New grad, new to home health - overwelmed

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I'm a new grad, never worked in health field at all and started my first job as a home health nurse a couple of weeks ago. I am so overwhelmed. I have 50 patients. I only see them for re-cert and starts, the rest of the time I'm in the office doing the paperwork, writing orders, and taking phone calls. For my orientation, I went on visits with another nurse for 3 days and then was just handed over a patient load. I just feel like I have no idea what I'm doing and I aced nursing school, but now feel like I know nothing. Anyone know any good books that will help me with this job. Anyone know if the "first year as a nurse" type books are useful in home health? I just feel like I'm in a whole new world that nursing school in no way prepared me for. This jobs pay and hours are perfect for my life and the work would be perfect for me too if i felt I knew what I was doing. I just feel like I don't know enough for such an independent position. I want to do good at it and keep at it, but I just hate feeling so discouraged with all the work that is just foreign to me and some of the lpns who are the field nurses are just rude when they ask me stuff or give me info about my patients and I don't immediately know what to do. Any information or help on how to improve and become the best nurse i can would be helpful.

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Your situation will improve as time goes on and you get more familiar with your caseload and duties. Of course, you may not see that now. All new people have a period of adjustment, so don't run off too fast. Organization is your key to success. A good planner is necessary and you really need to use it to help you stay on top of things. Here are some books you might find useful: ISBN 0-323-00911-5, 1-58255-039-5. These are dated, so look for the newest editions. Of course, bring your questions to this forum. Try to identify a mentor at work. Barrage your supervisor with questions if you have to. The better your questions are answered by your supervisor, the quicker you will cut down on "bothering" her/him. Don't allow the LPNs to show you disrespect. It is expected for them to be harried, but they still can be helpful and not take things out on you. Figure out a way to incorporate your relaxation techniques into your workday. Maybe pack a lunch and drive to a secluded spot with trees and fresh air for a 20 minute lunch break. It can help. Others will hopefully chime in with good tips to help you out. Stick it out. You will be glad you did.

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Hi,I wanna say hugs to you! I know exactly how you feel.I'm a new nurse as well and work in home health care.I orginally was going to work in the office doing paperwork and all but I ended up visiting patients.So far I only have three patients, kind of sucks but then on the brigh side I starting off slow and let me tell you half of the time I dont know what I'm doing to...I do SOC,regular visits,discharges (I will have my first one soon),recertifications,and resumption of care.I'm learning as I go and sometimes make dumb mistakes,like calling a doctor for a trivial thing or just in general trying to figure out a way with insurance,communicating with other health team members,refilling the prescriptions,ordering new meds and substituting meds for another ones.Home health is so totally different from hospital,you are your own private detective,looking up information after hours,making follow up calls after hours,doing paperwork after hours, I find coordinating care and dealing with other health care team members the worse aspect of this job.At times it feels like no one cares except you the nurse.It seems like the nurse is often put in the middle and the responsibility of coordinating falls unto her.It can be exhausting but so worth it..It is worth it when you see a neglected patient and gradually you help them out to establish better health habits,it feel good when your boss and your patients are gratefull for the care you give.

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Specializes in COS-C, Risk Management.

The situation you describe is exactly why I discourage new grads from home health and discourage my agency from hiring them. Home health can be quite overwhelming to experienced nurses, no way does a new nurse have a chance to feel competent.

The best advice I can give is to study. There are many rules and regulations to home health care and many agencies do not conform to those rules and try to take advantage of those who don't know any better. Review the Medicare Benefit Policy Manual Chapter 7, the CMS Medicare Home Health website, and whatever statutes apply in your state. Join the Home Health Nurses Association and subscribe to Home Healthcare Nurse Journal and Caring. Look through old threads on this forum and ask questions. Join your state home care association. Do CEU programs that applicable for home health care nurses. Try to find the OASIS Answers seminar in your area. And ask your supervisor for more training.

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I agree with Kate. Home health is not another floor in the hospital. Home health, the business, is run quite differently than a hospital. Ask the hospitals that sold their home care agencies. As a new grad you need to first learn how to nurse confidently. Remember you don't have colleague nearby to listen to lung sounds for you. The LPNs, should not be rude but they have to work under your leadership. It is frustrating when the leader frequently cannot roll out the answer. You have a lot of patients that I hope are not being mismanaged. Best wishes to you and to your patients.

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Specializes in behavioral health.

Could you request to do shift work with only one patient? I always thought that I wanted to do home health, but I didn't realize that there was not much support. After learning how independent that I needed to be I realized that I was way too green for that job. My bedside nursing was just a short time caring for geri patients and we were not a medical facility. Good assessment skills were necessary, but I always had an RN to report to. We just did some basic stuff, as colostomy care, straight caths and dressing changes and anything else we sent to the ER. I would feel comfortable doing shift work where I only cared for one patient at a time. Does your company do that type of nursing? Personally, I would never be able to pull off HH nursing after being a new grad. However, some do that have a great support for them, or a good orientation program. Three days is way too short. It is overwhelming enough being a new grad, but to be independent makes it even more so. Would your company agree to some more orientation?

Congratulations on being a new nurse.:yeah: Best wishes to you.

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I am just back in the work-a-day world from a 20 year break. I retook the NCLEX May 2009 and passed with flying colors. Not one hospital would even consider me for a job. Finally, I got a job in home health and I am grateful after a year of looking for a job. I think you are doing case management as opposed to home health nursing. Is that correct? Are you filling out the OASIS or are you doing bedside care?

I work 8 hour shifts right now for a recovering premie. I worked NICU back in the day and so it was a little hard acclimating myself to the newer equipment and charting, but I finally feel fairly comfortable after a month or so.

I agree with you though. These home health agencies do not orient you sufficiently to do the kind of job that makes you look professional. The lack of communication is horrible! It is a huge embarrassment sometimes when you have to ask the parents what this or that is. Thank God that I have had some great parents that were willing to work with me. I felt so stupid having to ask. I will never forget when I started reading about O2 tanks and the literature simply said that the tank should be off and the flowmeter off. I freaked out because I was home on my time off reading this and I had no idea if that was dangerous or not. I just knew that at the home I was at, the tank was open and the flowmeter off. So I, in my panicked state, called a respiratory therapist friend and asked. I mean, that is sad if you ask me. It is the grace of God that nothing has happened. :banghead:

At any rate, in time you do feel more comfortable until the next thing comes up and there is no one to ask.

Vera

PS. can we talk about salaries on this board?

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People talk about salaries all the time. Ask away. But the general answer is that it depends on your area, the agency involved, and how gullible they thought you were when you were hired. Most of them require some effort to negotiate an acceptable salary. Look on the employment websites for instances when salaries are disclosed to get a general idea.

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I am a new registered nurse graduate with a bachelor's degree and just got my license one month ago. I have been offered a per diem job from a home health agency that has just started off. They currently don't have many patients and are being nice enough to let me work with them to gain experience and start of my nursing career. This is because most places are not hiring new graduates and require at least one year of experience. They have informed me that the average visit takes 15-30 min. Most of their patients are diabetics and would just need a follow up assessment, blood sugar checks twice a day, and insulin administration. They have offered me $10/ visit and $15/visit if I need to perfom wound care. I know I have no experience and I am not expecting a large amount of pay as a beginner but I feel like that is a very low pay. Can any one tell me what the average starting pay is in home health per visit in the south florida area or how I can find that out. I have been looking all over but can't find an answer.

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This may not pertain to FL, but in general, RNs make a minimum of $35 to $45 a visit on the average. I do not know why you are being offered McDonald's wages, but I would think twice about it. I think you are being played.

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Caliotter thank you so much for responding. I did figure it was very low but needed to find proof somewhere. The owners of this home health agency are family of my husband's friend and said they normally require at least 2 years of experience in order to consider anyone for employment in their agency. Once I heard what she was offering me as pay I felt like it was a slap in the face for me. I just let the owner speak and told her that I would probably be interested just to gain experience but am not sure that I want to take the job any longer. I will not be trained at all and just sent on my own. I said I was interested at first because I thought I would be trained and figured I would just get some experience to feel more comfortable working as a nurse. Don't get me wrong I am still searching for other jobs hoping that I will be able to get a job in a hospital. I feel I don't want to put my license in jeopardy for that amount of pay. She informed me that right now they get their patients from two ALFs that they own and that's where I would be going. Any advice??

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You would do better getting a job in retail at $8 or $9 an hour, at least you would be working and would not be jeopardizing your license. Seek another home health agency. There are some that will hire a new grad but they are hard to find. Meanwhile, try to find some work doing flu clinics. It isn't bad for a first job to put something on your resume.

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