RN with GI condition

  1. I just started training for a new HH RN job and I am already afraid it's not going to work out due to a chronic GI condition that I've had since high school. In the hospital I was able to work around it, but I can see that in HH in order to get all your visits and charting in there is little time to stop.

    The preceptor I'm with does not stop at all and says she goes to the BR before she leaves and then not again until she gets home. She also doesn't eat. So, I have basically worked 9 hours straight today and only got to go to the bathroom once because I asked her if we could stop. My stomach was hurting so bad due to a full bladder. She didn't give me a hard time about it, but I feel absolutely horrible from not eating or stopping enough to go to the bathroom, driving all around in the heat, going into patients homes with often no a/c, dust and mold, animals jumping on me and some awful odors.

    I understand that some of this is just part of nursing anyway, but at least in the hospital I could go to the bathroom and got a break although not always when I would have liked to, but I could handle it.

    Is this typically how HH RNs work? I'm really worried because I will eventually be working 12 hour shifts and expected to get 27 points per shift. I don't want to just give up, but I also don't want to get myself so sick that I can't function and am completely miserable.

    I'd really appreciate input from other HH nurses on how they work and especially if it's possible to do the job with a condition like I described. Thanks!
  2. Visit runner502 profile page

    About runner502, ADN, RN

    Joined: Jun '11; Posts: 130; Likes: 35
    RN; from US


  3. by   caliotter3
    I don't see why you should have to try to adapt. Finding available bathrooms during the day while out and about is difficult enough for someone without a problem. If it were me, I would look for another nursing area, but you may want to give it a fair trial. Once you are on your own, you will control when and where you stop for necessary breaks. It might turn out to be doable for you.
  4. by   runner502
    Thanks for the advice/input. That was the only reason I was considering not giving up right away, but right now it seems like it will be impossible to get 9 points in one day. Even though I will be working a 12 hour shift, I can't imagine I'm going to be seeing many patients late in the day. The nurse that is training with me is a case manager for mon-friday 8-5 and basically does all her charting at the patient's house so she doesn't have to take any work home. I think she has to have 6 points each day. If I tried that with having to reach 9 points there is no way I would be able to see everyone. She's been a home health nurse for 10 years and a hospital nurse for like 10 yrs before that, so I know I shouldn't compare myself to her since I barely have a year of hospital experience and it's a second career for me.
    I think a doctor's office would be great for me with regular hours but around where I live it's almost all CMAs or LPNs. I thought home health would be good since I could spend more time with the patients but now that I'm seeing the whole picture, these working conditions may not be in my best interest. I will see how things go at least for this week. I hate to have to start all over looking for a job, but if that's what it ends up happening, I will just take it as a learning experience.
  5. by   OldDude
    A few things to consider...your ability to generate points is directly affected by the patients geographic location and their acuity and/or if you're there for SOC, ROC, visit, D/C or otherwise; and those are factors beyond your control. Since you are prohibited to use the patient's restroom you will soon identify decent public places in your area where you can routinely stop and go to the restroom. No, it's not the norm to go all day without using the restroom or eating "something." When you're through with orientation you'll have the independence and autonomy to schedule your stops as needed; even if it's just to clear the smell from your nose you carried from the previous patient. Charting in the home is widely encouraged but I disagree for two reasons...1. You are in the house considerably longer and some patients get impatient for you to get out of there and...2. I think the constant breaking of eye contact with your patient and no verbal interaction while you are pecking on the keyboard depersonalizes the visit. But, obviously, the opinions vary on this. I tried HH and hated it. My wife is a HH, PT, for 20+ years and wouldn't do anything else. Anyway, if you like that kind of work give it a try. I think it'll be different for you once you're on your own. Good Luck!
  6. by   runner502
    I appreciate hearing a different perspective because I was thinking the same thing about charting in the patient's home. The patient doesn't want to sit there waiting for you to do all of your work and I could see it in the patient's and family members while the nurse was doing it. But I've already heard the criticism from some of the supervisors saying they couldn't understand why nurses wait to do their charting and then spend 4 hours doing it later. I can now see why they do. One for time purposes and 2 because many of the homes are not somewhere you want to be in for one minute longer than you have to. I would much rather do my assessment, whatever skill I need to do and jot down notes. notes and chart only the essential parts. Then do the rest of the charting when I can do it in a comfortable environment. At least that's how I envision how I'd do it.
    I see that you do or did school nursing? How do you like it?
  7. by   OldDude
    My wife doesn't chart in the home. She'd rather get on home, kick back on the bed while watching all her DVR'd shows and chart in the comfort of her jammies.

    Yes, school nursing offers me the opportunity to work with the three of us...me, myself, and I...complete autonomy working with a group of elementary schoolers that have yet to accumulate a lot of social baggage and, for the most part, just want to be kids. If I didn't have to deal with their parents, it would be perfect hahahahaha!!! It'll be my last nursing job.
  8. by   runner502
    That sounds like a pretty good deal to me! I had thought of school nursing at one point since I used to work with kids (before I got my RN) as a special ed asst and substitute teacher from pre-k through 6th grade. Maybe I will look at it again if I end up leaving home health. Charting in my jammies sounds perfect too!
  9. by   caliotter3
    Have you considered extended care home health? Entire shift with only one patient and you would have access to a bathroom in the home. Not as sexy as visits, but a job nonetheless.
  10. by   runner502
    Thanks for the idea, but not really for me.
  11. by   Oldmahubbard
    HH must have really changed a lot. 20 years ago it was a rather laid back job, for the most part. People left the hospital and took a pay cut to come to HH because of the stress level in the inpatient setting.
  12. by   ruby_jane
    Quote from runner502
    Maybe I will look at it again if I end up leaving home health.
    Come to the school nurse side. We have saltines!

    As a former TB nurse, I would say...never, ever go to the bathroom in a patient's home. Ever. Before I was a nurse I worked for the state of Washington and I knew where every Starbucks was up and down the I-5 corridor (reasonably clean bathrooms).

    As previous posters said...the nurse you followed is doing it his/her way. Do I think we should be encouraging people not to eat lunch? Nope. Do you have to do it that way? Nope. It will take you a few months to be comfortable and get your rhythm about how and when to chart.
  13. by   Oldmahubbard
    I used to void before leaving the office around 9:30 and didn't drink much during the day. In all my years, I might have used a patient bathroom maybe twice? Only in a clean home, haha. I was lucky, I had a nice territory, for the most part.
  14. by   Have Nurse
    Poor thing! I did HH for about 5 years. In my orientation in the field, I made it clear that I will not be torturing my body if I need to use the rest room, or eat. I do best when I listen to it and there's no room for negotiation. Of course, I said it with a smile and brought treats for the both of us on occasion to soften the blow. It was fine.

    I good Preceptor will be kind enough to work around that. The upside to that is, you find out where the best bathrooms and places to grab food are!!