New Grad hired by home health

caliotter3 · Mar 4, 2010

Eight hours with one patient is called extended care, continuous care, or shift work, as opposed to intermittent visit work. You should have been provided with a copy of the 485 before going to meet your first patient so that you can read it over, look things up, and ask questions. Look up any meds that are unfamiliar, as well as the diagnoses and any of the orders that are unfamiliar to you. If there is a skill that is ordered that you have never done you can ask the supervisor to show you or explain. You should go to the home for an orientation that can last from one to eight hours (complex case). You should be paid for the orientation, but don't be surprised if your agency is no longer paying for orientation. They do everything they can nowadays to save money. For eight hours you are required to do everything on the 485 that is called for on your shift and chart that you did it. For example, if passive range of motion to all extremities is ordered for four times a day, and it is marked for twice on your shift (specific times may be given, depending on how it is listed on the treatment sheet), then you have to make sure it is done (around those times) and charted. If you don't do something you need to chart why. Basic nursing care and the same things you would do if you were in a facility and taking care of eight people. If the patient has a change of condition, you assess, notify the doctor, take any orders, and notify the nurse supervisor or leave a message at the office. You do one nurses note for the shift, fill out the MAR/TAR, vent sheet, or other pertinent checklists, and fill out any physicians order sheets for orders that you take during the shift; leave one copy of the MD order sheet in the book for reference and send the original to the office with your notes. Do anything extra for the patient that they, or the family request, within reason, if your nursing duties are caught up. The day can be relaxing, or hectic, depending upon your patient and their care. But anyway you look at it, you are only getting paid to take care of one patient and being paid a comparable wage to your pay at a facility. Do not be afraid to ask questions of the family, the patient, your supervisor, or the nurse who orients you. That is how you figure things out. Hope you like your hh job.

ItsTheDude · Mar 4, 2010

sounds like you fell into one of the better parts of hh nursing for your first gig. when you have downtime you can watch tv, read, surf the net, nap, play video games, make phone calls, study... (whatever, it will depend on the client/family and the relationship you build with them). once you get the routine down, it can almost be like getting paid to be at home, almost.

ArwenEvenstar · Mar 5, 2010

Also check out the private duty forum. Technically private duty is when a family pays you privately and an agency is not involved. However, I find the term private duty is often used in a generic way for shift work in the home, whether an agency is involved or not.

Be aware that if a nurse is needed for shift work, the cases can be pretty complex: vents, trachs, resp txs and suctioning, g-tubes, seizures, etc. Not to scare you though - not all are that complex!! There are easier cases.

I did private duty (through agencies) for over 4 years.... I sometimes think of private duty as nursing's best kept secret, and other times I think of it as nursing's best kept nightmare! You do only have one patient which is great. Once you get down the routine, you will have plenty of down time even with a high tech case. However, most families with a disabled loved one will have varying degrees of dysfunction. Expect to encounter families struggling to cope. Families can take advantage and be very demanding with unrealistic expectations. As a nurse, you MUST maintain a FIRM professional boundary. Follow the careplan strictly. You are there to nurse the patient, not to be the family's maid, cook, counselor, errand runner, or the babysitter of other kids! Things can get out of hand quickly...

chudy · Mar 23, 2010

hi,

I am also a new grad starting in hh. I do shift work, where I work 5 days a night...Not the most suitable job for me but thats all that is available in my area(NY) since hospitals are on a freez right now.. yeah, after you got the routine down pat, it is as boring as hell,,,lots of down time too, I got paid the same amount as working in a nursing home without having to care for 30 different patients. It is ok for now as I will be going back to school to complete my rn-bsn in the fall. It will work out, because I can always study on the job. I"m still looking for a hospital job in the mean time because I think med surg is the key and the basic step to a solid foundation in nursing. I am thankful for my job though, I get to learn about vents, trachs, g-tubes, and dressing change..I feel comfortable performing those skills now. my advice is to make sure you are properly oriented to your patient and ask for help with any thing your not familar with. I am praying for both of us all those new grads out there who are still searching for a job.

aubreysmommy · Mar 23, 2010

It sounds like you are doing private duty (or extended hours) whatever you want to call it. Let me just tell you, I went into thing as a new grad and I do regret it a little. I went in as an LPN and then went thru the RN program while I worked 36 hr Fri-Sun and was able to study while I was at work. If you plan to go back to school then this might be the right path for you, if not, you may find that you get stuck a little. I have a pt that has a trach/GT/gets CPT and neb tx's QID and meds. Once you learn the routine it can get a little boring. If you are ok with getting only those skills and staying within that scope then it may be ok for you. Or you can do it and work somewhere else PRN to get some more skills. Honestly though, for the most part, it is a very easy job with very good pay (my case anyway)......so once you are there for a while it can be hard to leave. I am finally leaving though, I am about to pull my hair out b/c I am soooo bored. Even if you are not constantly on your feet and you feel very bored most of the time, it s still a very important job! Oh yea, and like someone else mentioned you will have to deal with family drama....its almost a given. Good luck to you, it really is a well kept secret in nursing, until it gets old. (and it may not for you)

ItsTheDude · Mar 23, 2010

I am about to pull my hair out b/c I am soooo bored.

that's why hh has never been my only job, i always work some where else too (hospital, doc office, etc). hh is a great 2nd job, it's easy easy easy.

ArwenEvenstar · Mar 24, 2010

Originally Posted by aubreysmommy: I am about to pull my hair out b/c I am soooo bored.

that's why hh has never been my only job, i always work some where else too (hospital, doc office, etc). hh is a great 2nd job, it's easy easy easy.

I have noticed a repeated theme on a couple threads lately that private duty is oh so boring and easy. But...I worked private duty cases for over 4 years, and I would not call the cases I worked boring nor easy. Maybe it depends on how you define "boring" and "easy". Maybe my personal experiences were not typical. And maybe I am just defensive! :rolleyes:

Perhaps because I am an RN with a broad experience base, I was generally assigned to high tech and complex cases - vents, trachs, seizures, frequent treatments/procedures, etc. On one intense case I worked, I rarely got to sit down. Every time I did try to sit, the pt needed suctioning again, or needed a prn nebulizer, or an alarm was going off and equipment needed to be adjusted, etc...I oriented a nurse to this case who did not last more than several days and quit, because she could not believe how busy it was....I think she was looking for boring and easy, and this case was definitely not it. Additionally...EVERY case I worked had a degree of family "drama" (dysfunctional coping) and this always kept things "non-boring"...For example, one mother was very moody and volatile and I never knew what to expect.

But, on the other hand.... if you work the same case for many months in a row it can get monotonous and boring doing the exact same skills every day, even if it is a high tech and busier case. I eventually did become bored to tears on the above hectic case I mentioned...So I moved on to a new case. Maybe that is the key...knowing when to move on! If you are bored to tears or pulling your hair out....it is time!

tiffdeandre · Mar 24, 2010

What is the salary for a new grad RN doing home health?

ItsTheDude · Mar 24, 2010

I have noticed a repeated theme on a couple threads lately that private duty is oh so boring and easy. But...I worked private duty cases for over 4 years, and I would not call the cases I worked boring nor easy. Maybe it depends on how you define "boring" and "easy". Maybe my personal experiences were not typical. And maybe I am just defensive!

hh, just like any job can be hard if you let it be. i pick my assignments in hh, i'm not going to stay with a hard case when i can make the same money on a easier case. hh cases that are hard for me aren't hard due to care, but due to the family (some are nuts). the same thing goes for the hospital job, i'm not going to work in a hectic overworked department, when i can make the same in a more laid back department.

caliotter3 · Mar 24, 2010

However boring and easy a case is, it sure does beat being unemployed. Boring and easy is sitting around getting depressed and more depressed in your digs, because you know you've exhausted places to apply, and you're too fed up to hear the same excuses over again today from yesterday, and yet again, tomorrow.

aubreysmommy · Mar 25, 2010

I have noticed a repeated theme on a couple threads lately that private duty is oh so boring and easy. But...I worked private duty cases for over 4 years, and I would not call the cases I worked boring nor easy. Maybe it depends on how you define "boring" and "easy". Maybe my personal experiences were not typical. And maybe I am just defensive! :rolleyes:

I dont think there is any need to be defensive. I am personally bored and I too am an RN with 4 years of PDN experience and have complex cases with trachs, GT, JT, vents, lots of CPT and neb tx's. But I think you hit it on the head when you said "doing the same exact thing for that long with the same client can get very boring". And trust me I have had TONS of family drama too, and that to me is BORING. I am so over hearing it. And it is not always due to ineffective coping, sometimes it is due to the parents just being very rude and immature and lazy. Of course that is my personal experience....not all parents are that way.