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For those who have recently started in home health, how is it going?

What's good, what's bad, what was unexpected?

Libby,

I read some of your posts on here about your work as a Case Manager with a California nursing agency. It seems like your company really has it together, and I am dying to know what company it is, if that is okay. I am moving to California in 4 months as my husband is getting an amazing job. I have just began private duty nursing and I LOVE it, so Im really bummed out to have to leave my new patient in such a short period of time. I heard the job market in Cali is tough, so I'm really nervous. Any chance you know of any good reputable agencies to work for?

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Where will you be moving in California?

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Moving to the Irvine area.

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Oh, I'm up north.

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Specializes in FNP- BC, Med-Tele, PCU, Home Health Case Manager.

How's it going so far?

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Specializes in FNP- BC, Med-Tele, PCU, Home Health Case Manager.

That's very true! Idk how I missed your reply Libby, thank you. The trouble I've been having is some days I'll start out with 7-8 patients and then I'll start making calls and this amount is less and less...pt has have MD appt pr don't feel well. How do I get pts to just let me come see them? Lol. I figure the slow weeks balance out with the busy weeks on PPV but I guess I haven't been there quite long enough to decide yet. I'm still thinking this schedule is the best for me with my little guy....he will be in preschool this Fall so hopefully that can cut some daycare costs and allow me to drop him off and pick him up. Then when the baby comes (end of Dec/beginning of July) I'll take my maternity leave and maybe they will let me come back as part-time to accommodate daycare costs. Looking into possibly a nanny because I rarely am in the field for 8 hours a day and maybe it'd be more cost effective to have someone at our home? Need to do some more research. Seems like these days it's cheaper for one parent to stay home til the kids are in school full time lol. It's a budget my fiance and I will have to come up with and decide. I just can't even fathom working 12 hour shifts again or even a rigid M-F 9-6pm clinic job.

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If you can, call the evening before and then you'll cut out the MD appts and such and know what your day will mostly be like when you start in the morning.

Particularly call your admits to make sure that they're home and expecting a nurse to visit.

I don't always set a specific time but at least make sure they're going to be home and accepting either an am or pm visit and then give them a time in the morning.

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Specializes in FNP- BC, Med-Tele, PCU, Home Health Case Manager.
If you can, call the evening before and then you'll cut out the MD appts and such and know what your day will mostly be like when you start in the morning.

Particularly call your admits to make sure that they're home and expecting a nurse to visit.

I don't always set a specific time but at least make sure they're going to be home and accepting either an am or pm visit and then give them a time in the morning.

Most days though, I wake up and my schedule is different than the night before. But I'm going to request they get my admits lined up earlier so I'm not calling the day of or push them to the next day to give the pt a bit of a heads up.

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That makes it hard.

I'd still call who you can to at least exclude patients who won't be home plus avoid the early morning persuasion calls.

I do ask about my schedule the day prior, usually early afternoon for possible admits then again when I check out. I am pretty assertive (I mean enthusiastic :rolleyes: ) asking about upcoming admits and they do their best to get me at least preliminary info.

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Specializes in FNP- BC, Med-Tele, PCU, Home Health Case Manager.

Yeah. I'll finally be getting a laptop this week so I can have more control of my schedule but of course there's always new admits. I suppose I should also be a little more assertive and let pts know I do my best to accommodate however due to referall timelines, etc sometimes I am restricted on availability.

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Definitely.

It's really a communication/assertion skill that you will develop. IMO it's better to be pushed around initially instead of being overly aggressive while developing your style.

Patients and their caregivers own their time at home but you have limitations on flexibility when you're meeting the needs of multiple patients over a large area and avoiding OT.

I have 3 ways that I handle it.

1) On admit I establish trust and the value of home health services. They want me back because they're comfortable with me and I did enough to demonstrate the necessity of my visits.

2) I accomodate when I can, so when I say I can't do something I'm credible.

3) I don't sway when I can't and I persuade them with concern for their well being ie "I'm concerned about your lung sounds and really want to recheck that they're not getting worse, your jammies are fine, believe me I left a sink full of dishes too, the important thing is your recovery, I can sneak in and out quickly if you need me to, I'd just hate to have you get worse.."

I don't say all of that lol and it depends on the personalities and cognition involved but I swear I can sell a bridge*, though having that initial trust and credibility is key, or building it quickly in that phone conversation. I watch/hear others get declined and I never heard a genuine sounding persuasive discussion.

*Patient focused of course, they're not on my calendar if they don't need to be or I accept their decline if it's reasonable, and sometimes it is.

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