I am a new grad who took a position as a field nurse with an HH agency. I have applied to every hospital in dallas and have heard nothing positive. I am so frustrated with the whole job search and to add salt to injury, my mom lost her job. I was so desperate to find something so not to lose our house.
I took a position as a field nurse in an HH agency and from what we (The DON and I) talked about it seems different from anything else i know. I am still trying to wrap the number of visits per week around my mind. i called a friend to help me with paperwork so i'll see how that goes.
I am excited to start working as a nurse but i don't know just yet if this is where i want to be. Any suggestion for me would be appreciated. what should i look out for? who do i call if something happens to a patient on the field? i am sooo confused!
Specializes in Functional Medicine, Holistic Nutrition.
I'm sorry to hear about your bad experience in the SNF. I think you're missing the point about new grads working in HH though. Agencies hiring them and not providing adequate orientation would only be part of the issue. In SNF (and hospitals and many other practice settings), there is usually another nurse physically present in the building that can act as a resource to a new grad. Help is just right down the hall. But that is not the case in HH. In HH, you are practicing very autonomously. Having someone available by phone to troubleshoot issues, such as it is in HH, is NOT the same as having another nurse that can come into the patient's room and do their own assessment within a few seconds or minutes. In HH, you rely on your previous experience to recognize subtle signs and symptoms that the patient may be declining or may need a change in treatment, etc. It is very hard to teach that type of experience to a new grad. It comes from practicing in an acute care setting where you see what it looks like when a patient has reached that point. In my opinion, HH is not the place for a new grad. It's a situation where "you don't know what you don't know" and in HH, there is noone to step in after you leave the home and pick up on findings that you may have missed. I'm sure that there are some exceptionally bright grads who went through rigorous orientation programs with large agencies (perhaps associated with hospital systems) that went on to become fine HH nurses. But in general, and in the majority of agencies out there, I think it is a bad idea.
To KateRN1
Accepting new grads is not the problem. The problem lies on people who hire them and not provided adequate training for a period of time.
How else would new/old grads get their break if they are seen as "Know-nothing-nurses"?; how would they learn if they are not given a chance?
I had a break in a SNF and I'm an RN being trained by an LVN (new grad with barerly 1 yr experience) showing me how to pass medcs. from another patients medc. packet bec. the other patient that I'm about to give the medc. is out. Including insulin.
I got so disgusted that I had to raise the issue with the DON. They got scared that I could blow the whistle---I was not given a new schedule after 30 days. What's wrong with the picture? They said, " if it's not documented, it was given".
Well, b.s. because clearly there's fraud being committed. That when a nurse takes away medication to give to another patient doesn't justify that you did your job. That constitute stealing---and what about the vicious cycle? The never ending stealing from one's packet to give to the other. Who pays for that? and who keeps tab?
Accepting new grads is not the problem. The problem lies on people who hire them and not provided adequate training for a period of time.
How else would new/old grads get their break if they are seen as "Know-nothing-nurses"?; how would they learn if they are not given a chance?
I have to respectfully disagree. With the nature of skilled intermittent visits, the nurse is expected to have a certain level of experience and autonomy. I think we can all agree that the first year of nursing is the most difficult. Add to that, learning how to accurately complete OASIS assessments, case manage, teach patients about disease processes that the new nurse may not have experienced yet--it's too much. Expecting a new nurse to be able to identify subtle changes in a patient that can lead to interventions to prevent hospitalization--that's crazy. They don't have the experience in a structured environment with constant mentoring and experienced nurses to show them the ropes. It's not a matter of "know-nothing-nurses," it's the difference between what you learn in a book and how it actually looks in real life and being able to teach the patient about it. I've done well teaching patients about CHF, diabetes, COPD, etc because I've spent years at the bedside to learn how patients act, react, and how the diseases are treated. New grads with no experience simply don't have the experience to back up the knowledge base. To throw a nurse into that kind of environment is frustrating for the nurse as well as dangerous for the patient. They first need to learn how to be nurses before they're turned loose into an environment where direct supervision is practically non-existent--for their own good.
I know the job market sucks right now, I get that. It sucked when I first graduated, too, and I also started out in a SNF and dealt with the same issues. I was also trained by the LPNs on the floor, although I carried the title of "House Supervisor" purely due to licensure. And I know that there are new grads who are being hired by home health agencies, but that doesn't make it right or safe for the new nurse. Trust me, I've been doing this for a long time. And I know that there are the occasional "one in a million" new grads that can do well in home health, but for 99.9%, it's just not a good idea. Remember, even "old" nurses struggle with home health and all the rules, regulations, and bureaucracy. It's crazy. And they already know how to be nurses. It's a whole 'nother ball of wax, I guarantee.
I'm a new grad in Cali, there's no lack of unscrupulous home health agencies to hire new grads into the realm of intermittent visits without training, supervision, or appropriate resources. I saw a few post saying "in California, in urban areas, they expect at least a year." What is right - is not always what is done.
I work in home health, I do shift work. I get significantly less pay and work more hours. But I know my patients and I are safe. I know that I am not risking my license. I know that I am meeting the standards of care.
I understand that nurses need to feed their families and I know how hard it is out there. I also know a DON at an agency who has done ALL the SOC and ROC visits for a year or more because she didn't have an RN with adequate acute care experience. She also wouldn't send a shift care nurse out without having the nurse trained and then skills tested before taking on the case. That's integrity that is sadly hard to find.
Protect yourself and protect your patients. No one here can tell you not to take on the job that may keep you and your family from being without shelter. But I think a lot of us hope that you consider your options very carefully.
Thank you everyone! I have being working for some weeks now and so far so good. I left the agency i started with earlier because i didn't like how the worked around medicare and some of the things they did. I can't risk the license i worked so hard to get. I join another agency and so far so good. I'll keep you all updated!
HealthyNurse
143 Posts
I'm sorry to hear about your bad experience in the SNF. I think you're missing the point about new grads working in HH though. Agencies hiring them and not providing adequate orientation would only be part of the issue. In SNF (and hospitals and many other practice settings), there is usually another nurse physically present in the building that can act as a resource to a new grad. Help is just right down the hall. But that is not the case in HH. In HH, you are practicing very autonomously. Having someone available by phone to troubleshoot issues, such as it is in HH, is NOT the same as having another nurse that can come into the patient's room and do their own assessment within a few seconds or minutes. In HH, you rely on your previous experience to recognize subtle signs and symptoms that the patient may be declining or may need a change in treatment, etc. It is very hard to teach that type of experience to a new grad. It comes from practicing in an acute care setting where you see what it looks like when a patient has reached that point. In my opinion, HH is not the place for a new grad. It's a situation where "you don't know what you don't know" and in HH, there is noone to step in after you leave the home and pick up on findings that you may have missed. I'm sure that there are some exceptionally bright grads who went through rigorous orientation programs with large agencies (perhaps associated with hospital systems) that went on to become fine HH nurses. But in general, and in the majority of agencies out there, I think it is a bad idea.