New home health nurse. Advice/tips needed. - page 2

I will be starting a new position as a home health nurse at the beginning of Nov. I have almost 4 years of hospital experience in med surg and telemetry and also some prn work at a prison. Any advice... Read More

  1. by   squeegee
    I started working full time in HH last July after 5 years of medsurg ( that seems to be everyone's breaking point!) - I had been doing per diem work for the agency prior to that, but wow! it was still quite an adjustment. I am still trying to hone my time management skills so that I'm not bringing as much work home. I am also salaried and am expected to do 30 visits a week - anything beyond that is paid the per diem rate. An admission is considered 2 visits. The things I've learned are you've got to be flexible! At my agency, there are schedule changes all the time. Same day admissions really throw a wrench into the works. My agency is small - our census is around 90 pt's and we have 2 full time RN's plus our per diem staff. We have another RN that does on call every night and does every other weekend. We do computerized charting, which is great. I make my own schedule, but I'm still learning how to be smart about it and not be putting in 100 miles a day if I can help it. I love being able to case manage my patients and see them from admission to discharge with all the services they need to stay at home. As far as clinical skills go, you aren't going to see the action you might have had in the ICU or ED, but all in all I'm doing the same if not more when it comes to wound care, and some of the skills are just different in the home setting, like administering IV meds and lab draws.
  2. by   KelRN215
    Quote from mluvsgnc
    It seems there are different types of HH. In my situation, I did a meet and greet with the family and patient- neither of us was committed for any reason at that point. I personally wouldn't work in a "drug violence ridden area," a bug infested place, somewhere where I suspected child abuse, etc.) Once both parties were ok with one another and felt it was a good fit, we orient with another nurse for 2-3 shifts (8-12 hours) and then go out on our own. I only have one pediatric client, and he is mostly stable (although he is trach/GT/deaf/blind/CPAP/ etc. dependent), so stable but with a lot going on.

    To the OP: are you going to be working with an agency that sends you out to multiple places, or just with 1-2 clients?
    What you are talking about is Private Duty Nursing, which is different.

    With home health/intermittent visits you don't meet the family until you go out to do the admission. I have many patients in unsavory areas (think shootings at 2pm on a Tuesday in broad daylight) but I try to just park my car as close to the house as possible and be in and out.

    I don't find the documentation to be overwhelming but I'm seeing kids so I- by and large- don't have to deal with OASIS.
  3. by   redfoxglove
    Let's be clear, home health is not private duty nursing. I can only speak to home health. The admitting nurse meets with the patient and/or family at SOC, and there is no "good fit" discussion, it's either the patient wants our services or does not. Our agency covers a large rural 2 county area. Our average daily drive is around 100 miles. I am "PRN" that is, I get paid per visit. Our agency has 2 full timers and 3 PRN. If the visit time is extended or there are complications in getting orders, or other case management time requirements, I can charge some indirect time. The nursing skills in our demographic are repetitive: blood draw, catheter insertion, wound care, O&A, teaching, med rec. Home health is not for everyone. It is challenging, can be frustrating, and is not an easy stroll down the garden path. But, I like it.
  4. by   JJsMama79
    Hi there Sirdearis88,
    Let me know how your job is going! I've been in the med surg field for 7 1/2 years now, and am starting my new job in home health care at the end of December. I have the same concerns as you...please let me know how you like it, and what you have learned so far. Thanks and good luck!
  5. by   LTCNS
    I'm a LPN working for a major HH company as an Intake Specialist so no field experience, but one thing I do notice is that my branch does not send field nurses to known bad areas. They simply do not accept referrals from those areas, but there are other HH agencies in the area who do accept them. That is one of many reasons I like that branch of the company. They treat their field nurses like they are human beings and pay them well.

    OP, how is the job going for you so far? Do you like it?
    Last edit by LTCNS on Dec 3, '13
  6. by   sirdearis88
    So far so good. The hardest part for me was learning the charting. I'm enjoying the flexibility and not having to work 12hr shifts. I still pick up wknd shifts just to keep my skills.
  7. by   Tennisqueen
    Can you tell me the specific duties of an Intake Specialist?

  8. by   juliemck
    Is it possible to be proficient at HH if you are a new nurse and new to home health??
  9. by   Libby1987
    Quote from juliemck
    Is it possible to be proficient at HH if you are a new nurse and new to home health??
    No it's not, experienced nurses with the inherent wiring for autonomy and managing a case load are not proficient until they've had adequate orientation and experience. The learning of the complex regulations and reimbursement criteria as well as role and utilization of resources is very specific to home health.

    Now if you're hired into an agency that allows you to start slow with the uncomplicated simple routine patient visits it will be a lot easier of a transition but that isn't proficiency.