Home Health Nurse Interview

AMN74 · Mar 6, 2012

these are some pretty broad questions... i didn't see anyone respond so i thought i'd try to help you out... if you have any further questions pm me and i'll try to help.

interview questions:

how are the patients enrolled? enrolled? do you mean how do we get referrals? or how are they admitted? enrolled...if you mean referrals they come from all sorts of places... dr offices call in referrals, hospitals call in referrals, our hospital liasons pick up referrals, snfs refer patients they come from all sorts of places.. enrolled if you mean admitted? a start of care nurse goes out after the referral is made and evaluates the patient for home health and gets the ball rolling, does the soc oasis, the initial orders, enters meds in med profile, goes over the soc packet with hippa laws, homebound status, home safety, rules, rights and responsibilities, checks insurance cards and photo id of patient, teaching and info about how to contact our agency...etc...then the patient is handed off to the appropriate care manager and they staff with the appropriate nurse to continue the patient care during the episode.
is there a marketing group working in your firm? my home health agency has marketing people that work for our agency, they visit md offices, group homes, snfs, adult day cares, any place that may generate extra referrals. some of these marketing people have business or marketing degrees, some are nurses, etc
what is a typical day for you as you visit patients? this is a response that i typed out for another thread not too long ago:

get up and get ready early in the morning, finish up last minute notes from the day before, transfer laptop, pick up new patients start calling them to set up your day. transfer again to make sure your schedule is set for the day, out the door i go. grab a diet coke for the long day and need of some hydration. drive 20 minutes to first patient house. picc line care, wound care and documentation, oasis for re-certification, get labs. total time about 2 hours after care, teaching and documentation, drive 30 minutes to the lab and drop off labs. get a call patient in distress with blocked foley, make prn visit to change out foley, do teaching and documentation. get back in the car and start calling patients to tell them you're running late. drive 20 minutes to do a wound vac dressing change, photo and document wounds and teaching. get back in the car to drive 20 minutes, get behind a slow farm tractor and some cows in the road and get behind again... get to next patient house, new out of hospital resumption of care. major med changes, oasis documentation, medication and disease management teaching, realize he only has 3 of the 4 new meds in his home no rx for 4th med. call md to get rx called into pharmacy, patient can't afford med, call social worker. make med calendar, visit, follow ups, documentation, new orders 1.5 hours. get in car listen to voice mail a mother is in panic over her son's condition, call her and get details, calm her down, teach what needs to be done over the phone schedule visit for the next day to see him, pull over on side of road to document the situation. no time or place to pee. keep going, to next patient house just got home from doctor with new med changes and severe drug interactions, call md to clarify meds, he orders labs, get labs via venipuncture, document the whole visit, update meds and drive blood to the lab again. stop at office to pick up some paperwork and transfer laptop. can't locate next patient on the phone. call next of kin, no answer, call hosptial, he's hospitalized. do transfer oasis, necessary paperwork, notify hospital liasons. finally get to next patient, she is anxious and confused. she is not safe to be at home by herself, she has not taken meds from pill box in 3 days, bp elevated. call md, he says get social worker involved and notify family. spend 20 minutes on phone making arrangements with family and social worker for a family meeting that will be held later. next patient routine wound care, photos and documentation, mentions that he is having trouble and burning with urination, and blood sugars have been elevated, call md get order for ua and cx. have pt pee in cup, drive 45 minutes back to the lab and call last patient to see them they are mad that it's 5pm and you have not shown up yet. follow up visit and teaching, routine documentation, prepare them for discharge at next visit. get home around 630 pm, finally rush to pee, finish up notes, make important phone calls, follow up with social worker about plans for visits on patients with no meds or patient not safe to be at home and what we can do for them. 730 pm put laptop down for the night and pray all is quiet because you are on call tonight. several calls about crazy stuff after hours, laptop back out to document and alert necessary personel about the on call issues. try to get some sleep by 11pm because it starts all over tomorrow and you have more crazy stuff going on....

5. how much of the care is directly paid by insurance? if patient is straight medicare or medicaid coverage is 100% covered for billable visits. most medicare advantage plans are also covered at 100%

6. who decides when the patient is discharged and by what criteria? the skilled clinician that is seeing the patient and the patient and c/g decide. when goals are met the clinician reviews all that with the patient and makes sure they are ready for discharge. sometimes patients are found not to be homebound, are too non-compliant, not safe for homecare....all are reasons the patient could be discharged early...

7. are all patients seen by you paying customers? (do they have insurance?) no, we have many patients that are indigent, if they come from our owner hospital we have to accept all patients referred to our agency by the owner hospital, so we have quite a few indigent patietns.

8. has your customer census increased or has it dropped since the institution of the new health reform? since the health care reform we have to work "smarter", which means teach more in each visit, get the patient independent in their skilled needs and discharge sooner. so for a while we saw our census drop off quite a bit because we are discharging sooner. which means less skilled visits, but it has picked back up the past few months and doing better.

9. how has staffing been affected since the institution of reform? many of our prn staff did not get visits when the census got low, and we lost a lot of that staff, they simply had to go find new jobs. the paperwork has become emense because of the frequent discharges by cutting back on patient visit frequencies, so the full time staff are very upset right now nobody is happy with their job..the paperwork has slowed down everyone and the staff are working longer hours, doing longer visits to teach more, and more documentation for no extra pay...several of our staff have left because of their work load since the reform.

heathercummings · Mar 7, 2012

This is exacitally what I needed. Thank you so much for taking the time to help me out!

healing touch · Nov 25, 2013

Thank you for all the information. Maybe you, and some other Home Health nurses can answer this:

I'm a new RN grad, desiring to work home health. Is it necessary to have a certain amount of hospital med surg experience before doing this?

AMN74 · Dec 19, 2013

Healing Touch,

Back when I started in home health more than 18 years ago it was almost mandatory to have at least 2 years of experience before going into home health. I will say in my opinion, unless you get a super long orientation like a 6 month internship with a home health agency it would not be a good idea to be a new grad and go into home health. This is the rationale: When you do home health you are out in people's homes all by yourself. If you need to draw blood, you need experience with venipunctures..Have you done that before? There is a multitude of wound care needed in home health that requires you to know quite about wounds, what type of wounds they are, how to properly document wounds. You need to know when wounds are going bad and when to call the doctor and how to describe the wound and probably recommend a different wound treatment to the doctor and get approval. You are the only eyes and ears in the home, you don't have someone down the hall to say, "hey can you come here and look at this". You have to have experience enough to trust your gut about things. You need to have knowledge enough to teach patients about meds, disease process and how to change their lives to be healthy, prevent hospitalizations and change lifestyles...be a life coach in some ways. There are so many skills that you need to be prepared to do by yourself. Most people in nursing schools these days only get to practice on a fake person, that in no way makes you prepared to do these skills on a human body.

I could go on and on, but to wrap up here...you need to be independent with skills, knowledge and judgement. As a new grad you still have a lot to learn. My agency did hire a new BSN grad who had done some of her clinicals with us about 10 years ago. However, she had to precept with another nurse for 6 months, at first observing, then hands on, then mastering documentation and skills and communication with doctors and families. This nurse is an awesome home health nurse to this day. But you won't find many agencies that are willing to sink that sort of time into a new grad. And in my opinion, if they don't sink the time in to train them properly, then it could be dangerous for the nurse, the patients and the agency.