Job Offer in Home Health

Kitiger, RN · Apr 8, 2016

I don't know what you mean by "0.8 FTE" or "0.9 FTE". Do you have a year or so of Med/Surg under your belt? I worked float for about a year (everywhere except Labor & Delivery, ER, OR, Psych, and Burns). Then I did about 6 months in cardiac step-down.

When I started private duty home health, I was ready for med/surg type patients. The equipment was another story. I had cracked an oxygen tank once, in nursing school, but never while working for the hospital. I called the on-call Resp Therapist, and she talked me through it. I was not ready for vents, although I was taught how to trouble-shoot, and how to maintain and change the circuits. I didn't understand why the different settings were ordered, or what early signs of trouble I should watch for. Ask to shadow a Resp Therapist for a couple of days. You will learn so much!

I have found that most of my clients have some type of breathing problem by the time insurance will pay for a private duty nurse. A few have been end-stage cardiac, or peritoneal dialysis, but most are Respiratory.

Home nursing requires a nurse who can work independently. There is no one nearby to show you how to do something. Also, there isn't much chance for socializing. You are working alone. If you do days, you have the opportunity to interact with the different therapists; that can be very interesting.

I have 'way more control over my schedule than I ever did in the hospital, but the hours are not as regular. I can have 40 hours/week scheduled, and then one of my clients ends up in the hospital, and BOOM, I'm down to 20 hours/week. Do not plan to work paycheck to paycheck!

I love home nursing. I can work with my client on his schedule. I have time to do the things that make nursing fun. I can do a better job with range of motion, for instance, because I have to time to do it right, and I have much more cooperation from my client when we can work toward his goals, and in his timing. In the hospital, I spent most of my time doing what must be done while trying to keep my patients safe. And there never seemed to be enough time ... . Here, I can enrich his life!

I work some weekends, and some holidays, but that isn't a given. Just be aware that you will get hours in proportion to your flexibility. In the hospital, I could ask for Tuesday off, but I might get Thursday off instead. No flexibility there.

Health insurance is another big difference. Hospitals usually give it. Home care agencies, not so much.

I am not good at multitasking. I learned to do it, but it never came naturally, and it was always more difficult for me than for my peers. I always did better in the critical units, where I could focus on one or two patients. Running the halls while the docs changed orders all day long was so difficult for me! Home nursing is my style, and I excel here.

I think not everyone has the personality to do floor nursing, and not everyone had what it takes to do one-on-one home nursing. You need to find what works for you.

I have never looked back! :)

iowanursemom · Apr 9, 2016

Thanks for your response!

KelRN215, BSN, RN · Apr 9, 2016

1 FTE = 40 hrs/week

0.9 FTE = 36 hrs/week

0.8 FTE - 32 hrs/week, so in home care that would likely be 4 days/week.

OP, are you talking about home health as in visits or private duty? The previous poster is talking about private duty, which is very different than home health visits.

iowanursemom · Apr 10, 2016

It's home visits not private duty.

Kitiger, RN · Apr 10, 2016

Yeah, I do private duty, a full shift at a time in a home. Home visits are a whole different animal.

CFLA.RN · Apr 10, 2016

Home health can be amazing at the right company. It's important to have the right training because it is very different from floor nursing. You have to remember that it's only going to be you in the home - there is no back up if you can't place a foley or draw a lab. There's a ton of charting, different charting systems make a huge difference. Simple ones, like Kinnser or Axxess are a breeze. HCHB can be frustrating, but if you do as much as you can in the home it won't be so bad. Home health can be extremely flexible if you set boundaries with your company and with your patients. Make sure that your territory is a reasonable area, there is nothing worse than having dead time because you're driving 20-30 minutes between visits and having to complete 6-8 visits a day. You really have to be able to handle constant change because days hardly go as planned, patient schedules don't always line up with your planned route, and there is always calls from the scheduler begging you to pick up "just one more easy visit" that turns into a 3 hour wound VAC.

Pros - can be flexible, usually pays much more than hospital, frequently have same patients for months at a time so you build relationships, become strong with clinical assessments and skills because there is no back up

Cons - can have the same patients for months (can be very frustrating, emotionally taxing), charting is 110% worse than hospital, patients call after hours, driving (car always loaded down with supplies), charting, charting, charting, always charting.

I worked one year in transplant and then moved into home health for the last 8-9 years. While I appreciate the flexibility home health gave me as a single mother, I eventually had to move into a different field because I got so tired of the charting. Everything else I loved.

Libby1987 · Apr 10, 2016

Home health is no longer as task oriented as it used to be. The primary focus now is avoiding readmissions of high aciuty patients. No task will do that, it's more about assessments, early detection, good judgement and giving your patients/caregivers good working knowledge. The tasks are easy, or at least learnable then easy.

The other important part is to stick with it until you become proficient. Agencies run differently but you can't negotiate until you know what and have something to negotiate. The first year is hard and it takes a couple of years to really gain traction and be autonomous. That's when you can take advantage of the flexibility. I never missed any of my kids' stuff but you can't expect to pull that off until you have a very strong grasp of all of the aspects.

milesims · Apr 13, 2016

I currently own a home care agency, and have done quite a bit of research on this topic.

It is generally lower pay when compared to the hospital, and you'll have to do a lot of driving around. But you will see so many different types of patients working in home health than you would working on one floor in the hospital. It is quite an adventure.

Also, health care is shifting into the home to lower medical costs, at least in North America. There could be a good chance of promotion working with a growing home health company.

CFLA.RN · Apr 13, 2016

I don't know what area you're in milesims but I've never seen a HHC position that offered less than the hospital, at least in my state. I went from making 19.50/hr bedside to 35/routine visit and 75/admit (9 years ago). Current rates in my area are 40-50/routine visit and 100-125/admit. LVN's are making around 35/visit. Salaries can be low but a lot of companies are moving away from straight salary and paying on visit or point system. The lowest paid salaries can be supplemented working PRN with other companies. Its easier to pick up extra visits in HHC than it is to have to pick up an entire shift at the hospital, especially if your visits are grouped together. Companies in this area sometimes pay 1/2 point or visit rate for traveling over a certain amount of miles. Sometimes they offer company cars instead. Benefits are not always as comprehensive as the hospital (insurance is more expensive, very rarely has tuition reimbursement, etc) but that's the trade off for having more flexibility.

And I definitely wouldn't say you'll see so many different types of patients - you'll see mostly COPD, CHF, HTN, Ortho, DM, and wound care. You'll talk a lot about medications and managing chronic illness.

Libby1987 · Apr 13, 2016

I currently own a home care agency, and have done quite a bit of research on this topic.
It is generally lower pay when compared to the hospital, and you'll have to do a lot of driving around. But you will see so many different types of patients working in home health than you would working on one floor in the hospital. It is quite an adventure.
Also, health care is shifting into the home to lower medical costs, at least in North America. There could be a good chance of promotion working with a growing home health company.

Healthcare in the U.S. shifted into the home to reduce costs decades ago and the pay isn't generally less than in the hospital.

And like the above poster stated, we most commonly see the same chronic illnesses and post ops. We need to have a broad knowledge to manage home health patients and occasionally we see something we haven't seen before but for an experienced nurse, it's mostly routine.

milesims · Apr 13, 2016

I don't know what area you're in milesims but I've never seen a HHC position that offered less than the hospital, at least in my state. I went from making 19.50/hr bedside to 35/routine visit and 75/admit (9 years ago). Current rates in my area are 40-50/routine visit and 100-125/admit. LVN's are making around 35/visit. Salaries can be low but a lot of companies are moving away from straight salary and paying on visit or point system. The lowest paid salaries can be supplemented working PRN with other companies. Its easier to pick up extra visits in HHC than it is to have to pick up an entire shift at the hospital, especially if your visits are grouped together. Companies in this area sometimes pay 1/2 point or visit rate for traveling over a certain amount of miles. Sometimes they offer company cars instead. Benefits are not always as comprehensive as the hospital (insurance is more expensive, very rarely has tuition reimbursement, etc) but that's the trade off for having more flexibility.
And I definitely wouldn't say you'll see so many different types of patients - you'll see mostly COPD, CHF, HTN, Ortho, DM, and wound care. You'll talk a lot about medications and managing chronic illness.

I'm in Canada. Over here, the salaries are lower than the hospital by an average of $10 an hour. At least in my province. I believe because this business is still growing.

I run a non-medical home care agency, and have talked with many other agencies and nurses regarding this topic. This is just from my experience.