New Home Health nurse, need advice

dusky1228 · Jul 27, 2008

Hi everyone!
I'm just beginning a new job in home health. I am very excited about it, and was wondering if anyone might have any advice for me. I worked med-surg for about 9 months, and have been working as a postpartum nurse for a year. I decided I needed to refresh my skills, and have been interested in home health for awhile.
First of all, welcome to home health! I have been doing it since 1991. Prior to that, I worked in a very busy hospital setting, and took a "burnout year" in an industrial setting for 1 year, then decided to do home health for a year (!). When I was in nursing school, I never would have thought I would do this job and love it. I so loved the hospital adrenaline rush. But being older and wiser, and figuring it would be a brief learning experience, I did it. I loved it, and still do. There are a tremendous amount of pressures, and a large learning curve. Rules for insurance and Medicare and Medicaid change constantly, "paperwork" is often overwhelming (I'm still finishing up some of my week's documentation, for example). If you are organized and an independent worker, you should do well. If you can afford it, a GPS is invaluable. Reading maps is a real PIA, especially when you are driving. I have learned that most Dunkin Donuts have fairly clean bathrooms. I have also learned (some of our staff learned a valuable lesson here) that it's usually best not to use a bathroom in a patient's home, no matter how clean it seems. I do occasionally, but I have to be desperate.
DO NOT skip lunch, no matter how busy. Take at least a few minutes to unwind, relax and recharge. Invest in some really comfortable shoes. Take impeccable care of your computer device, whatever type it is. A finicky or non working device can throw you day into a tailspin, and unfinished paperwork can magnify into unmanageability very quickly. Invest in a medical phrases book for the main alternate language (if you don't already speak that language). Always keep a bottle of water in your car. Always keep your car gassed up and in good working order. NEVER make a home visit if it doesn't feel safe, no matter WHO tells you to do it. Follow your gut-it's usually right. Safety is paramount, and only you can protect yourself. A manager sitting in a safe comfortable office is usually just concerned with "getting the patient seen", but your concern needs to be getting home safely. We have a security team here for areas and situations if we need it, and they are invaluable. I have tons of other suggestions, feel free to email me if you like! I'd be glad to communicate with you.

annaedRN, RN · Jul 28, 2008

Dusky did a great job of summing alot of things up. Organization is key for me. Arranging your visits, keeping up with the charting. Charting as much as possible in the patient's home..or pulling down the street to a nice safe shady spot and finish charting. It is easier to spend 5-10 min after each patient rather than 1+ hr at home.

Learning the OASIS will take awhile, but it does get easier. Ask alot of questions - remember it is your license on the line. Learn to keep alot of extra supplies in your car. I have a box in my trunk with supplies for changing/managing/troubleshooting catheters, IVs, wounds, ostomies, etc. I keep my phlebotomy supplies in the car. I also have extra forms/paperwork for MC patients if needed.

But most of all, enjoy the job and the patients! You get to know their family, pets, favorite tv shows and hobbies... you really connect. Often b/c of that relationship, you can teach them much more than when in other environments.

The perks of the autonomy and flexibility are great too. I often eat lunch at home, let the dog out to pee, pick up prescriptions or groceries, swing by the bank, pop in to say hi to my mom, or get to an appt...and still see all my patients. LOVE IT! I hope you get to exerience the same. Good luck

I use computerized charting too. It takes a little while to learn, but it is SO beneficial in the field. Being able to access the other visits, assessments, meds, MDs, diagnoses easily (rather than trying to keep a paper chart with all of that) - it makes the job much more efficient. It lets you have even more autonomy too - you can tranmit and download patient info from home.

mo-mo · Aug 2, 2008

The main thing, most rewarding thing for me is that in this environment, you really have the ability to DO WHAT'S RIGHT FOR THE PATIENT. If that is always your first concern, you'll thrive in home health and you'll love it.

TiredofLTC · Aug 2, 2008

I'm glad you posted this. I have an interview for a home health position next week. I really hope I get it. I have been in LTC for a year and honestly I'm tired of it. Not the patients but the staff. I love the hours and flexibility of home health and the agency I applied for has great benefits and are very supportive of their staff. So ya'll keep your fingers crossed for me that I get the job.

Wishinonastar, BSN · Aug 8, 2008

1. Don't give up. You will be overwhelmed with the paperwork at first, though every area of nursing has a lot of it nowadays. Home health paperwork is uniquely overwhelming.

2. Keep learning. Go to the seminars and inservices that are offered.

3. Enjoy your patients. There is no area of nursing where you get to enjoy your patients so much. Yesterday I was cleaning out a cupboard and I found a carved wood piece that a patient made me a few years ago. He died not long after, but remembering him was such a joy! I have a hand decorated egg, a "bug house" to catch fireflies in, a hand made pottery girl, a grapevine wreath, and a strand of beads that patients have made for me over the years. None of them are valuable, but they are hand made gifts that I treasure more than anything.

4. If you like your work and not the place that you work for, try another agency. They are not all created equal! Non-profits are different! They are what I prefer.

*In home health since 1988 when I was ready to leave nursing all together.

pocovan, MSN, RN, NP · Aug 9, 2008

I try to bust a move and not stop the entire day unless I have to pee. I eat while I drive so that I can get done earlier. Does anyone else do this?

Wishinonastar, BSN · Aug 9, 2008

It depends on the day as to whether I would normally stop. Most of the girls at my office hurry through the day without stopping, then have lunch together at the office around 1:30 before tackling paperwork. I usually prefer to stop for coffee around 10:30 or so and regroup. Then I end up at the office later, sometime doing paperwork in my car for the solitude. Lunch usually waits for the office though, and is very late. Or, I might eat a quick apple or granola bar in the car. It is hard to take a lunch break by yourself. Some girls stop at home for lunch if they live close enough.

QueenAngie · Aug 10, 2008

Hello! Love these tips and tricks of HH nursing.

I just started HH this month, after 30 years of hospital nursing.

Totally different being in someone's home.

It is a joy and a privilege to do HH nursing.

It is one on one and holistic care.

Yes, too much paperwork! But, we are supposed to go to laptops soon. I'm ready for the laptops.

The patients are what makes the career worthwhile!

BrightEyes · Aug 15, 2008

Organise, organise, organise.

It takes a while to learn the ropes, OASIS certainly is not a desert paradise. Takes a LONG time to learn it. Try not to become frustrated/discouraged with the learning curve. In all honesty it took me "years" to feel truly comfortable with it.

Keep learning, stay up to date.

Don't let the paperwork get you down and try not to get behind on it.

Really, really listen to your patient. Go with your "gut" feeling, if you have that little niggle that something isn't quite right, investigate furthur.

You're always a guest in their home. It's a privelege for you to be there.

All in all, don't get discouraged, it's an awesome job, make it work FOR YOU. Good luck. :-)

annaedRN, RN · Aug 17, 2008

pocovan - I chuckled at the visual image of "bust a move"..but I often do the same. While it kinda stinks to have to finish up/work from home....I guess I'd rather chart at home, sitting in my couch, in my sweats, yelling at my kid, dinner in the oven...than have to stay an extra hour at a facility to finish up!!