Typical Day For A Home Health Nurse | Life of a Nurse

Hi guys, I thought it would be nice to start an ongoing thread to just post/vent about your usual day. With a lot of entries, it can sort of serve to show nurses who are thinking about getting into Home Health what it is really like on the good days and the bad. Specialties Home Health Article

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Not a bad day today... started back per diem today.

6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like I usually try to do.

8:00 am:6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that.

First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec steroids), reviewed her meds, VS stable, edema but no change. Off I go.

Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is back ordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re please give pt RX for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go.

Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now)

Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go

Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently, she was on spironolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back Thursday for labs. off I go

Next, funniest LOL, she answers the door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook and was taking her meds correctly. Then she pulls out five RX dated 1-21-03, two are new meds, but PRN types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason, she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relieved, she gives me a big hug. Off I go

Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad.

2:15 pm. Back to my township, drop wee wee at quest labs, drop off RX at the pharm, get to my house. Reheat leftover Chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much.

Worked on paperwork until 4:45, finished time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow.

Pretty routine kind of day today.

Anyone else want to share??

A Day in the Life of a Public Health Nurse...

 

Specializes in ICU, Agency, Travel, Pediatric Home Care, LTAC, Su.

Hiya. ICU RN here with 6+ years of experience. Looking for a change. Think that I am going to schedule a ride a long with one of the local HH agencies in the upcoming weeks. I really don't know a whole lot about HH. Most of what I know is from reading these posts on the HH forum. I am looking for a job where I can work straight evenings. For quality of life issues, I really need to find a 3p-11p job. I was wondering what questions I should ask my ride a long or interview person? What did you wish you had asked or do you reccomend asking? This is what I have come up with so far.

1- Is this job hourly or salary?

2- What do you consider full time?

3- Do you get paid per hour (regardless of if you are driving, doing paperwork, making phone calls, or seeing a pt.)?

4- Or do you get paid per visit?

5- Do you get a company car?

6- Do you get a company cell phone?

7- Do you get reimbursed 100% for gas and mileage and wear and tear on your car if you do not get a company car?

8- Do you have laptops or do you have to do the old fashioned paper charting?

9- What kind of orientation do you get?

10- What is the average daily/weekly mileage?

11- How many square miles, or counties, etc does this agency cover?

12- Know I need to ask questions on my personal safety but do not know how to work that ?

This is all that I can think of off the top of my head. Any input would be greatly appreciated. TIA.

Kimberly:)

I have been an in home peds LPN for many years through various agencies .The work is with children with trach, vent , gt, and many medical problems , but they do great in home with the right care. I love the work , but the pay has actually decreased over the last 10 yrs ! I heard that LPN,s can contract with medicaid directly and skip the agency and get much better pay for a lot less "agency" hassle. Does anyone know how to do this ? shansky

Specializes in SNF, home health.
I have been an in home peds LPN for many years through various agencies .The work is with children with trach, vent , gt, and many medical problems , but they do great in home with the right care. I love the work , but the pay has actually decreased over the last 10 yrs ! I heard that LPN,s can contract with medicaid directly and skip the agency and get much better pay for a lot less "agency" hassle. Does anyone know how to do this ? shansky

Yeah, I'd like to know if that can be done (contract through medicaid and skip the agency). I've been doing this for a few years with the youngest being 18 months to an 89 year old. My pay has increased with each agency that I apply to. But I know that eventually I'll be at the cut off point where I can't demand more pay. That's why I'm looking into going back to school.

Hi,

I have been out of the nursing field for about a year. Before that I worked on a medical-surgical unit at a hospital for a little over a year. I absolutely hated it. Now I have the opportunity to do home health nursing. I have a job right now that I like; it's not as challenging as nursing and sometimes I miss nursing. The agency pay is good, I would be making about 38% more than my current job plus mileage and cell phone reimbursement. The biggest drawback to me is the on-call stuff. I would have to be on-call one night a week and one weekend a month, or maybe a little more. They also do rotating on-call for holidays. Is this on-call schedule normal?

Any advice would be appreciated!!!

Specializes in SNF, home health.

Here I am again, I just posted raving about HH and now my patient got admitted to the hospital last night. :sniff: I had to convince the parent to take her to see her doctor. The doc strongly suggested that she be admitted tonight. That's probably a down fall about HH., if your pt gets sick enough you don't get to work. I might find my usual fall back case, that always needs a nurse to do a shift til she goes home again. I'll be praying for my lil' precious patient to get well. I ask those who read this to do so as well. Thanks.:saint:

I have been in home health the last 7 years straight and about 12 years total. This seems like a pretty typical on-call schedule. On-call is one downside to HH. Plus, a lot of HH nurses I know sometimes finish their documentation at home, especially if paid by the visit. If you would be hourly then this may not be an issue for you. But, the benefits personally and professionally, in my opion, you will reap being a home health nurse usually out weigh the on-call.

Specializes in LTC and Critical/Acute Care/Homehealth.

I really would like to do HH. I have just left a Nursing Home. Lord willing I will NOT work at another one. I need a change in direction. I believe that HH is it. Thanks for letting me know what to expect.

Hi all,

After the required 1 year of medsurg in the hospital post nursing school,(hated it!) I have decided to try home health. I am starting part time, so no mileage, no benefits, and no computer. I'll try it out and see. I went out with a nurse today, and I had to drive my shiny new car through horendous neighborhoods and park there! Got it scratched too! I am a bit spoiled and sheltered, and this is a little scary! I do want to make a difference and be a good nurse bla bla... Sigh! Pay is per visit. I got hopelessly lost on my way home, and decided to splurge $500 on a GPS navigation system. I cannot afford to be lost on winding highways, when I have to pick up kids from school!

:smilecoffeeIlovecof

I've been doing Home health for a few years now and going back to the hospital. Benami313, if you're seriously thinking about working for a HH agency, you really need to look into an agency that pays mileage because you are going to be using your car A LOT. Don't forget car maintenance. Instead of needing an oil change every 3 months, you're looking at every month and a half. Also, think about gas...with prices going up, it can get pretty pricey.

I'm leaving because of the paperwork. The pay may be a little better, but when it comes down to it, you're actually getting paid less because you're CONSTANTLY working. And as soon as you think you're back on track, the cycle starts all over again. Not only that, but it's the constant phone calls...the office will call you ALL DAY LONG, racking up your phone bill. My last phone bill was >200.00 -- a huge ouch on my pocketbook!

The good thing is you can set your own schedule; you're not stuck inside a hospital all day long; and you can run errands in between patients.

Good luck and hope everything works for you!

Specializes in Transplant.

I have been doing home care for 4 years. Rather than investing in a GPS system, why don't you just map out your assignment before you head out. I have used that method and http://www.mapquest.com has become my best friend. That has worked great for me.

I hope that helps.

Thanks guys. The mileage thing is definitely an issue, but I accepted a little more per visit in lieu of that. Mapquest is great, and I do use it a lot! But life is so unpredictable. One or two people cancel on you midway through the day, and suddenly I don't know how to get from A to C! I use mapquest as a backup, but the GPSis great! I recalculates when there is road work and detours and things that would otherwise have flustered me greatly!

Specializes in Gerontology, Med surg, Home Health.

I also bought a GPS and I'm using it as a tax deduction next year. The joke in my family is when they were handing out senses of direction in Heaven, I couldn't find the line!

My company gives all the nurses a cell phone so at least the phone bill isn't an issue and they have a mileage reimbursement, but I know what you mean about the wear and tear on the car....and my poor body trying to maneuver through some of the yards and houses is like being on Fear Factor!

Would it be rude to ask what all y'all make per hour or per visit?

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