changing lanes, home health?

RoAbreu · Oct 27, 2002

I think there were a couple of reasons I decided, when going back to work, to try HH rather than going back to the floor.

First off, I desired more autonomy; as a case manager, there is a lot of that... for a newbie, it's like flying without a wire, but I am gradually adjusting to the responsibility.

Secondly, I wanted more quality time with my patients, more direct and private interaction, something you just don't get in the hospital, at least as a floor nurse.

Thirdly, I have always despaired that I did not have enough time to do proper patient teaching, and that the teaching that was done in the hospital was "under stress" and probably mostly forgotten by the patient and family upon going home.

Lastly, even though I knew that it would require "home time" in addition to visit time to get charting done, I felt like that really gave me an opportunity to review charts properly, set up care plans that made sense and weren't cookie cutter, and do my charting in a more thorough fashion. Yeah, it takes time. But I think it is worth it.

I also chose a HH without knowing anything about the agencies, and didn't do a ride beforehand, which is a good idea. But my preceptor and I have very different caseloads and regions; hers is in a discreet area, while mine is spread out over a larger area. So a day with her looked like a busy but well organized cakewalk compared to a day with me, which sometimes takes a couple hours of driving or more in addition to the visits and charting.

So bear in mind you'll need a reliable car, that HH nurses go out no matter what the weather, generally, and that you need to know what the parameters of your particular position are going to be. Some nurses seem to get early risers, which is great if you start your day early... mine all seem to be grumpy before nine in the morning, so unless I get an insulin patient or labs, I get a later start, so I go in and get all my paperwork together before I go out, stuff I'll need signed during the day, a list of people I'm seeing with their phone numbers for quick reference, and any special supplies (like lately I have to check out the flu kit a lot).

I venture to say you will like it; there is definitely a learning curve, in the hospital we didn't have to fool with insurance, or what classified a person as homebound, for instance. Good luck on your ride~ your hospital experience will serve you in good stead!

renerian, BSN, RN · Oct 27, 2002

I put around 30,000 miles per year on my car. Check to see which agency has a local service area so you won't be driving to tim buck too. LOL. My last agency covered seven counties so I spent more time in my car than with patients. I also was paid by the visit. Some days I worked 10 hours and only made $75. Be careful because if your paid per visit you most likely will not be paid for office time or drive time. If your salaried that means you obviously are paid regardless. However, he cautious of this as well and ask if there is a bonus plan for seeing more patients than they required. When your full time you need to see a certain number of patients. The other post was correct about how nice home health is you just have to watch out for money stuff. Winter can be the pits in home health too if your service area is large. On call is a pain though too going out in the middle of the night. In my last agency on call meant working your butt off so it was not unusual for me to get 5 to 8 admissions to do plus take patient calls, plus work M-F the next week before getting a day off. All good questions to ask.......

I have done home health 11 years...

renerian

Brownms46 · Oct 27, 2002

I like home health because it gave me the freedom I needed as a single parent. But I would advise you to ge the best insurance money can buy if you happen to get into any accident, as I did. A young man hit me who was uninsured, and without even a driver's license. Also another HH nurse got her car stolen, while another had her's strip just in the time she was at her visit.

As state above make sure of the area you get. Mine was spread out in a large area, and my first mileage check was over $500.00!! It was nothing for me to do 200 miles a day, while another HH nurse had most of her pts. within blocks of each other, and from her. My area was more rural, and therefore stretched out. There have been times when it rained cats and dogs, and I didn't have a cell back then, and trying to find a useable phone was a pain sometimes when I got beeped!!!

We were paid by the visit, and for office time hourly pay was given. I did my office time in the afternoon, as there were less people there, and easier to get a phone, and do paperwork in peace. I would get my supplies for the next day then, and start out from home. Now days it's probably a little easier getting directions from mapquest and such. But not so easy when I did it from 88-92'. Back then we got $15/vist on week days, and $25/visit on weekends.

The thing about weekends is that you maybe covering someone else's territory, doing the dailies that are needing to be covered. I would ask how this is done where you are going.

Big draw back to home health is you never know what you're walking into sometimes. I have been in some scary situations. Once I drove around and around the block before I got up enough nerve to park and go in. The only thing that made finally go in and not turn and run, was the fact that there was a pt. in there who was depending on me coming. Otherwise I would have kept going!!!!!!!!

LoisJean · Oct 27, 2002

Home Health Care for me is fresh air. I always was a self starter and of the independent personality type. Home care gave me the chance to express these facets of my personality plus I found that I enjoyed 'working without walls', for the most part. I never was concerned about the size of territory because I enjoyed the traveling...and still do. I found that I enjoyed the more 'informal' in-services provided at the office; I liked coming off the road and doing my paperwork in an office where I wasn't pressured to get up and do something else every five minutes.

I had worked clinical settings for so long and had gained so many varied skills that when I opted for HHC I felt comfortable going into a patient's home alone and taking responsibility for the care required.

I thoroughly enjoyed the one on one nursing experience and to take the time to talk with my patients. I loved implementing the RN's plan of care for the patient and having my input added to the mix. Being a part of a real working team was what I enjoyed the most because when I decided to leave clinical nursing, the team concept of RN and LPN was becoming rarity and my skills were being gradually eliminated. In HHC I was able to utilize all of my skills and learn new ones.

I gained great appreciation for the environment that many of our patient's lived in. I received real lessons in tolerance and understanding for a person's lifestyle and came to realize that healing can happen no matter what the circumstances.

I also came to believe that home care can be the best care setting for any nurse who really wants to be a part of the healing process. While we can't always KNOW what the outcome for our charges will be, we can leave a home knowing that something we did made a difference and sometimes we can see that difference develop.....something we don't see in a more formal clinical setting.

I like to see that what was begun in the hospital setting is carried on and finished in the home setting; I like to see that people who need care and teaching can receive it BEFORE it becomes a necessary hospital stay, and I like to think that our presence in the home can possibly make the difference between dependence and independence for the person receiving the care. I love the idea of patient and caregiver teaching. I enjoy the participation on their parts. I love the look on their faces when they get an understanding of a disease process or the benefit of a therapy or an understanding of why the medication they take is good for them, really.

The greatest downside of Home Health Nursing that I can think of these days, is when a nurse's hands become so tied that the above mentioned things become difficult if not impossible to accomplish because of time restraints, insurance restraints and poorly managed agencies.

Peace,

Lois Jean

KP RN · Oct 28, 2002

Yeah....what LoisJean said!:chuckle

I need to print that response up and keep it in my car to reread when I'm having a bad day!!

kcrnsue · Nov 13, 2002

Hi duli!

We are kind of in the same boat. I just did a ride along last week! I have been a nurse for almost ten years, most recently as a travelling ob nurse. I have decided to go to home health for a couple of reasons. Number one is getting off of night shift!:zzzzz I want to be awake when everyone else is awake, and I never get enough sleep! Also, the agency that I am going to be working for offers excellent benefits which will hopefully make up for the cut in pay I will be taking. So good luck to you, and I will keep you posted on how I am doing as well!

Traveler · Nov 23, 2002

Lois Jean did a wonderful job with her post. I think it takes a certain type of person who loves home health just as it takes a certain type to love the hospitals. In Home Health you truly never know what you are walking into. When my husband asks when I will be home I never give an answer because your whole day can change in a flash.

In hh I really feel like I am practicing holistic nursing. You use all of your senses and skills. Not only does a nurse have to deal with the patient, you work with the whole family and enviornment. You learn very quickly to adapt. I've taken pictures off of walls to hang IV bags on the nails!

It's easy to become too involved and risk burn out and at the same time try to not become too calloused. Even the grumpy patients seem to come around and appreciate hh because I believe we really do make a difference.

You really have to be a patient advocate and be confident in your assessment skills and be able to work with the doctors and their staff. More often than not I'v found that they're receptive to my suggestions and assessments.

I have also found that there's a fine line we walk and need to really know and adhere to our scope of practice. It's a good feeling when you know that you have seen a problem and addressed it before it mushrooms into something more dangerous for the patients. I think the doctors appreciate this and realize this (for the most part) also.

Confidentaiality is a biggie for us. If I am seeing someone in the area I live in, people know my car sitting at the house and want to ask questions when I see them at the store about the patent's house they saw me at. I tell them if they want to know how so and so is doing, she would probably appreciate a call from them. I also make sure the patients know that I will discuss their condidtion with nobody. I know I would want the same for me.

You also need to be the type of person who can work well on your own and need to be organized (although my car doesn't look too organized.) We're pretty rural and it's really important to have extra batteries, plenty of wound care supplies, needles, etc. Your car does take a big time beating and gets pretty trashed and reliable transportation is so very important for convience and for safey. I know that this is my calling.

Ann

duli03 · Nov 26, 2002

Thanks for everyones input, I start my new career with HH on Dec 3, I will be in training for I don't know how long. I think learning the insurance/paperwork will be the most difficult as I have always loved patient care and have strong clinical skills. Please, if anyone has any words of wisdom to share please post them. Again, thanks. Duli;)

Home Health Columnist / Guide · Nov 27, 2002

SorryI didn't respond before.

Check out this intro article:

https://allnurses.com/forums/showthread.php?s=&threadid=22443

Read the threads here re wound care/cath care---info you need to know as supplies are limited in homecare.

Check out Hoolahans website--http://www.geocities.com/vnarn_nj/