Home Health for new grad??

KC CHICK · Dec 8, 2001

amy, I'm not a home health nurse, but graduated the same time you did. I would think some experience would definately be necessary in order to properly monitor someone....BY YOURSELF. The thing that would scare me about HH is that you are not able to run down the hall to ask someone a question...you have to be able to rely on yourself and your assessment skills. I would rather go to ICU or ER, where you have help available, than HH anyday....just my opinion. Also, keep in mind that some patients have had MAJOR operations and been sent home once they are "stable". Insurance would rather send someone home than keep them 1 or 2 more days, right?

Hospice would be different, I guess.....they are terminal already. I am guessing that you would be monitoring pain control and counseling pt and family.

Don't know...would be scary for me.

Good Luck. :)

Anne

hoolahan, ASN, RN · Dec 8, 2001

Hi Amy,

Not sure how to change your name, try the FAQ area, if it's not there, e-mail Brian, our leader.

You already have a few months of experience, that is already a plus. And if you have an agency that is willing to orient new grads, and this is something you really want, I say go for it!

Ask on your interview how the orientation for experienced nurses differs from new grads. If they are vague, seek clarification. You don't want them to throw you to the dogs.

The thing about hospice is emotions in the pt, but esp the family run high! Can you handle that. These are people who are facing one of the scariest times in their lives. They look to the nurse as their rock, they need your confidence and support. The best thing you can do is admit you are new, but if there is ever anything you think you could do better to please feel free to share that with you, and you will promise to get guidance from a mentor.

YOu need to be good at pain management in hospice too. I do not see this as an obstacle for you, not if you are willing to spend some time reading at home in the eves to dedicate yourself to becoming knowledgeable about these issues quickly.

Also, let me say as a 20 year RN, yet a relatively "new" HH RN (going onto 3 years), I get better with experience, just like everything else. When I first started case management, I didn't have a clue how to arrange transportation or how managed care co's worked. I read a lot, and tried new things, came here to ask advice, sought out nurses at work who other pt's respected, and whom I saw had their charts in order and did well for their pts for advice.

What is NRSKarens' signature line again? The sky's the limit if your heart is in it. That is the truth. That'[s the great thing about the nursing shortage, you can write your own ticket and have opportunities to try things you wouldn't have had 5 years ago.

Click onto my link to read more in the "About HOme Health" pages of my web site, the link is below. Good luck to you!

AmyRN1227 · Dec 8, 2001

Thanks so much for your reply! Yes, I'm getting experience but not the kind I want. Have you ever heard of this....at my hospital they start out new grads as "associate nurses', basically an LPN because I'm passing meds, hanging IVs, doing IV pushes, and patient care. No talking to docs, no assessing, no charting except for pain meds. I found out just recently that I have to be in the position for a minimum of SIX mos before I can apply for "team leader" which is like an RN position. When I was hired, they told me between 3-6 mos. So now I feel like I'm wasting my time doing this associate nurse thing, when I could be doing real nursing somewhere else.

Yes, most of my skills right now deal with pain management. Post surgical patients, with a lot of total knee replacements, total hips, post hysterectomies, etc. But I've only been doing it for three mos.

And yes, the emotional part might be a little much. I am a sensitive - sometimes too much - person and would have to work at keeping my feellings in check. Although, I'm able to keep a level head at work, it might be different in a home health setting.

Thanks!

Amy

Home Health Columnist / Guide · Dec 8, 2001

Amy:

Now, starting out with 6 months experience in a Home health position isn't too bad. You have mostly ALL telephone contact with physicians: reporting changes from norm, medications missing from the home on admissions, lab results, etc. Assessment is part of EVERY visit with a client. I think if you have a longer orientation with an experienced nurse, you might be OK. The hardest part is dealing with all the different insurance companies and learning Medicare rules in order to obtain needed services and equipment/supplies with clients: MAJOR hassle along with all the paperwork required for documentation.

In order to be successful in Hospice, you have to be an experienced nurse highly skilled in assessment and symptom management....these are things you state you have not done over the past 6 months so that concerns me. I think you have been doing more assessment that you realize. Hospice nurses need to be mature and handle very emotional patients and familles at times. if you are older and have lots of life experiences, you may be OK.

My concern for you is that you view yourself as functioning only at an associate level:

I'm passing meds, hanging IVs, doing IV pushes, and patient care. No talking to docs, no assessing, no charting except for pain meds.

These are skills you state haven't performed are necessary to function effectively in homecare. What are YOU doing to change the situation. Have you discussed with the team leader your desire to do admissions and paperwork, ASK questions when problems arise and show initiative to take on more responsibility or are you just keeping up with the tasks currently performing?

The answers to these questions will guide you in your decision.

If you are working 12 hr shifts, you might want to get your feet wet in home health by doing per diem followup visits in homecare to see if it's really to your liking. Check out Hoolahans website, it describes homecare accurately!

Good luck to you in your career. Follow your heart and your dreams.

Mijourney · Dec 24, 2001

Hi Amy. I agree with the previous posters. Maturity, keen assessment skills, and good common sense are crucial for HH. In the hospital setting, you're in a controlled environment. In the home, you're in an uncontrolled environment, you're on the patient's turf. You'll find the most successful HH nurses are those that go into the home with an attitude and objective to find a way to help the patient and family help themselves. Not to go in and dictate and overwhelm patients and families with nurses and doctor's orders. That, IMO, differentiates HH from facility-based nursing.

As NRSKaren has pointed out, external influences has significantly impacted our ability to deliver HH care in a way that would maximize patient and family benefits and help them reach their goals. Before you go into HH, study information as recommended and look deep into HH before making a complete switch. Particularly compare hospital based HH to independent HH companies. Best wishes.