Need advice on new job offer

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Specializes in cardiac/education.

If you can offer insight, I'd appreciate it.

I am an RN that graduated in 2007 and only worked a few months on a hospital floor before staying at home to raise my children. I am now currently enrolled in a refresher course and have taken a few classes towards my BSN. On a wing and a prayer, I applied for a home care weekend PRN position, interviewed, and was hired on the spot. This surprised me since I have not had any recent RN experience.

The lady I interviewed with was super nice and told me a lot about what the job would entail: Mostly admits on weekend, mostly older adults..medicare..many of which can be pretty acute since they will have been d/c'd from hospital day before. I'd do admits and regular visits, there could be a lot of driving involved since this is a semi-rural area and there could be as much as 45 min drive between pts. Typical is 3 admits per day. $65/admit, $45/visit, and 0.45 cents per mile reimbursement. I reiterated to her that I had nearly no experience and she repeatedly ensured me extensive training would be provided, including IV classes, wound vac training and cert, and then some. Oasis training as well and training on the tablet system they use.

I actually called her back to decline the position as my gut was telling me to be fearful. But, again she was super nice and reassuring, telling me that orientation would be sufficient, they have hired others like me in the past, and that they wouldn't just "leave me hanging". I told her i needed to mull it over and that I would call her back in a few days.

This is a rural area so I am thinking that is part of why there is such a need-smaller applicant pool. This area is also exploding in terms of needing home health. She also said she is wanting to hire people that are looking to advance, that there is promotion opportunity here. I would be commuting 1.5 hrs for this job and staying overnight in this town to get this experience since jobs are scarce here for new grads and I don't want to pass up an opportunity that also lets me continue to stay home during the week and care for my young children.

What do you think? Am I crazy to take this job? I don't know what else to do other than try it and see. I told her I did not want to accept and then quit because I did not have the skills she needed and therefore possibly be dangerous or risk my license. Any info all you veterans have about this would be appreciated (also in terms of the pay, reimbursement, etc).

Thank you so much!

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The pay sounds ok, but 3 admits per day? Consider this; first admit has 27 meds on discharge summary but only 24 in home. You must track down an MD to reconcile meds, orders, and by the way pt does not speak English. You spend 90 minutes in home, drive to next admit takes 45 minutes, you had to stop and pee and get coffee too. Second admit has wound vac which won't seal and you spend an extra 30 minutes troubleshooting. Pt has 9 wounds; skin tears, stasis ulcers, surgical wound. You need to measure and document all, order wound supplies, call MD, etc. Third admit is drunk/drugged, hoarder with 17 cats, 6 dogs and 4 birds w/out cages. Having trouble assessing gait, safety, nutrition, yada yada. You left your home 7 hours ago, now you have 10 hours of Oasis documentation.

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Specializes in cardiac/education.

WOW! LOL, that was depressing Maura! Thanks for the reality check, I know there are a lot of additional challenges in home health other than the nursing part. What you said is what I have kinda been thinking. I suppose what you describe is precisely WHY this job seems so easy to get and they seem so eager to hire someone with no experience. It's just too good to be true.?

I'd appreciate anyone else's take on it too.....

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Specializes in geriatrics.

Where I live, you are required to have a minimum of one year bedside experience. You will be on your own and your assessment skills are basic....which is to be expected. I wouldn't want your job. At the very least, find out who your supports will be. I would also review common procedures, meds, diseases. Good luck.

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Specializes in cardiac/education.

Joanna,

Yes, here you usually need at least a year too. The lady that interviewed me said she usually doesn't take anyone with less than 3 years! And I've been out of nursing for 5 years! She said she does make the occasional exception but why me I don't know since she didn't ask me much at all about me. Is this the huge red flag? She said she would not have hired me if she did not think I could do it but how could she determine that without even asking me questions? :(

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Exactly... Also, consider you will not be proficient or efficient for at least 6 months.

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They are desperate and in need of finding someone naive' of home care challenges. That's my 2 cents. And 3 admits per day would burn you out likity split! Not to mention you'd basically be working for 10 bucks an hour when it was all said and done.

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Have you checked to see if the company is listed with the BBB?

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Specializes in cardiac/education.

Thank you all.

Why would they hire me knowing they were just setting me up to fail and to likely quit anyway? It's not like it's a full time job and they know I am commuting 1.5 hrs each way so that said they must be really REALLY desperate LOL

I am bummed about it. I guess I'll move on......

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You're a warm body with a nursing license and a car.... They probably haven't thought much past that, if they are truly desperate.

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I can relay from personal experience as someone who did call every other weekend at a rural home health agency--it was a nightmare. I do not understand why but it seemed that the worst of the worst patients came out of the hospitals on Friday and were admitted on Saturday. I had start of care visits that lasted four hours (e.g., one patient had 21 wounds that all needed measured. In addition, he had an ileostomy, colostomy, and draining fistula that all required care). Guess what, I had to go back the next day and do it all again as I was the "on-call" nurse. I would leave my house at 7:00 a.m. and, oftentimes, not get back home until 9:00 p.m. or 10:00 p.m. The acuity of the patients, the drive time, and screw-ups of hospital discharge planners made it absolutely crazy.

Looking back--as a weekend on-call nurse--I would suggest trying to work out an agreement that the weekend on-call nurse does the admit visit with skill (including getting all consents and admission paperwork completed) during that weekend visit. However, on the following Monday--the regularly scheduled RN for that particular area can complete the OASIS assessment for submission. I don't understand why agencies beat up on the weekend on-call nurses and make us hate on-call so much by demanding that all SOC OASIS assessments be completed that first visit. Medicare guidelines state that an agency has five days to complete the admission OASIS.

Oh, and for those that say "yeah, but we have to get the OASIS locked and submitted to Medicare ASAP to get paid"--bah humbug. After working in the field for almost four years, I became a clinical supervisor. I was amazed to see that there is a one-month grace period from admission that the OASIS has to be locked and submitted. When I questioned the nurse who was training me--she said "It's our little secret. We just tell the field nurses we have to have the admission paperwork in 24 hours so we are certain that we get it."

Just be very careful about your decision. On-call during weekend in a rural setting home health agency can really burn you out and make you want to burn something down. I would probably (definitely) keep on looking for a different opportunity.

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Specializes in cardiac/education.

Thank you for all that Sweetsugar. It helps very much. I swear the lady that is trying to get me on board should sell cars for a living because man is she sure convincing. Every time I talk with her I second guess my decision...how can they make is sound sooo appealing LOL!!

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