Inquiring about HH Nursing

somenurse · Dec 29, 2012

You might find looking over the "stickies" articles helpful, as well as scrolling back over the other topics in this area.

I have only worked HH off/on, but, since no one else has replied, i'll share my ideas.

//"How much training does a HH position provide? Do they just throw you in on your own?"//

Beyond general orientation, for that organization, and their method of charting and charting for medicare patients prn, there is usually training for each individual home.

When i have worked HH, i rec'd some training when given a new patient, for THAT patient. This would happen in each and every home (unless new admit) This reduces workload on that family or patient to train each and every nurse who enters their home. This training was usually done by a nurse who was familiar with that particular patient, similar to a mentoring, and it might as short as an hour, for a simple patient, or an entire shift.

If you need more training to feel comfortable with that patients needs, you'd have to let them know.

//"How do you get paid? Hourly, salarly, per visit? Do you get mileage paid? "//

This varies from one org to another. Most nurses agree hourly is better than 'per visit' pay. I have not personally ever been salary when going home to home, but, i was once salary when i was working in the office of a HH org. Several threads in this area have posts by nurses stating that salary pay ends up with drawback of doing a lot of unpaid, or barely paid overtime work.

Everywhere i have worked did offer mileage.

//"Any information would be greatly appreciated. Also, if anyone working in HH can give me pros or cons of why you work in this area, that would be great too. "//

Each nurse might give you different answers, but here are some of my pro's and cons. There are several ways to work HH, from doing an entire shift in one home, which is usually not a hectic day at all,

to going home to home all day, doing skilled nursing care (IVs, dressings, trach care, blood draws, foleys, etc) which can feel slightly more pressure to get all the visits done and not spend TOO much time in any one home.

There is also pediatric HH, too, which are often shift work.

One can also be a HH 'admissions nurse', which i personally find to be kind of hard work, admitting new patients, has endless paperwork.

The kinds of patients you care for, can be anything from fairly simple patients, to occasionally very complex patients.

Just off top of my head, but, hopefully, someone else will be by to give better answers:

PROs

Less stressful, imo.

More time to do the things you want to do for the patient.

You get to really know the patient so well, as well as their family. This can often be a very rewarding bond, and you can really feel you are really making a difference for someone, reeeeally helping someone.

More flexibility in hours.

Way more autonomy.

Often can be very creative work, finding solutions with what you have on hand.

Way less interruptions in your work, although some minor multi-tasking can still be req'd.

The patients are almost invariably so so glad to see you, and very fond of you, and very appreciative, and become attached to you. Not like in hospitals where you run into some cranks. It's usually very pleasant work relationships there, less stress, imo.

CONs

Tons of paperwork or laptop work. If the org is using OASIS charting, i find OASIS overwhelming at times. I am not nearly as good at OASIS charting as other nurses are.

Some HH nurses end up doing their charting at home, in their off hours, that can get old and cut into family time.

Lotta time in a car, wear and tear on your vehicle that mileage doesn't really pay at all. If you like chatting on cell phones, listening to music or books on tape, it can help reduce the boredom of alll that driving.

No or few coworkers, which can be also be viewed as a plus, depending on how social you are. In some homes, you will occasionally cross paths with a respiratory therapist or PT or OT, or CNAs, etc, but, mostly, you don't see any coworkers.

Can be boring, is rarely exciting, if you have high need for that. Exciting in HH is usually not good. at all.

You have to be organized, such a bummer to get allll the way out to that one home that is so far away, and realize you don't have enough dressings or the correct size foley or whatever.

You are mostly on your own, to decide what is a problem, what to do, etc. Not completely, cuz you can always call your office or the doc, but, mostly, it's down to you & your eyes and ears to decide.

If you have poor navigational skills, or no GPS in your vehicle, it can be harder to figure out how to get from this one house to this other house. (not directly from the office, but, from one home on your list to another) You pretty much have to have GPS.

If you are doing the 'home to home' skilled nursing kind of HH, I think THAT kind sorta bites in winter when roads are icey. I myself dislike driving in winter, but, most ppl don't.

For some orgs, or some areas, your patient load can be variable, and if you are being paid hourly, you might encounter weeks where you aren't getting enough hours. For other orgs, in other areas, this might not ever ever ever be a problem though.

btw, i think 3 years nursing is sufficient background to do HH, imo.

LadyFree28, BSN, LPN, RN · Dec 29, 2012

I have worked in home health for about 7 years. There are two types of HH nursing: treatments, where you get a caseload and travel to see a list of clients, or one on one nursing, which allows you to have one patient for a set amount of hours.

In my experience, when I've had shift nursing, I usually had up to three cases, especially because you end up losing that case if they are sent to the possible. Visit nursing does allow mileage and there is always a case load in case one of your clients end up in the hospital.

I have never used OASIS, due to the fact I was not a nursing supervisor in the companies I worked for, even when I did visits either.

sue1000 · Dec 30, 2012

Thank you! Great Information!!!