New Grad - Home Health

caliotter3 · Apr 22, 2010

The better way to go into home health as a new grad is to take a position doing extended care, also called continuous care or shift work. You can train to a specific case or cases. Extended care cases are usually more stable patients with routine care. This would give you a slower start until you can build your assessment and critical thinking skills, as well as confidence. Insure that any agency willing to hire you is also willing to give you all the orientation that you need to do the job. Good luck.

anticoagulationurse · Apr 23, 2010

Good advise from Caliotter.

I would like to add some things that made my transition from various nursing jobs to HH better for me, my patients, coworkers and the docs. I only had 5 years of nursing experience, but in lots of different settings before I went to HH. Even with that my transition was rough. As a new grad I could see having a hard time wrapping my head around HH. It is a much different animal from most other nursing. I have done HH for 2 years and still run into things I have zero experience with, but experience in other areas helps!

To me, HH nursing is nurse directed, patient outcome oriented. Most of my other jobs were doc directed, company $ oriented. HH bends to fit the patient rather than trying to impose artificial restrictions and unrealistic expectations on the patient. To me it is real world nursing.

How my prior experience helped me:

1) Understanding the background processes with insurance crap, billing, faxes, referrals, phone tag, relationships in the medical community etc.

2) How to translate medical impositions into doable, realistic goals and interventions to have a mutually positive outcome on the patient and also hopefully the company. Basically, cutting the superfluous stuff and getting to the root of a problem. And hacking away at that root, over and over again, each visit. I could see that being difficult as a new grad, I just wouldn't have viewed patient problems in such an abstract way.

3) Confidence that only experience brings. I was a confident student, and a confident new grad and have remained confident all the way through my transition to HH. However, the kind of confidence that helps in HH is the kind it takes to call the doc and recommend something to them. I would say MOST of the time the doc doesn't have a clue what the patient needs, they want you to assess and tell them what the patient needs are. In a way, I am making orders, and offering it to the doc to approve, not waiting for the doc to tell me what to do. On the very few occasions I have called a doc not knowing what their intention for a referral was for and asked, "What is it you had in mind for Mrs. Soandso?", they have all replied, "You tell me." it takes guts to know what to say and to lead the way. Having been on the other side, I know that the docs expect.

Also, I would not be able to sleep at night if I was constantly second guessing my choices or revising my charting in my head. As a new grad I would did not have the confidence to write it and leave it without beating myself up. Now, when I am right, I KNOW I'm right.

4) Familiarity with standards of practice for Dx and conditions to sift through to the most important measurable issues. As a new grad I was barely getting my head wrapped around nursing Dx let alone care planning. Now, nursing Dx are second nature. No more NANDA. It also helps to have seen all kinds of conditions, to be able to judge normal from "normal".

5) Knowing medications! I cannot tell you how nice it is to just look at the name of a med and know what it's for and the most common side effects and labs without having to look it up. I would DIE if I had to spend so much time looking up meds all the time and it would be impossible to efficiently educate a patient without knowing meds like second nature.

6) Efficiency. Even with my 5 years (which isn't a lot) of nursing experience, my first several months in HH were rough. I felt like HH was calling to me, like I would jump right in knowing what I am doing, and assimilate it as quickly as other nursing jobs I'd had. Not so much. I had to relearn how I utilize the Nursing Process (remember ADPIE?), and look at the patient care in a new way, learn a new language. For a while every step of the way during my day was slow. I would check, recheck and recheck my work until I was sure I had chosen the right kind of forms for the right kind of visit, etc. I would think, think and rethink myself with each decision. If I had started HH as a new grad I would be so overwhelmed with little minutiae that I could even see myself being dangerous not knowing what I don't know. I would never and don't skimp on patient care, so what's left to skimp on but the part of my job that protect me and my license? Charting. Now I can chart more directly, understand the forms and such.

That was long winded but I hope it helps you! Best wishes.

Jess_Missouri_RN · Apr 23, 2010

Thank you Caliotter for your advise.

Anticoagulationurse - the points you hit on where the points I was worried about. I guess when it comes down to it I will need some hospital experience, which is what I had been thinking all along! Thank you too for you post, very helpful and informative!!

anticoagulationurse · Apr 24, 2010

I don't know that you need hospital experience specifically, but a variety of experiences. LTC is good, ALF is good, doctor's offices are good. I also like Caliotter's advise on getting a private duty gig to better be able to spend time absorbing the home care situation. When you get bored with that you could transition to HH.

AnnemRN · Apr 24, 2010

I believe if possible, it's best to get hospital experience. Being realistic, you will probably move around in your nursing career and not having med/surg experience might be somewhat limiting.

I have a very close friend who became a NICU nurse right after graduating and she had a very difficult time getting anyone to hire her 8 yrs. later when she wanted to leave that area of nursing.

Jess_Missouri_RN · Apr 24, 2010

Anne, I agree with you on med/surg experience. It seems to be invaluable. I put in two applications yesterday to

local hospitals, so we'll see. I'm glad I posted about it because I was torn on what would be best but now it seems pretty clear to me. I need the hospital/med/surg experience so that is where I will start. I see that you have wound care as one of your specialties, I love wound care. I was placed with the wound care nurse 3 times this rotation and I enjoyed every single minute of it. Usually each student gets one day with the wound care nurse but I was lucky enough to have instructors who place you where your interests are in the last rotation. Mine was med/surg and wound care!