Nervous about Home Health

Published

I have been a nurse for 24 years,, started in Labor and Delivery, Med Surg, and recovery room the past 7 years.

I have always worked in a hospital and have really never had any problems patient care or my skills. I can start an IV, hang Neo Drips, push Labetelol and Narcotics all day without batting an eye. Not to mention ART LINES, Vents, and caring for patients in resp distress.

I decided to take a per diem job as a home health nurse. I feel like I am fresh out of nursing school. I am so nervous and feel the families are so critical of my care. Granted, this is all new to me and I am sure it shows. I am changed PICC line dressings, accessing mediports, drawing labs, things I have practically no experience doing.

Every patient is different and I find Picc lines advanced 7 inches or more and trying to cover this in the small tegaderm is a challenge. I also have trouble getting the old dressings off with the adhisives stuck to the picc lines. It took me 15 minutes to get this off the other day and the mother called and complained about me to my DON. The patient ended up in the hospital (not my fault) with fever and there was alot said.

I feel so incompetent. Every visit, I wonder what am I walking into next.

Most patients are nice, but I feel so judged. I usually let them know I have been a nurse for 24 years and am new to Home Health. Starting IV"s has so far not been an issue.

I am sure with more time , things will get better, but its been 5 months and I'm still just not getting a warm fuzzy feeling like I get when I am in the hospital with all my peeps!

Advice?

Up Vote Up Vote ×

Families will complain about the way you maneuver your car into the parking space and whether your bangs are from left to right or right to left across your forehead. Should your bangs go straight up and down and stop 1/4 inch instead of 3/8 inch from the base of your nose, they will call the agency and tell them not to send you anymore. If you can not learn to do your best work in spite of this and not let it bother you, you probably should reconsider home health. The family behavior is common and it will not change.

Up Vote Up Vote ×
Specializes in ER, L&D, ICU, LTC, HH.

So true Caliotter. I laughed to myself when one family go upset about where I put my car.

It will get better. Just be yourself.

~Willow

Up Vote Up Vote ×

When it comes to parking your car, I find it hilarious to see how the neighbors all along the street take great pains to make certain you don't even think about parking in front of their place. They all own the street in front of their house and half of the street in front of the house next door. This is not so funny to me when I have to traverse some of these neighborhoods at night from where I am forced to park my car.

Up Vote Up Vote ×
Specializes in ER, Med/Surg, PCU, CCU, Home Care CM.

Ni way can you be incompetent after that many years nursing. It's just a different set of rules than in the hospital. Remember to treat the whole family and bring them into discussions and decisions (with the pts permission of course). Be a little political. e.g. "you look tired Mrs. Jones are you taking care of yourself?" or " Mr. Smith, as long as I'm here seeing you wife could I check your blood pressure before I leave? We can't have you getting sick too." It's call TLC for the family....whatever works.

Up Vote Up Vote ×

Some people sense and feed off of weakness or insecurities (and I don't mean that in a mean way) and get a thrill off exploiting them. It seems you're unsure of yourself and I guess it's possible certain types can see that and pounce on the opportunity. You'll get it!

Up Vote Up Vote ×

A lot of home care nursing is not that acute. You have great skills and you are way ahead of a lot of nurses in that. In my agency we don't even do the IV's, another agency handles that. You sound very well qualified, most patients and families are really nice, it should average out to be good.

As far as parking, I work in 'the neighborhoods' and no one ever gives me a hard time. I find 'the burbs' to be scary.

Up Vote Up Vote ×

I appreciate your replies. Today I have 4 visits. One more question: WHY are patients so demanding in the home? I guess I am used to patients being so drugged and "helpless" that they have no choice when it comes to BP meds, narcotics, and what to do next. At home, they demand, come at 2pm. Not at 8am. or I can't possibly learn how to do my IV infusion, you will have to come every day. Basically dictating their care. Ok, now I am venting.

I do want to make this work. I have a bad back and can no longer work in the hospital.

Any tips to increast MY tolerance? You would think after 24 years I would have developed a thick skin, but I haven't. The majority of my patients have been asleep or slowly waking up and then sent on their way! Now, they are wide awake, demanding, and extremely judgmental!!

Up Vote Up Vote ×

I always thought that the assumption is that patients are homebound-- that's the justification for sending a nurse to the home. I try to accommodate my patients but if it messes up my schedule I tell them it's not possible. I don't think the nurse should have to backtrack, keeping the driving down is a priority too.

Up Vote Up Vote ×
Specializes in COS-C, Risk Management.

Sad but true, treating many of them like toddlers is the only way to sanity. Give them two choices and ask them to choose, "I can come at 8 am tomorrow or 3pm on Wednesday, which would you prefer?" "Who would you like me to teach to administer your antibiotics, you husband or your son or perhaps both? I will be back on Thursday to change the dressing." A little praise goes a long way, "You are doing such a great job maintaining your IV line. It's so important to keep it up so that you don't develop an infection." And sometimes a dose of reality is needed, although I suggest using it sparingly. "When you asked to change your appointment time last week, I also had to rearrange the times for the five other patients who needed to see me that day."

In the hospital, patients are at your mercy, they are on your turf and your schedule. In the home you are on theirs. However, that doesn't mean that they should dictate your every action. Always start with assessment. If the patient wants to do something a particular way, find out why. Is it a matter of convenience? Lack of understanding? A power play? And then plan accordingly. As much as possible, don't make it about you. Make it about the patient and encourage them to accept responsibility for their health. Make sure that they understand that they have choices, but the also have to accept the consequences of those choices. "You don't want to take your blood pressure medicine? That's your choice, but you need to understand that untreated high blood pressure can lead to heart attack or stroke. If you don't die from the initial event, you could end up severely disabled and may have to spend the rest of your life in a nursing home."

Don't get emotional, just stay factual, and don't let them see that they've ruffled your feathers. You can cry in your car, vent to your coworkers, vent to us, but make sure that you've documented everything and notified the physician.

Up Vote Up Vote ×
Specializes in Hemodialysis, Home Health.
Sad but true, treating many of them like toddlers is the only way to sanity. Give them two choices and ask them to choose, "I can come at 8 am tomorrow or 3pm on Wednesday, which would you prefer?" "Who would you like me to teach to administer your antibiotics, you husband or your son or perhaps both? I will be back on Thursday to change the dressing." A little praise goes a long way, "You are doing such a great job maintaining your IV line. It's so important to keep it up so that you don't develop an infection." And sometimes a dose of reality is needed, although I suggest using it sparingly. "When you asked to change your appointment time last week, I also had to rearrange the times for the five other patients who needed to see me that day."

In the hospital, patients are at your mercy, they are on your turf and your schedule. In the home you are on theirs. However, that doesn't mean that they should dictate your every action. Always start with assessment. If the patient wants to do something a particular way, find out why. Is it a matter of convenience? Lack of understanding? A power play? And then plan accordingly. As much as possible, don't make it about you. Make it about the patient and encourage them to accept responsibility for their health. Make sure that they understand that they have choices, but the also have to accept the consequences of those choices. "You don't want to take your blood pressure medicine? That's your choice, but you need to understand that untreated high blood pressure can lead to heart attack or stroke. If you don't die from the initial event, you could end up severely disabled and may have to spend the rest of your life in a nursing home."

Don't get emotional, just stay factual, and don't let them see that they've ruffled your feathers. You can cry in your car, vent to your coworkers, vent to us, but make sure that you've documented everything and notified the physician.

Excellent response, KateRN1 !!! :up::up::up:

Up Vote Up Vote ×
+ Join the Discussion