The reality is home health care is where the jobs are.

  1. This is the new reality. Medicare wants patients out of the hospital as soon as possible and does not want them readmitted (at least within 30 days). So one of the specialties with the most jobs for the near future is home health care. Home Health keeps patients out of the hospital. I want to bring this to the board members attention because I see a lot of posts from new grads about starting in home care. No, home health it not a good place to start your nursing career because you need the experience of the hospital. However, the problem is that many cannot find a job in a hospital to gain that experience. I get it! You want to work! You want to be a nurse! You want to make money and use the knowledge that you worked so hard for! Ideally, after about 2-3 years working in the hospital you would be ready for a job as a home health nurse. But unfortunately times have changed and they are not adding hospital nursing jobs. So unless some of the hospital nurses retire or leave there are no jobs there. So how do we solve this problem? The only answer I can think of is to lower our expectations of experience to 1 year of hospital or long term care nursing. Also to have new grads work with an experienced preceptor for the first 3 months or more when starting in home health. What do you think? How do we solve the problem of --How do new grads to get their experience to be home health nurses?
  2. Visit paradiseboundRN profile page

    About paradiseboundRN

    Joined: Mar '09; Posts: 355; Likes: 319
    Home Health Nurse; from US
    Specialty: 11 year(s) of experience in Home Health, MS, Oncology, Case Manageme


  3. by   AnnemRN
    I think it's getting harder for new grads to get into home health. I recently got a job where an applicant had to be experienced in OASIS to even be considered. I think most agencies want someone that can hit the ground running, at least that's how it is around here.
  4. by   lovinlife11
    Totally agree. Home health is the wave of the future.
  5. by   mvm2
    Maybe the nursing Jobs in Home Health are different then the aides, but My Home Health Agency is begging for Aides and you don't even have to have a CNA licence. They do provide CNA classes as well as any training you need to be a successful aide. So I did not know that the Home Health agencies needed 1 year experianced nurses. That is so sad because I think that home health are perfect first jobs for new nurses. You can learn and do a lot of skills, but not too overwelming like a hospital can be. I believe all new grads need that opertunity to get that first job, and I am with you that I think home health needs a lot of caring nurses for their clients. Lets face it there is not enough hospital jobs to give every nurse a job. There are other places in health care that need nurses and i feel that home health will keep growing at an astounding rate because there will not be enough nursing home space as well for all that need care.
  6. by   paradiseboundRN
    I still think hospital nursing is the best place for a new grad to start. This is because, she doesn't have to make decisions on her own. She has a lot of experienced nurses on the floor who can help her. But the problem is, there is not enough hospital positions for the new grad and there are many positions, even a shortage, of home care nurses. Therefore we are going to have to find a way for these these new grads to SAFELY provide homecare. I'm suggesting that they work one-on-one with a preceptor at a minimum of 8 weeks, maybe more. During this time, the new grad does not have her own case load. What are your thoughts on this?
  7. by   JMichelle59
    I'm a new grad BSN, I graduated in August. I've been applying to new grad positions at hospitals continuously since I graduated; but there are so many applicants applying and so few positions. I wanted to start in the hospital to get my training and my required one year of experience, but I don't want to wait and lose everything I learned either. This morning I got an offer to start orientation as a home health nurse in my area, which I start on Wednesday. Hopefully I will be trained over an 8 week period, that will be nice (I will learn all the details on Wednesday). I've been reading up on forums regarding home health because I'm not quite sure what to expect. I would rather start in a hospital, but I feel like I can't pass up this experience either.
  8. by   Not_A_Hat_Person
    I wanted to be a home health nurse from the start. I would've applied as a new grad, but HH agencies in my area don't hire new grads. Unfortunately, hospitals weren't hiring new grads either. I worked in LTC (assisted living and the Nursing Home from Hell) for a year before I went into home health.

    I like my job, but I wish it paid more. My agency has problems retaining staff because the pay rate is so low. Plus, a growing number of HH agencies are looking for BSNs. Fortunately, my agency has a scholarship program.
  9. by   NJnewRN
    I think that's nursing all around. They want people to hit the ground running. I mean how do you break into L&D, OR, ICU?
  10. by   MBrickle
    Quote from NJnewRN
    I think that's nursing all around. They want people to hit the ground running. I mean how do you break into L&D, OR, ICU?
    I ended up beginning my career in pedi home health. There are NO nursing jobs in the Boston area. I received this opportunity and jumped on it. I am a self-starter so it worked well for me, but I can certainly see how it may not be the best environment for everyone. I will say that I have noticed a shift in hiring. A year ago my company wouldn't hire a new grad unless they had a connection to he company (which I did) but a new company moved to the area that DID hire new grads and so now mine does too. We'll see if having experience helps to get a hospital jobs when the time comes.
  11. by   QueenNasus
    I work home health and i would shake in my boots to know a new grad is starting in my field. The job you have to rely on your instincts and experiences to know if a person is going septic. Or a wound is going to blow. Or if the person is starting to develop pneumonia. There are times i just had a gut feeling and the person would have been much worse if i did not listen to instinct. You need to listen and observe the subtle changes then make the md and pt and family all understand that there is problems. And then get them to act. If you do not identify problems the next visit may be days away. Then it is too late.
  12. by   Obalabi
    I work in home health and I'm still relatively new to nursing (but not to the world of work or of self-starting work, either). I don't know if it helps that I'm an experienced health care worker first and a nurse second, or that I'm well into my third (or is it fourth?) career, but I LOVE the work & I am so grateful that I was given the opportunity to develop into a better nurse in this specialty. My agency has been very careful about helping me ramp up, moving out of orientation to patients who were less critical first, then slowly as I felt more comfortable, to patients requiring a bit more attention. My supervisor has also been invaluable and quickly available by phone. As MBrickle pointed out, this is going to be the place more and more of us are going to start, because honestly, especially in the over-populated nursing world of places like the Northeast, hospitals just aren't hiring us. The difficulty is that, as in most fields, no one wants to pay for mentoring to happen over a long period of time. The ideal would be if home health agencies sent nurses out in pairs, to give new RNs time to develop the sort of instinct that QueenNasus talks about. But is there any company out there doing that more than during a brief orientation period?
  13. by   QueenNasus
    Where I work the nurses get anywhere is from a 2 -3 months or longer orientation period. I do PICC line, wound vacs, multiple tasks, I have any where from 5 to 6 visit in the day I personally have 1 of the highest mileage is in the company but I do get reimbursement at 50 cents a mile. But my area is very rural area some girls work in the city and drive 10 20 miles a day. Yes talking on the phone is a great part of my work and because of my mileage I do work at home but when I get my charting done in the home it's a lot easier. we do oasis but it is the nursing admission, discharge and or change of condition. I get paid by the hour and if I go over my required visits I get extra pay or I can file for overtime which it time sometimes it's not granted my hours are fairly flexible there are times when people don't wake up till late after noon ok people that have to be seen in the morning or I be in a biotic say have to be administered at a certain time but I do make my doctor's appointment I do get to see my grandchildren things at school I just drop off my grandson to school every single day I have flexibility where if I need to do my visits in a hurry and chart later I can. I have a lot of autonomy. My caseload is anywheres from 15 to 25 patients they don't all need to be seen every day I work with an LPN and between them we get our visits done also I have to rely very heavily on the LPN who is a godsend I get called anytime this changes in the patient. Do I love my job yes what I change it No I've done Hospital nursing I've done nurse managing in a nursing home I love everything I've done but the rewards that I have of being able to spend 1 on 1 time with my patient is by far much more rewarding is this setting. Because my agency is affiliated with the hospital in a large city my Pay is comfortable with the hospital pay which puts me at a very nice pay scale. I know for a fact my pay is just a few dollars less an hour than the DON at the nursing home i used to work with. A few years back she tried to hire me back and the pay offered was over 6$ less an hour than i was making then. On the down side yes I work on call yes I work holidays because being sick is a 24 hour 7 day a week issue. Yes I come across the cranky people but being nice and helping them usually wins them over although sometimes it doesn't work yes I do get my heart broken a lot especially when I have to discharge people that I know need help but I do need to follow the Medicare rules. I do a lot of teaching which is where my flexibility of time is really helpful if I need to spend half an hour or an hour teaching somebody about the disease process I can do it I don't have to rush them but 1 of my biggest issues is I'm out there alone it is my assessment skills that is being tested every day my creativity with dressings to get them to stay on because if not somebody to be called out there later that day. And like I said before there are sometimes days between visits where my call will make a difference between whether they do better or not. It is definitely not an easy job it is not no brainer type of job you have to know what you're doing if your new coming into this as a nurse you really need to be able to think on your feet.
  14. by   paradiseboundRN
    I agree, but the question is...How do new grads get experience if there are no hospital jobs??