LVN Homecare during this pandemic, advice?

Mintezia · May 13, 2020

I've been working in homecare since late 2018 while I was still living in nyc. I transferred over from LTC at two different facilities (one in an affluent area and the other in a lower income area) both experiences were nightmares. In total now I've been with 2 agencies. I live in WA now and still working in home health.

I've had good and bad experiences. I'll list the cons first.

Cons

-The agency I worked for in nyc was OK. What I didn't like about them was that they were only located in Brooklyn, so most cases were there. And most of the cases were Jewish families. I have nothing against them except problems came along with certain Orthodox families. To keep it short, this meant if you needed them to show you something or you needed assistance, you were usually out of luck if it was on a Saturday evening or night shift. Also commutes from Brooklyn are long when you live outside of the borough. But I stuck around because I didn't want to do LTC. At one point I lived literally 2 doors away from a facility and still made the 1.5 hour commute. The subway was cheap so it's not like I had huge costs to traveling.

-Being sent to Dementia cases where the client was 200+lbs and not able to move on their own...as a new nurse. I almost quit working for my first home health agency because of this. I eventually specified I will no longer do dementia cases for this very reason. All of them except one were nightmarish experiences. The daughter in one of the cases was an absolute witch. It was a 12 hour shift and she was there for maybe 8 hours. She was extremely cruel and the only reason I stayed because money was tight at the time.

-I worked for a client that was young and had a crippling condition. He apparently went through 4 pages of nurses, multiple agencies.

-more individual troubleshooting. This can be scary for a newer grad but it's best to stay level headed and figure it out. I remember when one of my clients was desatting quickly and they were asleep on a ventilator. Rather than waking up the parents I managed to quickly figure out how to get my client's stats up. Sometimes it's as simple as repositioning them or giving a few saline drops in the trach.

-you sometimes get really personal with the families' issues. I've seen multiple marriage strains or disagreements. You also might have to deal with a messy environment, which was especially true when I worked in nyc. In 2 instances I was sent to high rise public housing, which is extremely nasty. Elevators often break. Sometimes you might have pets in the house and the client or their family may decide to use pee pads. One case I accidentally stepped in poop because it rolled off the pad into a dark area.

Good

-for both my agencies I received better training than I did at the facility. I received thorough training that made a world of difference.

-low stress- there's a lot of downtime which means you can read, watch a movie or study. This may actually be a con for a more extroverted type because it can get boring

-decent money-this was a bonus to the above. And in certain places home health pays more than the facility for far less stress

-flexible schedule-you get to pick or reject cases. Sometimes the family makes it clear they don't want you. But there's so much work available it's not a problem. It might be different in more rural areas though

-no mandated overtime-this was another reason I remained outside of the facility. I wanted my time to be my own, plus it should be illegal to do anyway. They even did this to new grads. So one could easily find themselves doing a 16 (really 17 or 18 hour shift with paperwork+commutes). It's easy to get overwhelmed as a new grad and for me, the threat of mandated overtime was a huge risk to my license

-more autonomy

-family usually changes the trach. May or may not be good. As a new grad I didn't realize the significance of this until watching a trach change on a baby and seeing them gasp for breath. It was a quick trach change but as a new grad frightening for me.

-more graititude expressed by employers- you being there means a family member does not have to stay up or miss work in order to care for their loved one. In school home health was discounted by my teachers, but I think people fail to realize this. And caregiver strain is a huge risk.

Home health is also really good for those with small children. I've also met others nurses use home health to work extra shifts when they had another job. This one seems to be extremely common. It took me maybe around 7 months to feel confident in home health. Sure you might not use a lot of skills as you would in a facility, but to me high ratios just aren't worth the risk.

Risk of infection is low. PPEs aren't really needed as much as a facility unless you are a visiting nurse.

Floor_Nurse · May 15, 2020

.It looks like Mintezia said alot of what I might have said. It's good that you already have some nursing experience before going in to home care, because (from my experience) I am often on my own here in a patient's home. Many homes are far less sanitary than most licensed facilities. One mommy kept pouring the contents of one bottle into another. Even though it was the same med, the lot# and expiration dates were mixed up. She also hid certain narcotics (as if I might steel them?) but I was trying to count the narcs... only what I could see with my eyes. Another mom pre-poured my meds, that is, put a half-tablet onto a syringe with water... for me to administer. How do I know what's truly in the syringe?

There's a lot of good stories too. I don't need to call EMS if a g-tube pulls out, I can replace it myself. Getting approval for time off is easy. Some days are easy, and the pay is satisfactory.

Mintezia · May 17, 2020

I forgot to add I had 1 client I had to administer Gatorade via G-tube. There wasn't anything preventing him from having it but it was a strage request. I'm certain I could have refused and the family would hire someone else who would.

caliotter3 · May 17, 2020

The site forum that discusses extended care home health is called the Private Duty forum. You can also find appropriate information in the Home Health forum which is more meant for the intermittent visit type of home health.