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Is home health that bad?

Home Health   (46,451 Views 44 Comments)
by trinan71 trinan71 (New Member) New Member

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23,384 Visitors; 3,726 Posts

I took a home health job after MUCH consideration. I previously worked in the ICU. I thought I had thoroughly weighed all the pros and cons, but unfortunately I greatly regret my decision. My days are LONG- 9 hours minimum. Admission charting will make you rethink your entire nursing career. I feel like all I do is work and sleep. My schedule constantly changes- I can look up all of my patients and then something happens and I have to look up new ones. This obviously adds to the length of your day. My territory is very large and my patients can be 20 minutes from eachother. Trying to fit in 5-6 patients a day, with driving time plus documentation-- it just cant be done in 8 hours (and I am a VERY organized person). I am also being frequently sent into the very bad sections of the city, though I live about 35 minutes away. I grew up in the country and unfortunately cant say I have any street smarts. It scares me just DRIVING down those streets, let alone finding a place to park, walking past the gang in front of my patients house, and going in. Talk about fear :(. I also have some pretty creepy patients at times-- remember, you are in their house ALONE. I carry mace, but still..

These are just some of the things that I failed to consider, so I hope they are helpful to you. There are positive aspects to the job as well-- you can start your day at home, finish your documentation at home, truly see improvement in patients, develop a connection with patients and care about them, and it is the best paying job I have had to date. I guess you just need to consider whether you are ok with very long days, and possibly being sent into unsafe situations. I noticed you mentioned about travel nursing. Most likely the places you would be sent as a traveler would be the places no one else wants to go ;). Just something to think about!

I wish you well with whatever you choose to do! If you do take the plunge, you can always get back into the hospital if you end up hating it (I am currently applying). Like you mentioned though, you may lose a hard to find position (for me that was dayshift in a very well run ICU).

If it's not working for you, it's not working, but with all due respect, you've been in HH only about 6 mos. if you were to stick with it another 6-12 mos, I'm sure you would see that time shave off. A couple of more years and with natural organizational skills, you'll be doing it with much more ease. Experience does make things go quicker and easier.

As far as scary neighborhoods, that depends on where you live (we don't have scary neighborhoods in our entire semi rural/rural service territory) and what territory you negotiate. A HH Case Mgr with a couple of years + experience is marketable and you could find yourself something different/better.

Good luck to you though, it sounds like you gave it a good try and it just isn't for you.

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1,181 Visitors; 6 Posts

"Actually I haven't took the leap to become a HH nurse. I am still a med surg nurse. I was just wanting everyone's opinion if they feel this is worth making the transition from the hospital to home health. It seems everyone is overworked in HH and I didn't want to make a mistake making that transition.

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1,382 Visitors; 47 Posts

Have you talked to anyone that works at your local agency? I would do that before making a decision. At my agencies (I work at 2) we are paid hourly and we absolutely ARE paid for our charting. Some days I might drive 3 miles, others I may drive 35, but we are paid for both our travel time and our mileage. Pay sounds like it varies greatly in different regions of the country and depending on how you are paid (per visit vs salary vs hourly). I think that I am very fairly paid. In my experience, Libby1987 is correct in saying that the first year is the toughest, and that being organized is a huge advantage. At my 6th month point, I felt like I was horrible at my job and was acutely aware of how much growth I still needed to attain. It was frustrating, but I read on here that it got better, and I forged ahead. :)

That said, there ARE some days that are stressful; days where you have multiple patients with unexpected issues crop up or you have multiple admissions, which are more time consuming. There ARE some days where I am not able to chart on everything before going home, but that is not my norm. Being behind on charting is the norm for some people at one of my agencies (the other does not tolerate late charting), even those nurses with YEARS of experience, so again, I think that being organized and focused is key.

At this point in my career, I wouldn't trade what I am doing for any other nursing job. It allows me to work a family-friendly schedule and I can typically arrange my schedule so that I can pick up my kids from school. I love my patients, I love having only one patient at a time to focus on, I love the impact I have on patient lives and love driving around and seeing the beauty of the landscape I live in. It would be extremely difficult for me to give that up and be stuck inside all day!! There are certainly downsides, especially if you work for an agency that doesn't give adequate orientation (mine did not, but I am a very strong independent learner and spent an incredible amount of off-work time researching and learning) but the upside for me, is absolutely worth it.

I think you need to sit down and think about why you are interested in switching to home health. Write a list of questions you have and then talk to someone at the agency where you want to work. Come back here an look for feedback, after you talk to someone. I think you can't really make a decision until you have a better idea of what things are like in YOUR area.

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gibsongirl has 33 years experience and works as a RN.

2,024 Visitors; 108 Posts

Try per diem before you accept the position. You will have the opportunity for a birds eye view during orientation. Ask to orient with more than one nurse to get more than one perspective and see if you pick up trends. Ask the nurse when and how she begins her day, breaks she takes, travel time, how and when she ends her day. It's that simple. See for yourself how much time it takes for you to review a chart, make an appointment with the patient, document, travel. Then consider call you will have to take, case conferences you will need to attend if you are a full time RN.

Edited by gibsongirl
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AtHomeNurse has 16 years experience and works as a Home care RN.

2,980 Visitors; 236 Posts

I took a home health job after MUCH consideration. I previously worked in the ICU. I thought I had thoroughly weighed all the pros and cons, but unfortunately I greatly regret my decision. My days are LONG- 9 hours minimum. Admission charting will make you rethink your entire nursing career. I feel like all I do is work and sleep. My schedule constantly changes- I can look up all of my patients and then something happens and I have to look up new ones. This obviously adds to the length of your day. My territory is very large and my patients can be 20 minutes from eachother. Trying to fit in 5-6 patients a day, with driving time plus documentation-- it just cant be done in 8 hours (and I am a VERY organized person). I am also being frequently sent into the very bad sections of the city, though I live about 35 minutes away. I grew up in the country and unfortunately cant say I have any street smarts. It scares me just DRIVING down those streets, let alone finding a place to park, walking past the gang in front of my patients house, and going in. Talk about fear :(. I also have some pretty creepy patients at times-- remember, you are in their house ALONE. I carry mace, but still..

These are just some of the things that I failed to consider, so I hope they are helpful to you. There are positive aspects to the job as well-- you can start your day at home, finish your documentation at home, truly see improvement in patients, develop a connection with patients and care about them, and it is the best paying job I have had to date. I guess you just need to consider whether you are ok with very long days, and possibly being sent into unsafe situations. I noticed you mentioned about travel nursing. Most likely the places you would be sent as a traveler would be the places no one else wants to go ;). Just something to think about!

I wish you well with whatever you choose to do! If you do take the plunge, you can always get back into the hospital if you end up hating it (I am currently applying). Like you mentioned though, you may lose a hard to find position (for me that was dayshift in a very well run ICU).

im sorry it stinks so much for you, but it sounds like you have some fear of people in general that is playing into your discomfort, and maybe home health isn't the best place for you. I work for an agency that has a very large territory. I can visit a rural trailer park (complete with rusted out cars and chained dogs) and an inner city homeless shelter all in the same day. Initially I though i would be scared of these places and people, but I have yet to encounter a situation where patients have been anything less than happy to see me, and I have never been harassed by the gang members on the corner. Mind you, these are not areas I would ever go to at night, and my agency is very clear that if a situation looks or feels unsafe you don't go. You might spend some time thinking about if your anxiety is founded, or based on stereotypes etc. are there high daytime crime rates in the areas you are going to? Honestly, violence in hospital settings is so prevelant these days, I personally wouldn't go back to a hospital setting for that reason.

Visit speed and documentation speed come with time. I can easily finish 4-5 visits in my 6 hour day, including longer drive times. Oasis admits don't phase me at all, yes it's a lot of paperwork, but again once you are accustomed to doing it, and understand the right way to do it (it's not like any other charting for sure!) it is not a daunting task.

My one complaint with HH is in relation to my position as a per diem. Some nurses just suck at coordinating and communicating plan of care. I don't case manage, and some days I can spend an hour or more just trying to figure out why exactly we are still seeing someone I am assigned a visit with, what's been done for them, what still needs to be done or what the discharge plan is. And, unfortunately, those nurses that stink at planning care also stink at documentation, and also fail to answer emails or phone calls. Interestingly, my agency rates excellent in every area of care, except our readmission rate which is the highest in the state and above national average. It doesn't take a genius to make the connection.

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lgag30 has 4 years experience and works as a Registered Nurse.

1,521 Visitors; 39 Posts

Try private duty. Not much paperwork (I never take home). With the same patient all day. And a good transition to home care. I work for Bayada and I know there are many similar companies

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280 Visitors; 1 Post

I can relate to your experience in this area, there are many challenges in this field. But, I am glad to have found that home healthcare PRN works very well for me in my current season of life. Prn gives me a greater flexibility with the schedule and I avoid after hours call visits. It seems that with home health, in my experience, part-time is full time, and full-time is all the time, unfortunately..

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1,763 Visitors; 30 Posts

I have been in HH 7 short months. I left 6 years of bedside nursing with my last 2 in ICU. I hated the bedside. I knew I was unhappy but didn't realize how unhappy until I left. I love love loove home health. I work under the Amedisys umbrella and have found them wonderful to work for. I feel so lucky to work in the office I do. My bosses are literally the best ladies EVER!!!! If I had to a complaint it would be call. We do take it two week nights a month and one weekend (with another RN) every 4-8 weeks, so that can suck but with that said I have gotten 0 calls my last 4 weeknights. Weekends are usually busy but as a paid per visit employee I feel we are so well compensated. I make 1000-1800 A MONTH more than I made at the bedside. Best of luck in your choice!

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Idaho_nurse has 18 years experience.

1,107 Visitors; 66 Posts

I absolutely LOVE home health. I have been in the medical field for aprox. 20 years and have worked in MANY different areas from ER, OR, clinic, and long term care. I was unsure how I would like it when I took the job, but I have truly found MY niche in this field.

That being said, its a very difficult job, especially for a new grad.. not saying they cannot thrive, but in home health (at least in mine), you MUST have a very broad knowledge base. I work very rural, often times in places where there are no cell coverage, so you really have to be able to think on your feet and be efficient and have a very strong clinical skill set. Your the only person that the patient may see.. in my job, being so rural, many of my patients cannot even get to the doctor if they cannot drive or have people helping them. You really can be their lifeline. Triaging what is important and focusing on the big picture can take some talent You have no help and why I think many nurses fail in home health is because they do not have the experience to think outside the box or have a strong clinical "know how". You are on your own out there, so accurately noticing a problem before it becomes a critical issue is paramount. Again, many nurses are just not confident in their skills or have the ability to be completely independent and handle a possible critical situation. Many who have worked one particular field (such as long term care... this is just an example), may not have experience in, for example, wound care... again it comes down to confidence and a strong, widely varied skill set. I'm not saying that its not a good job or field to get into... I am just saying that the nurse has to be confident in her abilities and skills. In HH, there is nobody there to help you if you dont know the procedure, its up to you to figure it out and "do no harm". Yes, you can get feedback and call out for help, but you cannot just "call" another nurse in to help you IN THE MOMENT. Time management is also a factor. in MY agency, you DO get paid to chart as all our charting is done on tablets, and you get paid mileage. I get paid well, and I love my rural drives.

That being said... not everyone is right for this job and there is no shame in that. There are TONS of disciplines to try out. What I dislike about nurses coming into the agency is that they dont know when to throw their hands up and say "this field is not for me" and quit. I have seen nurses (who, IMO, shouldnt even BE nurses), stick it out even though they put the patient at risk and creating more problems with co-works. Again, there is no shame in saying that and moving on to a different discipline. I really cannot imagine working in any other field now. Good luck in your decision.

Edited by Idaho_nurse
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IceDancer has 20 years experience and works as a Retired RN.

573 Visitors; 16 Posts

I worked in home care for nearly the last fifteen years. My job in our agency was primarily admissions. The paperwork and information collecting for admissions is something like you have never seen, but I had it down to a science. I know that when I had orientees or students go out with me, one of the main things they said they were impressed with was my ability to give the patient and family my full attention, continue to collect all my needed information, and at the same time weed through what is immediately relevant for the RN, what needs to be pushed down the care plan for later, what needs to be directed to another discipline etc. etc. And at the same time I am reassuring the folks that we will be addressing all of their needs but that Rome was not built in a day, we will be back again, first impressions are very important to patients and families.

You have to be a very good teacher...not only to you continue to educate the public on disease process and management, you have to teach lay people to do basic medical procedures that they are often terrified off...you gotta be the cheerleader for them. You must sense what someone can and can't learn. You have to be nosy...very nosy. Check every med bottle, reconcile every current order. Nine times out of ten there will be some discrepancy on an admisson....many folks have never had their meds gone over with a fine tooth comb, I have found all kinds of weird stuff in med bottle and boxes over the years. You will be able to load a mediset faster than Secretariat.

Communication is huge. If you are a case manager you need to keep in communication with the docs and the other members of the care team. In particular my job was to communicate with the case managers. My reports to the case managers had to be good....complete. I did not want them walking into a mess they were unaware of, or dumping something on them I could have taken care of during the admission process.

I think my favorite part of the job was that many people told me it was the first time they ever had uninterrupted time with a medical person. There I am, rocking in their easy chair, and they could ask me as much stuff as they wanted. Usually they ran out of questions before I ran out of time, I could almost always chart while we chatted if I needed to stay a bit. They loved the non rushed attitude...very rare in the medical world. What others have said about weird homes and bad neighborhoods is true...I would say be very choosy what area the agency is in that you choose to join.

You must have excellent people skills, be able to diffuse frustration and anger (hey, you may be the first time they have had a medical person around for that long, but they might be furious with the medical system and want you to know it). One of my most difficult cases is a person that really should be in Hospice and somehow the referral missed it's mark and they were sent to home care. I can't count how many patients I have helped guide to Hospice in that very first visit or sometimes even over the phone. Talk about emotions running high. Sometimes it was just briefly mentioned to them, and by the time I call, they are only then ready to discuss it. That leads to the point that, if they are not appropriate for home care for whatever reason (they may not be homebound for instance) it is my job to direct then where they can get help..that might be outpatient, a clinic, etc. I never just leave and say, "Well, ya don't need us, see yuh" there is always follow up communication.

Above all, I am a sticker for acute care experience for new home care nurses. I also think they are better to start as a staff nurse like I was all these years instead of case management if possible, to get their feet wet. Case management is a tough job. I personally feel that three years is minimum for the hospital experience, but most agencies will say one year is sufficient. I was an inpatient Oncology nurse for five years before I started, and I still got a bit intimidated when I realized it was just them and me, no back up to call other than 911, no other nurses to run stuff by (at least not right away), no docs.....your assessment skills and "gut feelings" need to be spot on if you are going to be good in home care, and that really comes with dealing with the very sick in an inpatient setting for a while.

I have recently retired for medical reasons. I miss it... and I don't, as I am sure other nurses can understand. I was very flattered recently when I stopped by my office to say hello and one of the case managers said, "Nobody does an admission like you, I miss it!" And my previous boss said, "I hate that I cannot put new people with you anymore, they are missing out" Boy did that feel good. I know all those years of blood sweat and tears made a difference.

Finally the only other thing I can say is that you should like driving and spending time in your car. It will be your new part time home if you work in home care.

Edited by IceDancer
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23,384 Visitors; 3,726 Posts

I worked in home care for nearly the last fifteen years. My job in our agency was primarily admissions. The paperwork and information collecting for admissions is something like you have never seen, but I had it down to a science. I know that when I had orientees or students go out with me, one of the main things they said they were impressed with was my ability to give the patient and family my full attention, continue to collect all my needed information, and at the same time weed through what is immediately relevant for the RN, what needs to be pushed down the care plan for later, what needs to be directed to another discipline etc. etc. And at the same time I am reassuring the folks that we will be addressing all of their needs but that Rome was not built in a day, we will be back again, first impressions are very important to patients and families.

You have to be a very good teacher...not only to you continue to educate the public on disease process and management, you have to teach lay people to do basic medical procedures that they are often terrified off...you gotta be the cheerleader for them. You must sense what someone can and can't learn. You have to be nosy...very nosy. Check every med bottle, reconcile every current order. Nine times out of ten there will be some discrepancy on an admisson....many folks have never had their meds gone over with a fine tooth comb, I have found all kinds of weird stuff in med bottle and boxes over the years. You will be able to load a mediset faster than Secretariat.

Communication is huge. If you are a case manager you need to keep in communication with the docs and the other members of the care team. In particular my job was to communicate with the case managers. My reports to the case managers had to be good....complete. I did not want them walking into a mess they were unaware of, or dumping something on them I could have taken care of during the admission process.

I think my favorite part of the job was that many people told me it was the first time they ever had uninterrupted time with a medical person. There I am, rocking in their easy chair, and they could ask me as much stuff as they wanted. Usually they ran out of questions before I ran out of time, I could almost always chart while we chatted if I needed to stay a bit. They loved the non rushed attitude...very rare in the medical world. What others have said about weird homes and bad neighborhoods is true...I would say be very choosy what area the agency is in that you choose to join.

You must have excellent people skills, be able to diffuse frustration and anger (hey, you may be the first time they have had a medical person around for that long, but they might be furious with the medical system and want you to know it). One of my most difficult cases is a person that really should be in Hospice and somehow the referral missed it's mark and they were sent to home care. I can't count how many patients I have helped guide to Hospice in that very first visit or sometimes even over the phone. Talk about emotions running high. Sometimes it was just briefly mentioned to them, and by the time I call, they are only then ready to discuss it. That leads to the point that, if they are not appropriate for home care for whatever reason (they may not be homebound for instance) it is my job to direct then where they can get help..that might be outpatient, a clinic, etc. I never just leave and say, "Well, ya don't need us, see yuh" there is always follow up communication.

Above all, I am a sticker for acute care experience for new home care nurses. I also think they are better to start as a staff nurse like I was all these years instead of case management if possible, to get their feet wet. Case management is a tough job. I personally feel that three years is minimum for the hospital experience, but most agencies will say one year is sufficient. I was an inpatient Oncology nurse for five years before I started, and I still got a bit intimidated when I realized it was just them and me, no back up to call other than 911, no other nurses to run stuff by (at least not right away), no docs.....your assessment skills and "gut feelings" need to be spot on if you are going to be good in home care, and that really comes with dealing with the very sick in an inpatient setting for a while.

I have recently retired for medical reasons. I miss it... and I don't, as I am sure other nurses can understand. I was very flattered recently when I stopped by my office to say hello and one of the case managers said, "Nobody does an admission like you, I miss it!" And my previous boss said, "I hate that I cannot put new people with you anymore, they are missing out" Boy did that feel good. I know all those years of blood sweat and tears made a difference.

Finally the only other thing I can say is that you should like driving and spending time in your car. It will be your new part time home if you work in home care.

This is a seasoned home health nurse who really gets and knows how to implement the role. I bet that agency misses the heck out of you!

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IceDancer has 20 years experience and works as a Retired RN.

573 Visitors; 16 Posts

This is a seasoned home health nurse who really gets and knows how to implement the role. I bet that agency misses the heck out of you!

Your comment brought tears to my eyes this morning Libby. Thank you so much for those kind words.

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