Home Health----LPN specific

pagandeva2000, LPN · Dec 14, 2007

I found a lot of good info on home health by searching the site. Most of it was written by RNs who shared their duties and experiences. I'm an LPN and am pretty sure I will be getting an offer to do home health soon.
I was wondering, as an LPN, what will I be doing in home health. I'm guessing that I'll be changing dressings, possibly giving meds, maybe doing trachs, beyond that, I'm not really sure what else I should expect. If anyone can share anything they know, I would appreciate it. Also, what kind of charting and paperwork will be involved. I'm think I'll be expected to see 5-7 pts per day, and it is an hourly wage job.
I've been in psych for quite a while, night shift at that so, I've forgotten a lot of medical skills. My concerns are I.Vs, drawing blood, etc. I will definitely have to be retrained. Will there be a lot of this?

I did home health, and had only one pediatric trach patient. I stayed there 10 hours on Saturday, only. I had to do an assessment sheet of the systems, such as listening to bowel sounds, vital signs, mention if the eyes were clear or cloudy, skin integrity, etc... There was an MAR at the home with the names of the prescribed medications, times and dosages to administer. I suctioned and gave nebulizer treatments, gave medications, and basically kept the child entertained. It was more of a baby-sitting job, actually. Make sure that you have the name of the doctor, the nearest hospital, pharmacy and the agency nurse in case of emergencies. There should be emergency equipment such as oxygen, or whatever the patient needs in the home. Be sure all of the medications are there and that the emergency equipment is operable the minute you get there, and have the numbers to call in case you need replacement oxygen or whatever they are using.

My agency didn't allow LPNs to do IV care at the home, so, I didn't worry about that, and didn't have to draw blood for that particular patient. And, I requested to meet the client while the other nurse was there for her to orient me to the case and to see if I can actually handle working with that client. Good luck!

CPI61 · Dec 17, 2007

Thanks P2000. Anyone else have any insight. I'm still on the fence as to whether or not to take the plunge into HH. About how much charting is involved for the LPN. Surely not as much as the RN,no?

What about admissions? Is that strickly for RNs or will I be involved in that too?

pagandeva2000, LPN · Dec 17, 2007

I just did narrative notes that summarized what events occurred during the course of the day. My sheet included an area to document vital signs, pain, muscular-skeletal, digestive, eyes, seizure activity, skin integrity, etc...where we just checked off as we went. It was not very laborous. What I would do is write on a piece of paper and then document on the form at the end of the shift. This particular agency had their form in triplicate, one went to the patient, the other with the agency and the nurse kept a copy. It had to be submitted to the agency because it also acted as a time sheet, where the client or family member signed to attest to that I was in fact there for the hours stated. The care plan was in a folder with the MAR, which was done by the RN. It was not that bad, really.

What one must be careful with is being sure that the agency gives you a scope of practice or a duty sheet of some sorts to outline your basic job responsibilities, or the client may take advantage. I have heard of some nurses being requested to do windows, basic housekeeping, etc...which, is not to be done. Of course, the patient area must be clean, and portions of the house that the client may use, such as the toilet, utensils, and such, but you are not there to be a maid or a babysitter for the children in the house, other than the client (if this is a pediatric case). The pediatric client's mother I had told me once that her daughter had a half sister by the father who visited and she would ask the day shift Monday to Friday nurse to 'keep an eye on her as well'. I would not ever take that responsibility because I am not paid to watch anyone else but that client. Family dynamics is very important as well, because basically, you are there on your own. There is a home health forum here in allnurses that can share some really horrible stories of things that have happened. I am not trying to place fear in you; in fact, I do plan to return to home care myself because I enjoyed it. But, be sure that people do not overstep their boundaries with you because it is hard to turn that around once it starts.

pagandeva2000, LPN · Dec 17, 2007

Oh, I don't think LPNs are involved with admissions for home care, but that may depend on the area you are located in. That sounds like an initial assessment to be made by an RN. You never know, though...

CPI61 · Dec 21, 2007

There is a home health forum here in allnurses that can share some really horrible stories of things that have happened

Where??????? Why am I not seeing this forum?

pagandeva2000, LPN · Dec 21, 2007

On top of the screen, under the allnurses.com logo, look to the tabs where you see the word "Specialties". They are listed in alphabetical order, and I have also posted there on numerous occasions earlier this year.

CPI61 · Dec 21, 2007

Got it, thanks.

caliotter3 · Dec 22, 2007

I do shift work in home health and do not have as much paperwork as someone who does visits. As far as I know, LPN/LVNs don't do the intake assessments, recerts, and other RN functions. This cuts down on our paperwork considerably. There are many RNs who do shift work also. Not every RN is involved with supervising, or intakes, recerts, post hospitalization assessments, etc. When you do visits, there is a minimal amount of paperwork that you must do for each of the five to seven clients you see each day. I only have to produce one shift flowsheet, sign off on the MAR, and maybe complete a physician's supplemental order to send to the office.

It is up to you to voice your need for orientation and training. Some agencies are good about seeing that their personnel are well-trained, and other agencies are not that good about it. The big thing you should do to assist yourself is to look at the plan of treatment prior to even going to your first visit. You can determine whether the client is suitable for you and prepare yourself ahead of time (I look up meds, read over the treatments and orders, look up anything I need to learn about, ask questions of the supervisors and other nurses on the cases). If you want to do visits, when you find out that you will be required to do something that you are unfamiliar with, ask about it before you go out. You shouldn't have any more trouble adapting than anyone else. Hope you try out hh and find it to be your place in nursing.

joprasklpn · Dec 22, 2007

Not sure if you mean you will be a visiting nurse or a home health nurse. I shadowed an LPN during nursing school who did the visiting nurse thing and she would drive around and do dressings and IV meds, blood draws and assesment of patients. That is what I observed on my one day with her, but she may do other things I am not sure. I do peds home health with one patient per shift and basically take care of anything they need from personal care to calling dr. for orders. Lots of trach and vent work out there. Either way there is always paperwork, just not as much as skilled care or med surg. I would hope you would get trained until comfortable, but I know how that is. Anyway I think you should just go for it. You won't know until you try it. Good luck.