HH general questions

vampiregirl, BSN, RN · May 14, 2020

Home health can be tricky without a solid skill base and some experience. I know a couple people who have successfully navigated it... with great orientations and accessible mentors. These people also had some type of medical background before nursing and were very motivated learners.

There are other options to the hospital to get experience... SNF is one option but I know there are others. My background was a busy SNF before I decided to "try" home health.

Home health nurses care for diverse patient populations and perform many different tasks. The care plan for each patient identifies what the specific needs are and the goals established at the beginning of care. Typical tasks can include assessing patients, reconciling medications/ filling med planners, performing procedures if needed (blood draws, catheters, wound care, IV skills, central line care etc), providing education to patients/ caregivers (this is huge in home care!), communicating with providers, and documentation. Rarely are two days the same. And the learning never stops.

Successful home health nurses need to be able to work with many different types of people and are able to adapt their teaching styles to meet the needs of individual patients. Technical skills need to be strong as well - home health nurses are by themselves in the field so they need to be proficient at blood draws, IVs, catheters etc. They need to be organized and able to multitask.

It's nice to be able to focus on one patient at a time. It's really rewarding when you see patients apply what they've learned. The autonomy is great. Not being "stuck" in an office building all day is a huge benefit for some.

Home health nursing is like any other area of nursing, there are positives and negatives... it comes down to whether it's a good fit for an individual nurse.

DallasRN · May 17, 2020

Congratulations on your upcoming graduation! Not meaning to take away from your education, I believe you will soon discover how much you really don't know as you enter the profession. Think of it as a Thanksgiving dinner for 15 people. Your mom fixed it every year, it was delicious and beautifully presented on a decorated table. Now you are standing in the kitchen with $200 worth of groceries, minimal cooking skills, no helpers, no cookbooks, limited time and 15 people in the living room watching the parades on TV. That's my perception of a new grad going straight into HH.

I had 30+ years experience when I tried it - primarily ICU/ER (in some top notch hospitals), some Med-Surg, Case Management. And it was tough duty! Alone, lots of questions, nobody to ask on the spot, trying to deal with sick patients AND sometimes strange family dynamics, hours and hours of paperwork, calling doctors for things you think are really important and not getting a callback.

I strongly encourage you to put in a year or two on a good Med-Surg unit with a strong support team, learn all you can, take CEU's even if you don't need them, write down questions for later review as you come across things you don't know or understand. Also, vampiregirl suggested a SNF. Not bad but generally SNF Units are so incredibly busy you aren't going to have time to even speak to co-workers, much less ask questions, etc.

Again, good luck and if you really want to be a HH Nurse, great! I believe that is where healthcare is headed and the need will be huge. But learn how to cook that Thanksgiving dinner first. ??

And PS: for what it's worth, I ended up hating HH and all that went with it. Not to mention I wasn't good at it. Truth hurts sometimes. ?

poko, BSN, RN · May 17, 2020

I am a Canadian home care nurse.

I was fortunate and did my final preceptorship in home care, where I learned A LOT! I was hired as well after I graduated. I have been working home care for 5.5 years now.

I couldn't picture myself successfully navigating my way though home care nursing without clinical experience as a student there first. As a new grad without any exposure to home care, I don't think I would have been too successful.

My suggestion is that if you are very interested in home care, try and arrange your final pre-graduate/ preceptorship placement in a home care agency. You will learn a lot.

poko, BSN, RN · May 17, 2020

Just to continue answering more of your questions.

I work for two different companies, by choice, part time.

I spend my day travelling to patient's home. Some of the things I do:

- wound care and dressing changes (diabetic foot ulcers, surgical wounds, VAC dressings, wound packing, pressure ulcer treatment, prevention, traumatic wounds, venous leg ulcers, arterial wound treatments, compression therapy)

- G/J/NG tube feeds, medication adminstration

- Foley catheterization, in/out catheterization, teaching I/O cath

- Central line dressing changes and flushing/ maintenance (PICCs, Hickmans, Ports, Aphersis), port access, de-access

- Chemotherapy disconnects. Assessments that go alongside oncology patients

-TPN adminstration and teaching

- peripheral IVs- starts, d/c, infusions

-medication admin- injections (s/c, I'm), oral, topical, eye drops. IV abx, hydration, potassium, magnesum, lasix

-ostomy changes and teaching

-palliative care- stable and end of life care, death pronouncements

-subcut pain pump management

-trach care

-chest physiotherapy (when trained appropriately on routine)

-ESAS assessments

- Diabetic management, insulin admin, teaching, to both adults and kids

Much more.. but this gives you an idea of the skills I use often and assessments that go along side that

DallasRN · May 17, 2020

poko - just my own curiosity but about how many visits do you make daily? And what about SOC's? Also, once you admit a patient do you continue to see that patient through the course of HH or is patient passed off to LVN, leaving you to do the recert? That is common around here and I really hated it. For myself, the LVN, the patient.

A good HH nurse is worth his/her weight in gold and I've known several. Unfortunately, many go into the field thinking they can just slide. And they do. For awhile.

futurern12983 · May 18, 2020

Thank you all for your input!! I can see it make more sense now... I had a feeling you should have at least some experience before going straight into home health..

DallasRN · May 18, 2020

Two more things:

1. Talk with your community health instructor to help you assess your needs before going into HH.

2. Try to get into an internship in a good med-surg program. A good preceptor can influence your intro into actual nursing practice for years to come.