New to home care and need help!

puppielove · Sep 23, 2008

most homecare agencies have a lot of paperwork, once you learn how to prioritize your time you'll find it much easier. maybe you should try 12hr shifts or nocs it would make things easier for you just a thought;) :nurse:

HmarieD · Sep 23, 2008

Hang in there, it will get better with time!

I would recommend completing as much of the paperwork in the home as possible. In terms of the OASIS assessments, it may take some time to find a system that works for you. I eventually established a routine something like this -

- I started with my med list. It can clue you into additional Dx, and while you are making your list you should be simultaneously talking with the patient to make sure they understand their medicines, find out if someone sets them up for them, etc. This can be applied to your med management OASIS questions.

- Move on to your physical assessment. When you become more familiar with the OASIS you can gear some of your assessment questions to get information that will help you complete your OASIS like the wound section, respiratory, etc. (and believe me, you will become intimately familiar with OASIS...)

- Have the patient demonstrate their functional abilities. I cannot stress this enough. You will never get an accurate picture of your pt if you only interview them. My favorite method was to tell the pt that "the boss" says I have to check your bathroom and make sure you have everything you need and that it's safe. Ask them to show you to the bathroom. You will then observe them transferring in and out of the chair or bed, and ambulating. Once you get to the bathroom, ask them if they can get in and out ok with their walker, cane, etc (for OASIS toileting question), how do they usually take a bath, and can they demonstrate for you how they would normally get in/out of the tub/shower if they tell you they are able (let them do it fully clothed). Apply all of your observations to your OASIS ADL questions.

Some of your OASIS questions can be addressed using your H&P if the pt was recently hospitalized. If you have a talker who has an anecdote for every question, utilize this type of info as much as you can. Sometimes you have to be a little firm and re-direct pts to the question at hand or just direct them at the beginning that you only want a "yes" or "no" answer. Otherwise you will be there literally for hours.

Be sure and follow the skip patterns on the OASIS. I have seen clinicians struggle over a question that they're not even required to answer.

I will stop here, I am sure that lots of folks will have great suggestions for you. Good luck, and take heart...it will get easier. :redbeathe

pedshomehealth · Sep 25, 2008

I have always done nights. I think that is a good starting place until you are comfortable with the paperwork and the routine, then, go to days.

Second · Sep 27, 2008

Thank You all for great suggestions and encouragement! The past few days I haven't been able to use my computer and I was so happy to have your notes. This week I seemed to have one good day followed by another in which I felt at sea. But this is progress. Today I had an all day OASIS seminar. Surely a bunch of sadists gathered in a room to figure out how to torture hard working nurses and came up with this! But I tried mightily not to be bored and to understand the forms. There is so much to it. Is there anyone out there willing for me to ask questions about paperwork if I'm stumped? I think my plan (0nce I'm out on my own) will be to see patients early doing as much paperwork in the home as possible and then actually going home to finish the rest. The office is full of interuptions and it's distracting. Does that sound right?

nursechris1 · Sep 27, 2008

I agree. Stay out of the office if you can. There are too many distractions.

enurslw · Sep 28, 2008

I have an interview for a Home Health Nursing position in a couple of days.

After reading what some people have to say about HH nursing, I must say I'm not altogether sure this is for me. After reading so many negative things on several internet forums, I am hoping to hear some positive comments about HH nursing. Can anyone help me?

pedshomehealth · Sep 28, 2008

You will enjoy it if you: 1)Stay out of office gossip/politics; 2)Sign up with multiple HH companies so that the antics of any particular one does not hold you hostage b/c of need to work; 3)Be friendly but not friends with your clients and their families. You can easily get sucked into family conflict. Politely say, "It is best that I don't get involved." 4)If you work nights, be sure to have lots of entertainment for yourself. Join NetFlix, get a connect card and laptop, a thermos filled with coffee and plenty to healthy snacks---it is so easy to gain lots of weight while doing home health. Good luck!

annaedRN, RN · Sep 28, 2008

Hello enurslw, HH is definitely not for everyone...but I LOVE it and would never be happy working in a facility again. The following is how I responded to someone who was unhappy and thinking of leaving HH

" I am sorry that HH is not working for you. I understand/agree with many of the things you say. But, I feel if you truly love HH you look at the same things in a different light. For example, my schedule is M-F 8-430 but my day often ends much earlier..and where else during those hours can you keep dr appts., swing by the bank or pharmacy, let the dog out to pee, etc and not need to use any PTO? I only have on-call every 5-6 weekends...much less than in a hospital.(don't work weekends at all) Or yes, I do finish up my charting at home ...but I get to do so on my couch in my sweats..not stay over an extra hour after a crazy 12 hr shift. I feel that I do get to practice most med-surg skills and yes they are often adapted for the home. IMO, hospital nursing is not always "real world nursing" b/c these patients (except for the very acute stuff) are going to be managing their needs at home and not in the fashion that it was done in the hospital. To me that is what makes HH so rewarding...along with the challenges posed in the home. I love that each new patient is a totally new challenge in a totally new environment. I love that I get to help this patient stay in their home! But, thank goodness everyone has their own "fit" for where they want to be in nursing - we need all the parts to make the whole! "

Anyway...I feel the doctors give you more respect. You get alot of flexibility. Once you have had the autonomy that HH gives you it's hard to imagine working in a hospital again. You actually get a chance to TEACH patients what they need to know- without being pulled 10 other directions simultaneously. Of course, no job is perfect. There is alot of charting but once you get familiar with it it gets a little easier. If you learn to chart as you go- doing as much as you can in patient's home- that really helps. Ok...I've gone on way long enough. Hope that helps you see HH in a more positive light!

enurslw · Sep 28, 2008

Thanks for the responses. You all have helped me immensley. My interview for the HH nursing position is tomorrow. A friend of mine who is a case manager at a hospital told me I would not like Home Health. I wish she wouldn't be so discouraging because as far as I know she has never worked in HH. I am the type of person who does not like to be couped up in the same place all the time, being on the run is more my style. Are there any questions I need to ask at the interview? I do not speak Spanish and many of the residents of one county I will be covering are Hispanic. How do you communicate with them? Interpreter?

Second · Sep 29, 2008

Hi Enursl, I want to say that after 3 weeks, I am hopefull that I can master the paperwork. It is the hard part and I am taking the attitude that I want to learn it as quickly as I can so that it does not become a constant bother. I have also resolved not to waste time talking about how bad the paperwork its because it only makes me feel worse and really, all jobs have something negative. In this job, I am already loving the intimacy one has with patients at home and the freedom to schedule things as I like. In my agency we are all busy, but it helps to be able to set one's own schedule. I too like the idea that I can take paperwork home and do it on the couch in sweats! Being able to go home keeps you out of office politics and negativity. I have much to learn and I do think it will be months before I am truly comfortable with this job, but I think I will love it.

enurslw · Sep 29, 2008

You are right. All jobs have something negative about them. My goal is to go into this realizing I will have a lot to learn, but I am up for the challenge. I have so many questions to ask the HH manager I will be interviewing with. I have in the past let what some nurses say, negatively speaking, effect how I viewed my job. I do not want in any part of the office politics. I am going to be there to do a job and I want to do a good one. Thanks, and keep me posted on how your charting is coming along on the computer.