home health as a new grad?

RN1989 · Dec 7, 2007

I do not recommend any new grad, LVN or RN, start immediately in HH after graduation. You must have excellent assessment skills and be able to make spur of the moment decisions without the assistance of others. A new grad does not have the experience necessary to do this and is putting their license on the line by taking a HH job right out of school. There are too many things that you are not taught in school and need the wisdom of experienced nurses so that you learn the subtle s/s of a problem. Tell your friends to play it safe and get a job where there are other people around them and the patients so no one dies and no one loses their license.

acerila · Dec 7, 2007

I totally agree with RN1989. It's a bad idea for a new grad to be put in a position where they are totally on their own without anyone else to go to if they have questions. I know a lot of new grads always complain about not being able to go straight into ICU/home health or another specialty they want but as a new grad that did go straight into ICU I now defiantly see the reason why so many places will not take new graduates into the ICU.

walk6miles · Dec 7, 2007

I also agree.... new grads should concentrate on developing assessment skills......... a high temp or headache in the home nursing setting could mean trouble for the patient if the nurse doesn't have that "assessment eye".

Besides, home health is HARD and you don't know it until you've worked in all types of settings and then try your hand at home health (I did it briefly but went back to hospital setting when I did two home visits in a 12 hour day - don't ask!!! - I went back to hospital pronto!

Good luck!!

julezzz26 · Dec 7, 2007

I just started as a new grad RN in home health, have been doing it for a couple weeks. I have 2 years of experience as an LPN in family practice and urgent care. I am going to quit as soon as I find a hospital job on Med Surg. It is very overwhelming. I feel very unsure of myself. My friend is the sales rep for this company and painted a really pretty picture of what it is like. Like a complete idiot I felt for it hook line and sinker. You go to the patient's house and get paid for that but then you still have to chart which is very hard to get done in that same hour especially if you have back to back patients. You have to call all the patients the night before to get your schedule set for the next day which you are not getting paid for either. I have only one patient this week which is a very easy dressing change so I am OK with that. It is very scary to be out there on my own and I would not recommend it to any LPN or RN new grad. Hope this helps.

ragtopnurse · Dec 8, 2007

I am a Home Health RN and I have to agree with the other nurses that have posted a reply. This is not a setting that a new nurse should be in. I had experience when I started but I have worked with some nurses that had been out of school for less than a year and they did not efficiently provide the kind of care that the patients needed. It takes time to develop assessment and more importantly critical thinking skills. You are out there on your own more or less and do not have someone else's opinion or assistance to fall back on. It is hard work but it is also very rewarding to help a patient to be able to stay home instead of the hospital and sometimes even LTC facilities. I know some of the agencies pay per patient but the company I work for pays by the hour so I got paid when I was doing my paperwork or calling my patients to set up my schedule ( currently I am not in the field, I recently took a Quality Improvement Coord. position). If you think Home Health is what you would like then I would suggest getting your skills in a hospital for at least 2 years and then look into it further. Keep in mind though, that you are not in a controlled setting. Not all homes are clean, in fact you won't believe how filthy some of them are. Some of them smoke continously while you are there, or some of the homes are so dirty or insect infested that you don't even want to set your bag down, much less set down yourself to chart. On the other hand, geriatric people are very kind and for the most part appreciative. It is so easy to become involved in their lives and find yourself very emotionally attached. I guess in a nutshell it is like any other area. It has its pros and cons but I love it and I really miss being out in the field. The only thing I don't miss is being on call. Sorry this is so long but hope it has helped.

TazziRN, RN · Dec 8, 2007

I am an old RN new to home health, been there since June. I'm still learning the ropes and that's after years of nursing experience. I still get a little nervous when I'm on call because it's just ME. I would not feel comfortable working with a new nurse with NO experience at all, because of the lack of assessment skills.

caliotter3 · Dec 8, 2007

I got my first home health job while I was still in nursing school. I had my LVN license and was hired for a specific case when I walked in the door. I was scared and just did the best I could to learn what I needed to know to get along both on that particular case and with the nursing agency. I already knew that I was interested in home health because I had finished that clinical experience in school. After I left that case I just approached each case as if I were a student. I got a copy of the info I needed, and looked everything up before I went. Sometimes they would have me get an orientation to the patient over the phone. It was really not the best of experiences with that agency, but I stuck it out and learned a lot.

My next home health job was better. I was hired when I walked in the door. This agency would give me copies of the 485's for any cases I was to consider. I would review them and decide what I wanted to try and then look everything up and go for an arranged orientation. This is the key. A very thorough orientation from a good nurse who has been working on that case. Anybody can be taught what they need to know to work a particular case if someone takes the time and effort. Even so, I do not generally recommend that someone right out of school go into home health. I had some previous experience in long term care, so I had some assessment skills to work with. I would have had an easier time if I had one or two years experience in med surg, as is generally suggested.

There are some agencies that will hire a new grad right off the street. If you go this route and are hired, you absolutely must insist that you get as much orientation as you feel you need to be able to work your case without crashing and burning. Insist on the orientation, even if you have to go on your own time and more than once. Take notes. Ask questions. Go over the 485 with a fine toothed comb. Look up every med and every treatment and insure you have an idea what to expect. Get the phone numbers of the other nurses on the case, especially the primary nurse, so you can call them in a pinch. It is not advisable to go into home health right out of school, but yes, it can be done. Good luck.

snowfreeze, BSN, RN · Dec 8, 2007

I worked as an agency home health aid occasionally for county mental health while going to paramedic school and taking pre-nursing courses. I had a deaf/mute MR patient who had a massive MI one evening. I called the supervisor to further assess this patient, she refused to allow me to call 911, instead she finally came and took him to a local hospital and they life flighted him for emergency CABG to another facility. She called and appologized later. She thought it was anxiety as I was new to this patient and the ambulance would have freaked him out. I found cyanosis, low BP and slow heart rate along with not eating dinner, my further assessment started with his not eating his dinner. I called the supervisor 3 times before she finally came to the facility. According to his chart he had a ravenous appetite and loved the food that was for dinner that night. Without my prior assessment training as an EMT and current medic classes this would have been missed and he would have gone to bed and not been alive by morning.

HM2VikingRN, RN · Dec 8, 2007

I worked as an agency home health aid occasionally for county mental health while going to paramedic school and taking pre-nursing courses. I had a deaf/mute MR patient who had a massive MI one evening. I called the supervisor to further assess this patient, she refused to allow me to call 911, instead she finally came and took him to a local hospital and they life flighted him for emergency CABG to another facility. She called and appologized later. She thought it was anxiety as I was new to this patient and the ambulance would have freaked him out. I found cyanosis, low BP and slow heart rate along with not eating dinner, my further assessment started with his not eating his dinner. I called the supervisor 3 times before she finally came to the facility. According to his chart he had a ravenous appetite and loved the food that was for dinner that night. Without my prior assessment training as an EMT and current medic classes this would have been missed and he would have gone to bed and not been alive by morning.

My daughter was working in an MR group home. SHe had a girl that she was caring for who had a BS of 16. My daughter called the ambulance. The patient was transported and hospitalized for several days. She ended up getting a nastygram from her supervisor because she "should have transported her" using the group home van.