month- short staffed- so this gal is getting dropped in the deep end of the pool- I can't swim- so right now I'm just hoping I can float!!!! Honestly I'm feeling like three years has been a long time which I had left a position working in a busy drs office- which was different from hospital nursing in that in 3 years there I only catheterized one pt- but I performed different functions than in the hospital. Maybe I should go to work in a hospital med/surg floor and hone up on my skills where there are people- bc in the field it'll just be me:( but I'll feel horrendously guilty bc I hate quitting!! And they've invested their time in me- I'd especially feel ashamed with my preceptor bc she is awesome!! I don't know- I'm just feeling overwhelmed and scared:(

Libby1987 · Feb 4, 2015

It doesn't sound like they invested much time.

Our new nurses don't start out doing SOC's. They do routine visits for while and observe at least an open before going on their own to do one SOC, then back to the office for help in completely the charting. No one does their first open along with additional visits.

dream'n, BSN, RN · Feb 4, 2015

Before quitting demand more orientation, they might say yes. It's not your problem they've lost a lot of nurses recently so they want to shorten your orientation. That's not appropriate. I've seen this happen at places I've worked (not HH though) and it's really not fair to the new nurse.

Mommytracknurse · Feb 5, 2015

Thank you!! To top it off- my manager sent me a message that they wanted to know what day I could cover on call this weekend and coming week-What!!! I'm not able to do a lot of the skills bc I just haven't seen them- like trach care, supra-pubic catheters, etc---- and I'm supposed to be responsible for all the patients on call for an entire weekend????? Nope- and I told them that- I don't mind helping out but it's not safe and I don't feel comfortable doing it. We'll see if I still have a job- lol!! And I'm supposed to just be prn???? So I've already worked three days this week but I'm supposed to arrange childcare on two days notice for basically the entire weekend????? I think they're rushing things bc they're short handed but that's not my fault. If this is how they treat their nurses then it's no wonder they've lost so many nurses recently!! And yes I'm ranting- but three days prn is three days prn-if I could work more- I would bc then I'd have insurance, PTO, etc- I don't get any of that being prn- but if I'm expected to work 5 days a week then that's atleast part-time and I should get the benefits!!!

caliotter3 · Feb 5, 2015

Develop a different way of looking at it. You have a mission to accomplish with each patient, you engage until the mission is completed and the paperwork done. If you have to leave a situation to return later, do that, move on to the next mission. Write all of your missions down in your daily/weekly/monthly planner and line through them as you complete each mission. You will be surprised how quickly you will develop a sense of accomplishment. I would certainly revisit your PRN status before you go too much further or you will see a precedent set that you may not agree with. That will just get harder and harder to rectify as time passes. Good luck.