Home Care Nurses... Questions for you!

JustBeachyNurse, LPN · Oct 13, 2014

Wow that's a lot of specific questions that requires a lot of writing on behalf of an interviewee!!!! Did you try contacting a local home health agency to interview a nurse in person or over the phone?

taggart84 · Oct 16, 2014

What if we all answered one question and you compiled them as one interview?

kakretsc · Oct 17, 2014

that works! answer any questions you desire. no need to answer all of them

anh06005, MSN, APRN, NP · Oct 17, 2014

1. What is your experience as a home health nurse? Do you like it? How many patients do you see? How many hours per week?

I have been working in home health for 3 years. I absolutely enjoy the autonomy and (most of) the patients. I work weekend option now (12 hrs Saturday and 12 hrs Sunday) and how many patients I see depends on what type of visit they are. Initial evaluations/Start of Cares take a while to do as they have a lot of paperwork and an indepth assessment. I can see 3 of those in my 12 hour day or up to about 9 regular visits.

2. What other types of professionals do you interact/work with? How would you describe the role of the nurse as unique or different compared to these other professionals?

Since I work weekends I really only ever interact with the physical therapists (who see some of the ortho patients on the weekends) and doctors (if I need to call them). During the week, though, we have access to OT, ST, social work, dieticians, and home health aides. I wouldn't say the nurse is more special than any of the other disciplines. We are usually the hub among all of them, though. Almost all of our patients have nurses in the home. Sometimes we have a patient who may be ST, PT, OT only.

3. What would you consider your most important skill used in home care?

Assessment skills are an absolute must. You are the only one in the home. You are the eyes and ears. You don't have anybody "down the hall" to come double check your assessment. YOU sometimes are the one who is expected to recognize potentially life threatening situations.

4. What kind of diseases and treatments do you most often see? What is a typical day of work like for you?

I do intermittent home health nursing. I see patients when they get out of the hospital usually for things like CHF, COPD, pneumonia, surgeries (TKA, THA), strokes, etc.

My typical day is going into the office, checking my schedule, getting my papers/charts organized (we don't have computers yet), then calling each patient (sometimes unsuccessfully) to set up a time to see them (and double check the address is correct). On the weekends I am also on-call so I get patient phone calls throughout the day if they have issues. Sometimes I wind up going to see these patients for a PRN visit, sometimes I send them to the ER, and sometimes they just need reassurance. If a patient is having issues I call the doctor and sometimes get an order for lab work, IM, IV, or PO medication, and sometimes IV fluids depending on the situation.

5. Do you feel your job is rewarding? What are some examples of how you felt that you greatly impacted the health of a client?

Absolutely the job is rewarding. When you notice something and intervene early to prevent the patient going back to the hospital? You feel good. When you go to a patient's home and notice something seriously wrong and get them the help they need? Awesome. One example I have is when I worked this past Thanksgiving. I was to see a patient who had recently had bowel surgery and had been home a few days. His wife called to say he threw up that morning and I said I'd see him 2nd (so mid morning). She didn't seem too concerned as she just wanted to let me know and see if it was ok. I got there and this poor man had blankets all the way up to his chin. If I moved one he complained of how cold he was. He was shivering, obviously not doing well, and abdomen a bit taut. The man vomited during my quick assessment as I told the wife he needed to go to the ER. She called an ambulance and I did a quick assessment then stayed at his bedside holding a basin for him to vomit in. Vital signs weren't too bad really. Called a quick report to the ER and EMS got there. By the end of the day the guy had another surgery and came out of the OR with a colostomy as his bowels had ruptured. When I got the chance to go back out to see the patient the wife kept thanking me saying I saved his life. She would have let him lie in the bed until he died.

Another more recent--patient very debilitated but wife cares for him at home as she won't put him in a nursing home (who can blame her). Anyway his fever spiked so I went out to see him. Guy has PEG tube and all and doesn't really ever respond to me. Lungs sounded like CRAP, pulse ox 90%. Call doc as wife is pleading to only send him back to the hospital if ABSOLUTELY NECESSARY. Poor guy is a frequent flyer. As I'm on the phone with the doc daughter yells for me and says he's not responding to her. Sternal rub....nothing. Put pulse ox back on...50's. Crank up his oxygen and throw on an updraft even though he had one not long ago. Don't want to move him much but we at least scoot him up in the bed to help lung expansion. Stop continuous PEG feeds. Call 911. Fingers start turning dusky but pulse ox back to 70's.When EMS got there pulse ox back in 80's at least. I was amazed guy wound up back home in a couple of weeks and doing fine. We have had this guy for a long time and so we all know his wife. This was the first time I saw her cry.

6. Have you impacted or influenced procedures or health policies in your work? How? How successful were these efforts?

I have been one to bring up issues and (sometimes) they get remedied. One in particular was how they scheduled on the weekends. The nurses who scheduled would be happy if all of the names that needed to be on the schedule made it. This sometimes meant the weekend nurses driving all over God's creation to see patients. I pointed out that we are much more productive if the patients are lumped together based on geographic area and it makes everybody a bit happier. They now list out the area the patient lives on the schedule so they can group them in a more logical way.

7. What is most challenging/frustrating about your work?

Most frustrating is the changing schedule. As I said I work weekends and I'm on call so it's often my schedule that I wind up changing to accomodate a PRN visit if one comes up. I'm a planner. I don't like my plans to change.

8. What advice would they give to a new nurse about preparing for a role in public health/home care?

There are some posts here about new nurses going into home health. I think I'd advise a nurse to get some experience elsewhere first. As mentioned above assessment skills are an absolute MUST as you're the only skilled person in the home. Also for the experiences I mentioned above. If you've never had a patient crash on you you may not think as quickly because you're freaking out. These patients are SICK or they wouldn't have a home health nurse.

Also be prepared for the unexpected. Walking into a new patient's home you have no idea what to expect. I have been in spectacular homes with amazing views and also homes that belong to hoarders. Homes where you only take the bare necessities in because you don't want bugs to get into your bag. Homes where you don't sit down because you're afraid or there's just nowhere to sit. Animals (chickens, snakes, lizards, birds, dogs, cats, maggots, etc.). Chain smokers who don't care that you're there or that they just got out of the hospital with pneumonia and were on the vent. You see it all.

Thankfully I was on my computer or else you wouldn't have gotten much from me as I don't like to type on my phone..................

MrsICURN14 · Oct 31, 2014

1. What is your experience as a home health nurse? Do you like it? How many patients do you see? How many hours per week?
I have been working in home health for 3 years. I absolutely enjoy the autonomy and (most of) the patients. I work weekend option now (12 hrs Saturday and 12 hrs Sunday) and how many patients I see depends on what type of visit they are. Initial evaluations/Start of Cares take a while to do as they have a lot of paperwork and an indepth assessment. I can see 3 of those in my 12 hour day or up to about 9 regular visits.
2. What other types of professionals do you interact/work with? How would you describe the role of the nurse as unique or different compared to these other professionals?
Since I work weekends I really only ever interact with the physical therapists (who see some of the ortho patients on the weekends) and doctors (if I need to call them). During the week, though, we have access to OT, ST, social work, dieticians, and home health aides. I wouldn't say the nurse is more special than any of the other disciplines. We are usually the hub among all of them, though. Almost all of our patients have nurses in the home. Sometimes we have a patient who may be ST, PT, OT only.
3. What would you consider your most important skill used in home care?
Assessment skills are an absolute must. You are the only one in the home. You are the eyes and ears. You don't have anybody "down the hall" to come double check your assessment. YOU sometimes are the one who is expected to recognize potentially life threatening situations.
4. What kind of diseases and treatments do you most often see? What is a typical day of work like for you?
I do intermittent home health nursing. I see patients when they get out of the hospital usually for things like CHF, COPD, pneumonia, surgeries (TKA, THA), strokes, etc.
My typical day is going into the office, checking my schedule, getting my papers/charts organized (we don't have computers yet), then calling each patient (sometimes unsuccessfully) to set up a time to see them (and double check the address is correct). On the weekends I am also on-call so I get patient phone calls throughout the day if they have issues. Sometimes I wind up going to see these patients for a PRN visit, sometimes I send them to the ER, and sometimes they just need reassurance. If a patient is having issues I call the doctor and sometimes get an order for lab work, IM, IV, or PO medication, and sometimes IV fluids depending on the situation.
5. Do you feel your job is rewarding? What are some examples of how you felt that you greatly impacted the health of a client?
Absolutely the job is rewarding. When you notice something and intervene early to prevent the patient going back to the hospital? You feel good. When you go to a patient's home and notice something seriously wrong and get them the help they need? Awesome. One example I have is when I worked this past Thanksgiving. I was to see a patient who had recently had bowel surgery and had been home a few days. His wife called to say he threw up that morning and I said I'd see him 2nd (so mid morning). She didn't seem too concerned as she just wanted to let me know and see if it was ok. I got there and this poor man had blankets all the way up to his chin. If I moved one he complained of how cold he was. He was shivering, obviously not doing well, and abdomen a bit taut. The man vomited during my quick assessment as I told the wife he needed to go to the ER. She called an ambulance and I did a quick assessment then stayed at his bedside holding a basin for him to vomit in. Vital signs weren't too bad really. Called a quick report to the ER and EMS got there. By the end of the day the guy had another surgery and came out of the OR with a colostomy as his bowels had ruptured. When I got the chance to go back out to see the patient the wife kept thanking me saying I saved his life. She would have let him lie in the bed until he died.
Another more recent--patient very debilitated but wife cares for him at home as she won't put him in a nursing home (who can blame her). Anyway his fever spiked so I went out to see him. Guy has PEG tube and all and doesn't really ever respond to me. Lungs sounded like CRAP, pulse ox 90%. Call doc as wife is pleading to only send him back to the hospital if ABSOLUTELY NECESSARY. Poor guy is a frequent flyer. As I'm on the phone with the doc daughter yells for me and says he's not responding to her. Sternal rub....nothing. Put pulse ox back on...50's. Crank up his oxygen and throw on an updraft even though he had one not long ago. Don't want to move him much but we at least scoot him up in the bed to help lung expansion. Stop continuous PEG feeds. Call 911. Fingers start turning dusky but pulse ox back to 70's.When EMS got there pulse ox back in 80's at least. I was amazed guy wound up back home in a couple of weeks and doing fine. We have had this guy for a long time and so we all know his wife. This was the first time I saw her cry.
6. Have you impacted or influenced procedures or health policies in your work? How? How successful were these efforts?
I have been one to bring up issues and (sometimes) they get remedied. One in particular was how they scheduled on the weekends. The nurses who scheduled would be happy if all of the names that needed to be on the schedule made it. This sometimes meant the weekend nurses driving all over God's creation to see patients. I pointed out that we are much more productive if the patients are lumped together based on geographic area and it makes everybody a bit happier. They now list out the area the patient lives on the schedule so they can group them in a more logical way.
7. What is most challenging/frustrating about your work?
Most frustrating is the changing schedule. As I said I work weekends and I'm on call so it's often my schedule that I wind up changing to accomodate a PRN visit if one comes up. I'm a planner. I don't like my plans to change.
8. What advice would they give to a new nurse about preparing for a role in public health/home care?
There are some posts here about new nurses going into home health. I think I'd advise a nurse to get some experience elsewhere first. As mentioned above assessment skills are an absolute MUST as you're the only skilled person in the home. Also for the experiences I mentioned above. If you've never had a patient crash on you you may not think as quickly because you're freaking out. These patients are SICK or they wouldn't have a home health nurse.
Also be prepared for the unexpected. Walking into a new patient's home you have no idea what to expect. I have been in spectacular homes with amazing views and also homes that belong to hoarders. Homes where you only take the bare necessities in because you don't want bugs to get into your bag. Homes where you don't sit down because you're afraid or there's just nowhere to sit. Animals (chickens, snakes, lizards, birds, dogs, cats, maggots, etc.). Chain smokers who don't care that you're there or that they just got out of the hospital with pneumonia and were on the vent. You see it all.
qualities. Thanks!!
Thankfully I was on my computer or else you wouldn't have gotten much from me as I don't like to type on my phone..................

This was

MrsICURN14 · Oct 31, 2014

This was

My phone is being stupid. I was trying to respond and say that was super helpful as i'm also looking into PDN and while I know it is difference from HH they do have similarities. Enjoyed reading it!