New grad, new to home health - overwelmed

Blackheartednurse · Aug 8, 2010

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.

Wow the pay is very low:( I graduated last year and recently found a job in a home health nursing.I also have patients that are relatively stable (COPD patients,diabetics,CHF,and hypertension) My job doesnt require me to use too much skills but I do admit,assess by body system weekly,take vital signs,check blood sugar,set up meds in a med box for some patients,also I make sure patient are compliant with their meds and teach them about meds,their conditions.I get pay about 50 dollars per visit and when I admit patient for the first time I get 65 dolars.According to my agency the visit with a patient should last about an hour but at times you are finish in 30-45 minutes.

NMendez,RN · Aug 9, 2010

Thank you everyone for your responses. I had already made up my mind but wanted to have an idea of how much home health nurses got paid per visit. I figured the pay was extremely low but wanted to research before I said anything. I am calling the home health agency and telling them I will not be able to take that position.

Luv2care0907 · Aug 9, 2010

They have offered me $10/ visit and $15/visit if I need to perfom wound care.

I wrote this is another thread but will say it here too. I made $2/hour for orientation (no joke). I am making as much money now as I made 20 years ago with a shift differential working night shift. I asked my very respected established agency if there were raises or more pay for seniority and they indicated that there wasn't. That means that no matter how long you've worked, no matter what kind of job you do, no matter what shift you work, everyone gets the same pay that the government is willing to pay. Obviously, from your testimony it also doesn't matter what kind of degree you have either. If you happen to land a job where the client has private pay insurance, you might get more pay. But if you are working for a client with either Medicare or Medicaid, the agency will pay you only what the government pays and it is a pittance. $17-$18/hour regardless of what shift you work. For the nurses working the public schools, the pay is $15/hour for RNs. That is way less than what I made 20 years ago.

Many of the clients are aware of these things and they treat the home health nurses like low lifes. It is very hard to come under that kind of scrutiny. I admit, that bothered me a great deal. In my case, because I work pediatrics, I have had parents reject me as a potential nurse because of just coming back into the field thanks to the hospital nurses telling them that home health nurses are the rejects. I had one potential mom that I made an effort at my own expense to go to the hospital to meet, ask me until I caved, how long it had been since I worked. She knew exactly what to ask and she rejected me on the spot because of it.

I will tell you something else. Because of the HIPAA laws, I am even further reduced to being a glorified servant at times. This is not always true because it depends on the client, but some clients expect you to be their child's nanny. Seriously. I didn't last but a day at that case. :icon_roll We are expected to do exactly what the parents tell us to though up until it is a danger. I am very fortunate right now to have some excellent clients.

Kim, HHRN · Aug 10, 2010

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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.

your concerns sound a lot like mine have been except I have outstanding support behind me and the lpns I work with r great. If ur in Oklahoma email me. That's where I am too. Would love for u to come work with us.

k7redeemed · Aug 21, 2010

Can some experienced HH nurses please tell me what info/docs the HH ofc is supposed to provide you with for SOC pts? Shouldn't they be providing discharge med lists or MD orders prior to us going out to see the pt? I know it's a different world than the hospital but legally we can't give instruction on what the pt is supposed to be taking without orders, right??? Just because they have recently filled Rx's doesn't tell us anything. They could be refills not new Rx's for all I know.

WARNING: I'm about to unload....

I just quit a HH agency because they wanted me to go out for a 2nd visit for med mgmt with a pt who is post CVA, just dx'd with leukemia, has multiple Rx narcotics in her home, doesn't have a copy of her discharge med list & has no idea what she's supposed to be taking. How am I supposed to know??

Isn't this totally wrong??? An experienced RN may have known how to handle this, but as a newbie, it freaks me out. Then when I call & let the RN sup know my issues & that I'm dropping my pts she tells me "HH isn't for everyone. You have to just be ready to jump in." Whatever! She hired 3-4 of us new grads knowing we're inexperienced! I didn't get any experienced RN to go out with me to help orient me. I did work for another HH agency prior to this one for about 3weeks (who was better with orientation & support in the field but didn't pay enough for me to survive). But how can they send a new grad out in the field without sending an experienced RN with them for the 1st couple of visits at least? They are crazy & I was crazy/stupid to allow myself to be taken advantage of & put my license at risk. Ugghhhhh! :banghead:

Thank God I have wellness clinics, flu clinics & ADHC work. I so want to get into a hospital & get proper preceptored training! I graduated in Dec 08 & feel like I already need a refresher course, but can't afford to pay for it. This is so frustrating.

Sorry to unload but I really needed to let this out to other RN's that will understand. Thanks for listening.

Kelly

HealthyNurse · Aug 21, 2010

Wow, I'm sorry to those new grads that have been placed in this situation. IMHO, new grads absolutely do not belong in home health. The job is far too autonomous and requires too much critical thinking, such as knowledge of how procedures could safely be done differently (due to lack of supplies or other alterations in the home environment). How do you make such decisions if you don't even know how it should be done as a textbook procedure? And there is noone right down the hall to get for help and no supply room to go and grab a few extra sets. To the original poster, this sounds like an even more unsafe situation. You do realize that you remain ultimately responsible for the care of the patients that are being seen by the LPNs? You need at least 1-2 years experience to begin to function safely in the home environment. And even then, I would recommend going to an agency that will give you experience in true case management, where you are able to open the patient, see them for revisits, and follow through with the discharge.

A reputable home health agency would not consider hiring new grads, and if by chance they did, would offer an extended orientation with at least 6 months of in-field precepting and another 6 months of having a mentor available and continued classroom support. You both need to RUN from these agencies. You are jeopardizing your license and the patients you are caring for.

HealthyNurse · Aug 21, 2010

Can some experienced HH nurses please tell me what info/docs the HH ofc is supposed to provide you with for SOC pts? Shouldn't they be providing discharge med lists or MD orders prior to us going out to see the pt? I know it's a different world than the hospital but legally we can't give instruction on what the pt is supposed to be taking without orders, right??? Just because they have recently filled Rx's doesn't tell us anything. They could be refills not new Rx's for all I know.
WARNING: I'm about to unload....
I just quit a HH agency because they wanted me to go out for a 2nd visit for med mgmt with a pt who is post CVA, just dx'd with leukemia, has multiple Rx narcotics in her home, doesn't have a copy of her discharge med list & has no idea what she's supposed to be taking. How am I supposed to know??
Isn't this totally wrong??? An experienced RN may have known how to handle this, but as a newbie, it freaks me out. Then when I call & let the RN sup know my issues & that I'm dropping my pts she tells me "HH isn't for everyone. You have to just be ready to jump in." Whatever! She hired 3-4 of us new grads knowing we're inexperienced! I didn't get any experienced RN to go out with me to help orient me. I did work for another HH agency prior to this one for about 3weeks (who was better with orientation & support in the field but didn't pay enough for me to survive). But how can they send a new grad out in the field without sending an experienced RN with them for the 1st couple of visits at least? They are crazy & I was crazy/stupid to allow myself to be taken advantage of & put my license at risk. Ugghhhhh!
Thank God I have wellness clinics, flu clinics & ADHC work. I so want to get into a hospital & get proper preceptored training! I graduated in Dec 08 & feel like I already need a refresher course, but can't afford to pay for it. This is so frustrating.
Sorry to unload but I really needed to let this out to other RN's that will understand. Thanks for listening.
Kelly

Good for you for recognizing that you couldn't handle this situation. Unfortunately, it's a common situation, at least in my agency, where you are doing an admission and there is not a med list available to reconcile with the patient's meds in the home. The referral sources are supposed to send this information. Most hospitals do, most of the time, send the discharge med list (which can sometimes also be inaccurate), but it is especially common with physicians' offices and nursing facilities not to have this information. Home health nurses play a big role in med reconciliation and sometimes this involves getting on the phone with the physician who is going to sign orders and confirming the meds that are in the home. Some of our nurses also fax a copy of the meds that are found in the home to verify that they are correct. The meds found in the home also go on the certification, which becomes the agency's orders for that patient. So, when the physician signs the orders, they should also be verifying that the meds are correct and thereby authorizing the nurse to give instruction on those meds. By the time the physician signs the orders though, it would usually be too late if the patient were taking an incorrect med. So, the answer to your question would be that it is up to the nurse to do the investigation as to what meds the patient should actually be taking, whether that involves a phone call to have the doctor fax their list to the agency or confirm over the phone. This can be a frustrating part of the job, but it's necessary and very important. Med errors account for a large percentage of rehospitalizations.

You are right- the agency should have put someone with you for several months.

k7redeemed · Aug 22, 2010

I actually did call the pts PCP, however this is a new PCP & he didn't order the discharge meds so couldn't give me anything. When I spoke to the HH sup she asked me "Have you ever heard of a hospitalist?" Ummm, no....I'm an in experienced RN, haven't worked in acute care & no one told me I'd have to do this before sending me out to do med mgmt. Apparently I was supposed to call the hospital she was discharged from & track down the med list from them. I was very frustrated with their expectations of a new grad & lack of training/orientation. They basically just through supplies & paperwork at you & expect you to figure it out. If there was someone available by phone or text that may have been different but every time I tried calling the sup that oriented me (on paperwork for about 1hr) she was too busy or didn't answer her cell.

I really enjoy going to pts homes too. Like I said, the first HH agency I worked for was better with support. There was another new grad RN who started out in the ofc, then started seeing pts who was more familiar with things. She was great support for me. But again, we were both considered new grads. Maybe someday I'll go back to HH, but for now I'd like to get more experience & confidence under my belt.

carwin · Aug 23, 2010

K7 I am very sorry for your experience. There is no safe place for a new grad in home health. I say safe mainly because we as RNs have a license. You must allow no one to be the caretaker of that license but you. In court, you are held to the responsibilities of an RN. You took the job saying that you could do it.

Most freestanding HHAs have frequent turnover, especially those owned by non-licensed individuals. They rarely understand the clinical but they have the money piece memorized. They see RN and you're hired.

I absolutely love homecare. It is reverse from the hospital in many ways. You are the one who informs the doctor of meds and treatments equipment in the home. The hospitalist just gives the order to get you there. The PCP is the one who will direct care based on all of your data. You are the doc's eyes. Many times the doc trusts that you know what you're talking about and says ok. You develop the med list from all the meds the patient has stashed in every little shoe box, bread wrapper bag, etc. You will go to the home and through your very thorough assessment, fax findings to the doctor. The doc will go with what you say 90% of the time BUT you have to know what you are talking about

A hospital based HHA tends to provide the best orientation because they have the money to pay you while you are non-productive. Small agencies need for you to hit the ground running. My first job's orientation for HH nurses was a total of 6 mos. By the end of 6 months, you could comfortably manage a caseload of 20-25.

I stayed away for 6 years having the children. I started up again with a hostpital-based company because OASIS-B was implemented during the time I was away.

Good Luck

k7redeemed · Aug 23, 2010

Thanks for the comments. I'll keep seeking a good hospital based preceptored program.

UNFORGETABLE2667 · Oct 12, 2010

to the RN who was offered 10-15 bucks per visit doing home health...i would turn that down. i am an lpn in florida and to do wound care, diabetic visits, cardio/pulmo evals etc... i get 22.00 per visit. so i would keep looking if i was you. just saying......

pjp122954 · Oct 19, 2010

I can appreciate your feelings of being overwhelmed. I have been a RN for 20 years. Med/Surg and float pool for medium sized hospital for 13 years and hospice for 7 years. Recently quit hospice for home health. Pay rate was much better. I have been there one month and it is kicking my butt. Ready to go back to hospice, more autonomy, more laid back, less regulations if you can believe that. Home health is way to chaotic for my tastes. I'll work for less to save my sanity. Good luck!