NERVOUS ABOUT STARTING HOME HEALTH

MD_Rn · Dec 19, 2000

Hi,

I just left home health after 2 yrs there and returned to the hospital setting. As far as teamwork, you really need to be confident with your own assessment and skills, because your it! You can call in to the office or call the MD, but the bottom line is you are the only one who is actually physically with the pt. Home Health is a very autonomous career and I always worry about new grads going in to it, but if you are confident in your abilities and being on your own than I am sure you will do just fine. It is a great schedule for kids, just be careful to make sure you know what the on call requirements are. Why did I leave? The paper work sucks The new HCFA requirements for reimbursement made paperwork the majority of what I did. I missed seeing patients and I missed the challenges the hospital setting offers. Good Luck!

mustangsheba · Dec 19, 2000

I too quit home health because of the paper work. I feel the government has gone too far. It's an illegal invasion of privacy. (My opinion, of course). Personally, I would feel uncomfortable doing HH without at least a year med/surg. Most of the ER nurses I worked with didn't have a clue about HH. You don't have technology to rely on out there. When you listen to that heart, you have to know what it's saying to you. BEFORE oasis, it was not unusual for me to spend two to three hours charting after I was through seeing patients. I love the time with patients and indulged myself in spending as much time as I deemed necessary. The team work is different. It takes a while to develop the rapport with the docs so they know when you are on the phone, they really need to answer. You will do a lot of determining what is going on with your patients without benefit of immediate labs. You will need to be comfortable recommending to transport or not to transport to the ER. You will deal a lot with the terminally ill, pain, and socioeconomics. You will be in an unstructured environment where you have only a modicum of control over things like "sterile fields". You will have to deal in much more depth with family dynamics. You will probably go out with another nurse for orientation. See how comfortable you feel. If it's not quite right for you, you can always change back. Good luck.

NickiP · Jul 1, 2001

I am also considering a change to home health, but am not sure if I have enough experience. I have been an RN for 2.5 years, working in Burn/Burn ICU and now in same day surgery as relief charge for past year. I loved Burn but had no support from staff (basic sink or swim attitude from managers) which was scary for new grad. I love Same day Surgery and the variety I see, but am missing the long term relationships I had with burn pts and families. I am thinking of going into HH but am uncertain. Any opinions? I am comfortable with basic wound care from burn and of course can do IVs. I also know most area docs from sds and used to work as an intake coordinator for state non-profit agency. I would appreciate any thoughts from experienced HH nurses or any tips. I have been reviewing my assessment and disease books from school to reorient myself but don't want to get in over my head. Thanks for the help.Nicki

hoolahan, ASN, RN · Jul 1, 2001

Hi Nicki,

I would suggest you go on a ride-along. Take a day off, and arrange to go with another nurse on a ride-along. I did this when I first applied to HH, and knew after the first visit, That maternal child was NOT for me. So, they sent me with the adult nurse, we did 2 visits, and knew instantly, "I can do this."

Make sure they give you a really good orientation, especially with the paperwork. If you don't do it right the first time, it keeps coming back to haunt you. You should have at least one week with a preceptor.

Click on the link beloe to me HH web site, and go to the "about Home Health section." That may answer many of your questions.

Others mention autonomy above, this is exactly what I love about HH, that, and the flexibility of being able to stop mid day, and see my son's hockey game. If you sign on with an agency that covers several counties, be prepared to have a lot of milegae, and make sure you are paid for it! IV HH nurses make a little more $$, but visits may be long and complicated, and you may have the same amt of visits as nurses who have "routine" adult cases. If you liked the contact you had with your burn pt's I think you'll love HH nursing! Best of luck!

mgmaniac45 · Jul 9, 2001

I am the Nursing Supervisor for a Home Care Agency. I did home care as a Staff RN for 10 years. The biggest problem I see in going into Home Care is knowing your limitations, and your Supervisor knowing your limitations. ASK the scheduler or Supervisor if the patient has any high-tech needs BEFORE you accept the assignment, and don't go out and try to "wing it". Home Care forces you to become very proficient in assessment of patients, and to do it right, the Nurse must be aggressive in being a patient advocate as well as advocating for yourself and for your needs. Too often I have followed Nurses on a case who were not fully competent in caring for that patient. Usually it is due to poor orientation. In an effort to "fill a slot" Nurses are assigned just because there is an RN after their name. Everyone is on a different learning curve. At our Agency, I go out with the Nurse to the first shift that they are scheduled to work for each new patient. I stay to orient them to the patient and to be there for questions and support. It usually takes only 1-2 hours to make the Nurse comfortable. I also do an extensive orientation prior to hire, at least a week, with hands-on return demos (on teaching dolls) by the applicant for trache care, gt care, IV insertion, etc. I have also identified some Staff RN's with excellent skills to accompany the new employees to their first visits. It helps to overcome that feeling of being alone out there. Start out by doing routine cases, and not a full assignment. Riding with another Nurse sounds good, but I think you have to be an official employee of the agency due to confidentiality. I worked for 10 years in the Hospital, but Home Care is my "Home" and I have never looked back. Give it a shot!!!

misskek · May 10, 2002

hello everyone, I have been reading lots of the posts in here regarding home health, as I too am thinking about switching from my current 12hr/nights on med/surg/oncology to home health ( I have worked the med/surg for five years now ). The thing is it all seems so different and so daunting, yet, working in the hospital setting is getting so bad ( for me ), everyone shouting at you because you are not on time, always keeping people waiting etc etc etc. We dont get to spend time with patients in the hospital setting, its a matter of run in, do it and run out. I am organised and get as much of it done as is humanly possible yet I always leave my shift dissatisfied with my perfomance as I didnt get it ALL done. Most of the nurses on my floor and also in the whole hospital are fed up and want a way out, some of them out of nursing all together.

So, can home health be an option for me ? I think I might really like it once I get to know it but there again, reading these posts here I get nervous about being out there alone, although, that is also one of the things that excites me ( a little ). And all that paper work you are all talking about .... how in heavens name do you get all that done? I dont like the idea of working ten hour days five days a week ! Please give me any advice, I need desperately to get out of the hospital setting before it makes me very ill ( mentally and physically ). Also, I see many recomendatins to view Hoolahans web site BUT I cannt not find out how to get to it. Thanks for any suggestions and hopefully good feelings to come. ps. this is a great place for nurses, thanks for all the info.

sf5391 · May 10, 2002

I will be graduating my RN program in just a week. I have been working in the home health setting, as an LPN, for the last 10 years. During my years doing home health I have been partnered with an RN. I would see her clients if she had a day off or had overflow. I plan to begin working full time, as a GN, the week after I graduate. I do feel somewhat nervous about case openings and management. Having practiced my assessment skills for the last 10 years hopefully they are up to snuff! Of course I will not be case managing untill after I pass boards. This will give me lots of time to learn the ropes. I am looking forward to the challange.

hoolahan, ASN, RN · May 10, 2002

Hi misskek,

I used to have the link to my web site in my signature, sorry about that.

Here it is http://www.geocities.com/vnarn_nj Hope you find some useful info there. Anything else you need to know, you can ask here! We are a helpful and pretty active bunch in this forum!! I have gotten excellent help here from everyone.

Misskeke, with 5 years of m/s expereince, you will be FINE!! All you will need to figure out is the paperwork, and you will just be totally overwhelmed by it in the beginning, so expect that. I suggest when you start in the new job, you ask someone to explain each form used on a new admit, and track the process the forms go through in the agency, so you know what copy goes to where and WHY. Knowing the WHY of the paperwork helps you get the right form filled out for the right thing the first time, and prevents duplication. Be prepared, there is a lot of duplication in the paperwork, and after you get things figured out, if you have a suggestion to make it easier, believe me, I am sure your employer would love to hear about it. My agency always asks for our input about fine-tuning the paperwork. As far as the pt care....you will love it! Try to remember to think, and even ask your pt's, what do they expect to get out of home care? Know where you are going with the cases. Stay focused, and ask your peers how they manage certain problems. I learned a lot from the other nurses, and I still learn from them!

sf5391, you will also be fine!! You already know the P&P of your agency, the notes, how to document to stay in compliance. All you need to learn is to schedule and case manage. You're already halway there! For you it will be easy. And don't panic, every once in a while we all forget to put a pt who needs labs in the schedule. Don't BS about it, call the doc, admit it, and get the visit in asap.

ONe very wonderful little thing I got was a tiny yearly planner. When you open the pages, you can view a week at a time with a few lines in each day to write on. There are also monthly calenders in the front. On the inside covers and first few pages, I write all my most used numbers for DME co's. meals on wheels, pharmacies, quest mobile labs, etc... ON the days, I write stuff like "WHOEVER: Visit before 9am " or OTHER PT: MD appt, see next day Or "BEET BOOP: Needs HHA Sup" so I don't forget important stuff. That way when I am in the pt's home, yes, I can note that in the chart, but when I am doing my schedule, I can't pull out every single chart to remember this stuff, so I have my tiny planner, and I mean this thing is the size of a credit card. I picked it up at Walmart in the stationary section. I love this thing. I also wrote down the numbers for the guard stations at the senior buildings I go to in the city, in case a pt doesn't have a phone, I can call the guard and see if they know if they are home, if I don't have another visit there that day, otherwise I have to make a trip for nothing if the pt isn't home.

One thing we are trying to do at my agency is to eliminate as many lab draws as possible. For our non-homebound medicaid pt's, we make them go to the lab. For our homebound Care and MC co's, we use Quest Miobile Phlebotomy and LabCorp. Yes, they both have mobile services, so why waste your time and gas going to labs? The only ones I am kind of stuck on is my homebound chronic Medicaid pt's, I still have to find out if they will accept that for the mobile labs. For now, those are the only pt's I see, but I plan to have them get done by mobile labs asap too. I will do any labs ordered on initial referral, but the routine PT/INR's, forget that!!! So many docs abuse us by referring those pt's just so they can get labs, when there isn't really a skilled need, it's not worth my wasting my time, or agency resources.

Keep posting guys!!

SOCALRACERX911_RN · Feb 18, 2003

Mustang,

I'm an ER nurse, considering HH as a part-time job for extra cash and a change of pace. I was just curious as to what you meant about ER nurses not having clue. From your experience, do ER nurses have a harder time adjusting to HH.

Gordan Summners

hoolahan, ASN, RN · Feb 18, 2003

libmi, I hope she answers you, note the dates on these posts, this thread has been going since 2000!

Maybe you can start a new topic re Do ER nurses make good HH nurses??

Frankly I don't see why they wouldn't. Not all pt's in an ER get monitored, etc. I think your assessment skills will be an asset as well as your ability to triage. Plus, you will do good teaching about emergency signs and symptoms, and be able to tell a pt when they need to go to the ER.