home visit nursing vs hospital/clinic

Been there,done that, ASN, RN · Oct 1, 2013

Consider what you are escaping from.. and what you are escaping to.

Home health visits require traveling (sometimes great distances) for 45 cents a mile. That does NOT cover your time, gas, wear and tear on your vehicle.

You will be entering the patients home.Sometimes.. dirty, in a bad area , and you are the only professional that is responsible for what you find on the visit.

You will be assessing the patient and delivering care with what you can carry in the trunk of your car.

Reaching the physician for orders regarding your findings , will not happen in real time.

Can you tell I think Home care stinks?

babyjRN · Oct 2, 2013

I'll give you the other side (I work home hospice):

I have autonomy. Physicians generally respect my opinions and always listen to what I have to say. *I* am considered the expert at times.

I can set my own schedule as long as my patients are seen the minimum times per week. I can make personal appointments in the daytime without burning PTO.

I don't work nights or weekends.

I am not confined to a building, desk, or cubicle space.

Management and corporate are not breathing down my neck like they would be in a hospital.

I can focus on one patient/family unit at a time and spend as much time as they need.

I do get paid mileage and driving time. I get paid by the hour and not per visit (recommend).

HHN2472 · Oct 2, 2013

Well... I work in home health. I have worked in the hospital... the first poster mentions that .45 cents a mile doesn't cover gas, mileage etc... I bought a $5000 car that gets 35 mpg. I MAKE money on my .45 cents a mile. A pretty good chunk of extra cash really. Also, I work 8-4 M-F so I get my nights and weekends. I am balls to the walls, so I don't generally need to carry work home. I have a family I see EVERY afternoon, I can take my kid to school, I can drive the countryside and see the sights, run some errands, make dr. appts around my schedule, and I have an on call weekend about once a month where I get paid extra and even get a 2 days of during the week to make up for my weekend on so I can use those two days to get business done that I wouldn't normally be able to because I work M-F 8-4. I love my patients, and they welcome me in their home. They know me well, I know them, their family, their likes and dislikes. They are MY patient for sometimes months on end and there is a kind of rewarding feeling from that I cannot explain. My elderly patients think of me as one of their grandkids. They know and remember my birthday, my son's birthday... I help them manage their chronic diseases and prevent exacerbations and the feeling of catching something before it gets out of hand is amazing and makes me feel as if I make a difference in their lives. The work is generally light considering there is no heavy lifting, no standing on my feet 13 hours... The documentation is longer, but to me SO worth it. The ability to be able to get up and leave my office and run to walmart if I feel like it is great. I can take time and do paperwork at home if I need to if I want to take off to go visit my son at a school function, I can work around my life. I am telling you what I PERSONALLY feel about home health, but that is me and nobody else. We have our not so sick chronic patients and we have our patients on TPN or vents, central lines etc... I have found it easier to care for people in their home, but again, that is just ME :) I disliked the hospital, I had high blood pressure, stress, felt exhausted with a bad back from standing and running my legs off, I left and never looked back. I hear a lot of bad stories about home health and it is stressful at times but to me the good outweighs the bad.

stylishgurl · Oct 2, 2013

I am novice to field nursing and so far I am liking it I've been working as Med-Surg RN for 7 years and field nursing is way a lot better less stress more autonomy and it's just awesome I am just hoping it won't close down.Best of luck and I believe if you keep wondering it's worth the experience.

jive turkey · Oct 2, 2013

Well... I work in home health. I have worked in the hospital... the first poster mentions that .45 cents a mile doesn't cover gas, mileage etc... I bought a $5000 car that gets 35 mpg. I MAKE money on my .45 cents a mile. A pretty good chunk of extra cash really. Also, I work 8-4 M-F so I get my nights and weekends. I am balls to the walls, so I don't generally need to carry work home. I have a family I see EVERY afternoon, I can take my kid to school, I can drive the countryside and see the sights, run some errands, make dr. appts around my schedule, and I have an on call weekend about once a month where I get paid extra and even get a 2 days of during the week to make up for my weekend on so I can use those two days to get business done that I wouldn't normally be able to because I work M-F 8-4. I love my patients, and they welcome me in their home. They know me well, I know them, their family, their likes and dislikes. They are MY patient for sometimes months on end and there is a kind of rewarding feeling from that I cannot explain. My elderly patients think of me as one of their grandkids. They know and remember my birthday, my son's birthday... I help them manage their chronic diseases and prevent exacerbations and the feeling of catching something before it gets out of hand is amazing and makes me feel as if I make a difference in their lives. The work is generally light considering there is no heavy lifting, no standing on my feet 13 hours... The documentation is longer, but to me SO worth it. The ability to be able to get up and leave my office and run to walmart if I feel like it is great. I can take time and do paperwork at home if I need to if I want to take off to go visit my son at a school function, I can work around my life. I am telling you what I PERSONALLY feel about home health, but that is me and nobody else. We have our not so sick chronic patients and we have our patients on TPN or vents, central lines etc... I have found it easier to care for people in their home, but again, that is just ME :) I disliked the hospital, I had high blood pressure, stress, felt exhausted with a bad back from standing and running my legs off, I left and never looked back. I hear a lot of bad stories about home health and it is stressful at times but to me the good outweighs the bad.

now that and the hospice nurse sound a lot more like what im talking about. im a dialysis nurse. I started out in home health but I stayed with one patient the whole day rather than make visits and leave. dialysis would be much more enjoyable if I werent overwhelmed with twelve patients per shift, meds,, symptomatic patients, and a bunch of charting and logs. does the home visit schedules have to be M-F or can you tailor it to 3 days? thank you everyone for your input

jive turkey · Oct 2, 2013

babyjrn tell me more! one to one patient care without being rushed is what I love. I hate being rushed away from a patient because of time constraints

babyjRN · Oct 3, 2013

The only time I feel rushed is if another one of my patients is in crisis and needs me. Other than that, I decide how much time I can spend on each patient. I do have minimum number of visits to complete each week but beyond that I am free to set my schedule as I see fit.

I am a case manager and I don't really see how one could do this job only 3 days per week (at least not hospice....maybe home health ?). I do know of some that are .8 however.

LadyFree28, BSN, LPN, RN · Oct 3, 2013

I did 3-4 days per week in Home Health private duty; I would do two days with one particular client and 2 with another; it gave me variety. I enjoyed being able to teach and see the nursing process at work with my patients; whether there was improvement or maximizing their current functional patterns. I also did home visits intermittently. I worked in Pedi home health.