Home health as a life long career? Did you lose skills

[HHN2472]

I am a fairly new grad. I worked on the M/S unit of the hospital for about 6 months and then I went into home health in July. Surprisingly at the hospital I worked at, I never got to do a ton of skills. I hung IV meds, and that is actually the most skilled thing I was able to do besides the few catheter insertions, and actually in the 6 months there I only got to start 4 IVs... Rural hospital. I started this job at home health and I do like it, I actually love it, but I don't do a whole lot in regards to skills. I do my assessment, and the most challenging thing are blood draws and I actually never did that at all until home health, so its been intimidating, but I am getting through it... There are PICC line dressing changes and wound care, but the job is actually quite simple in regards to patient care. The hard work is the tremendous paperwork to do with oasis, although I hear we will be going to computer in 2014. I love my job because I get holidays off, nights off, and my company is so cool because they do not overload you and you get your paperwork done if you focus. What I am wondering is the skill aspect. I am seeing all these nurses I went to school with working at heart hospitals, and ERs across the nation, and I think OMG, am I letting it all go? I don't do anything like that. Again, I enjoy my job, but I also wonder about the pay of HH compared to hospital? I made $21 at the hospital (Shreveport) and now I make $24 and I want to know if HH agencies usually advance their workers salaries well? Mine told me it was based off of some %age each year that decides your raise, but I have heard its usually like .50 a year to maybe 1.00 per year if you have been there a while. Do HH nurses usually end up making a good living and getting a raise equal to the hospital? And what about losing your skills? Have you? Does that bother you? Just some questions I have and thanks ever so much for your time.

[homecaresurvivor]

Prior to becoming a home care nurse, I worked in both in- and outpatient oncology for approximately 8 years. At that point, I decided I never wanted to see the inside of a hospital ever again. I got a job in home care, and 20 years later, I'm still at it. Skills? With a few exceptions, (like administering blood products), I've performed the same and many more technical procedures in the home as I did in a hospital setting. Catheter changes, central line dressing changes, mediport access, administration of IV's/TPN/Chemo, care of chest tubes, complicated wound care, wound vacs, cpr, etc. Your assessment skills should only improve, because the only one you can depend on out there is YOU! One of the skills you undoubtedly will gain more expertise in is patient teaching, which has got to be a focus on almost every visit, no matter the reason you're there. You'll probably also learn some other unexpected skills along the way, because the one predictable factor about home care is its unpredictability. Every home environment is different, and you have to help meet needs that go way beyond the medical. The only skill I believe I've lost in all these years is the ability to walk those darn floors for 12 hours at a time. That's a "skill" I'm glad to have lost!

As far as pay is concerned, I guess it depends on where and for whom you work. Every agency is different, and they pay you in different ways, some per hour, others based on per-visit rates. I don't even know what hospital nurses make anymore. One thing I do know is that, in my area, the job market for hospital positions is quite competitive. I believe it will improve, as the economy improves, and as older nurses like me begin to retire (nurses over 50 currently make up over 45% of nurses), More positions will open, I'm sure. However, our home care agency seems to always need more nurses, and they have trouble filling positions.

Anyway, I hope this answered some of your questions!!

[MyUserName,RN]

I'm leaving the hospital on a telemetry/med-surg floor for a home health agency. I will be paid per visit with mileage reimbursement and am expected to make a lot more than I currently make at the hospital. Granted, I will be working more hours probably and have to deal with more paperwork, but I'm pretty much done with the hospital setting. I have a friend who went home health and she said she has done more in regards to skills than she did in the hospital.

[MomRN0913]

I believe the most important skill you can ever have as a nurse is your assessment skills.

I also don't believe you lose skills like inserting a foley or changing a dressing. They made need some sharpening , but you don't lose them.

Go where you are happy.

[anh06005, MSN, APRN, NP]

The main skill I don't feel as comfortable in is starting an IV. I can draw blood no problem...it's actually establishing the IV. I have never been the best at it, though, and don't think I ever will be. What is interesting about home health is you do get a different set of skills. You learn to have more ingenuity and creativity. Dang it this guy has IV antibiotics to give through his PICC but I forgot to get an IV pole!! No problem....a hanger and a nail by his recliner work just fine

I don't feel I have lost any skills except dealing with codes/ACLS, etc. I worked cardiac/step-down in the hospital and (thankfully) still get mostly cardiac patients in home health so it made my transition much easier!

And as someone else mentioned your assessment skills get much better and you gain confidence in them! I feel much more independent and feel if I went back into the hospital I'd be one bada$$ nurse calling the shots!! LOL!

[KelRN215, BSN, RN]

I can't imagine what skills I'm losing working in home health. I use all the same skills that I used in the hospital. The tasks might be different but the skill set remains.

[Success2011]

HEllo guys..I love your comments..I just got offered a homecare position..full time but are paying me per visits...They saying benefits hourly/per visit is 27 service units. what does that mean? is it 27 visits per week...I have no idea..and what amount of time are you expected to stay with a patient per visit.

[spurs21550]

You need to verify with your employer what units are for that particular agency. Generally they count more lengthy visits as more units, such as an admission being 2.5 units, a regular skilled visit 1 unit-to give an example. For a regular skilled visit you should spend at least 30 minutes with the patient to allow for assessment and teaching/performing treatments, and or giving meds. For visits requiring OASIS assessments they will take longer-usually an hour or more.