New Nurse in Home Health

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Specializes in Urgent Care, Pediatrics, Home Health.

Hi everyone, I am a new nurse working in home health, and I am really struggling. I know experienced nurses advise new nurses not to start in home health, so that was not my initial intention. However, I was working as a home health aide during nursing school, and I loved it (it was far better than working in ALF where I was prior). A recruiter on LinkedIn from a home health agency had reached out to me while I was still in nursing school. This HHA is part of a reputable hospital based health system in my area, and they offered a nurse residency program, so I really thought I would be getting the support and additional training/education I would need. I ended up applying for the position and getting an offer prior to graduation. I started working there at the end of October after I passed the NCLEX. 

In a lot of ways, they are providing a lot of support, training, and education. And they are not starting me off with a full patient load. I have 2 amazing preceptors, who have helped me tremendously and are still available for all my questions. But after only 8 weeks, they had me start seeing patients on my own. My preceptors will still come out with me for certain skills I'm not signed off on yet, but there is a definite push for me to do more and more solo. I just recently learned how to do SOC visits. I was told that I was not part of staffing and should not be used to cover visits on overflow. Instead, I should be sharing patients with my preceptors and going out with them for skills (there are still so many I am not signed off on yet). However, I have been consistently assigned patients on overflow, and I feel like I don't have the experience under my belt to handle any and all situations that could arise. And sometimes I feel like the visits are pointless (when there is no direct skill involved) - we are there to do an assessment and provide teaching, but a lot of these patients have had these diseases for a long time, and they don't really need me to teach them anything. I honestly prefer doing wound care visits because then I feel more useful. 

My biggest issue, however, is how I feel that I am working ALL the time. Since I am on orientation, I only get paid 8 hours per day. It was already explained to me that I would not be getting OT on orientation. But I am driving around all day in my own vehicle seeing patients, and I try to get as much documentation done in the home or in between as possible, but I inevitably always end up bringing the rest home. I know it's supposed to get easier and quicker the more you do it, but I am also seeing only 3-4 units a day now (1 RV = 1 unit, 1 SOC = 2 units), and the expectation will eventually be 6 units a day. If the day goes smoothly, I suppose I could see how it's possible to get all 6 units done including documentation in 8 hours (for someone with experience), but there are often multiple issues that pop up. These people are not well, after all. I just don't see how it would be possible without rushing through the visit and missing things. 

And I find scheduling to be an enormous time suck. Just when you think your day is just about over, you remember you still have to schedule your patients for the next day, and I have to comb through their charts too to make sure they're appropriate for me to see. It can be so hard to get a hold of patients, and then it's often a lot of back and forth with the schedulers. I am probably working at least 10-12 hours 5 days a week, and then I'm working quite a bit on Sundays as well as I prepare for Monday. I already sacrificed so much time with my children during nursing school. I am regretting that I didn't find a 3 day a week 12 hour position because even though those days will be long, at least it will only be 3 days and not 5 like it is now. Plus I would be getting paid for all the hours that I would work. When I'm off orientation, I am technically still hourly, meaning I will get paid for meetings, trainings, etc. But each unit is still only worth so much time. The only way to get extra time would be extenuating circumstances, and I'm sure that's few and far between that would get approved. So, I feel like it's not going to get much better. It may just not be the right fit for me. I thought I would enjoy visiting people in their homes, but I am honestly hating not knowing where I am going to be each day and not always having my schedule figured out the night before. I also feel so anxious that I will be faced with a situation that I don't have the experience to deal with. We have been so lucky this Winter, but I do worry about what it will be like when we get a rough Winter. 

My husband thinks I should find a new job now (considering a hospital, dialysis outpatient, or urgent care - somewhere that I won't be alone and I will have a set location for the day), but I have been hesitant. I know my company has invested a lot of money into training me, and I would hate to burn this bridge, and for it to look bad on my resume. But my husband said I should be thinking of my family first and not the company. Plus the longer I work there, the more resources I will be using up when I don't intend to stay. I would not leave without finding a new job first of course. I am the primary breadwinner right now, and this job is providing great benefits for my family. 

I am just looking for some advice from those of you who know the home health field so well. Does it get better when you start case managing? They are supposed to train me to case manage. Should I stick it out for at least a year, or should I get out now when I know this probably isn't the best fit for me? 

Thank you for reading and for any advice you have to offer! ? 

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Specializes in Rehabilitation,Home Health, Neuro ICU, PACU.

Hey, Cookie.

I worked in home health for 3 years, did regular visits, and start of care (SOC).

In my agency, they try to give you a specific area to work, and to have a full day you have to see 5-6 patients. Sounds good right? But ...when you try to schedule people for the next day, you spend 2-3 hrs of your time calling and then they have their time preferences and no one wants to see you at 9 am. You have to jump through many loops to make your schedule, frustrating...

If you are a regular field nurse, try to chart your patient while you are in the house because later you have to catch up and it takes your time from your family and you may forget something. You will improve with time charting and talking-listening to your patient because they loooove to chat.

The most part I disliked was when you made your schedule, you came to see patient BUT nobody was home! That really sucks because while you trying to replace the visit ( you want your money after all, right?) the time comes to see the next patient. So you end up with low points/money. 

And all this going on 5 days a week, no wait, 6 days a week because half Sunday you spend calling people and making a schedule for Monday.

In my company, we also had to take calls through the weekend, which was not fun at all. In addition to talking to people, you have to chart in their chart about the call and then send an email in the morning to the office, to the responsible parties. 

And yes, you will feel like you work all the time. My hubby was not happy at all.

Yak, I did not miss it at all.

If you have little kids, I would suggest finding a 3X12 job and having 4 days off to spend with your kids and husband.

Seriously, home health only sounds nice but nooooo.

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I was able to find a home health position which gave benefits for 24 hour employees at a slightly higher cost than those working 30+. I chose to work 3 days on salary with the ability to pick up extra patients on other days at a per diem rate. Often I ended up working 2 half days and 3 regular days, but it was my choice. If I felt like 4 days off every week I could do so. Other employees negotiated 4 days at 7-8 points (30 total) for a 40 hour position, 5 days at 4-5 points for part time etc. to get the balance they needed between personal time and $$ and keep benefits. As you said, they have a lot invested in your training and might be willing to be flexible about how to spread out your points rather than lose their investment. Maybe it is worth a conversation with management 

1
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Specializes in Urgent Care, Pediatrics, Home Health.
Svit said:

Hey, Cookie.

I worked in home health for 3 years, did regular visits, and start of care (SOC).

In my agency, they try to give you a specific area to work, and to have a full day you have to see 5-6 patients. Sounds good right? But ...when you try to schedule people for the next day, you spend 2-3 hrs of your time calling and then they have their time preferences and no one wants to see you at 9 am. You have to jump through many loops to make your schedule, frustrating...

If you are a regular field nurse, try to chart your patient while you are in the house because later you have to catch up and it takes your time from your family and you may forget something. You will improve with time charting and talking-listening to your patient because they loooove to chat.

The most part I disliked was when you made your schedule, you came to see patient BUT nobody was home! That really sucks because while you trying to replace the visit ( you want your money after all, right?) the time comes to see the next patient. So you end up with low points/money. 

And all this going on 5 days a week, no wait, 6 days a week because half Sunday you spend calling people and making a schedule for Monday.

In my company, we also had to take calls through the weekend, which was not fun at all. In addition to talking to people, you have to chart in their chart about the call and then send an email in the morning to the office, to the responsible parties. 

And yes, you will feel like you work all the time. My hubby was not happy at all.

Yak, I did not miss it at all.

If you have little kids, I would suggest finding a 3X12 job and having 4 days off to spend with your kids and husband.

Seriously, home health only sounds nice but nooooo.

Hi Svit,

Thank you so much for your input! I am having similar issues with scheduling. I have been trying so hard to document in the home, but sometimes it's nearly impossible (when doing a wound vac for example). And then I will try to document in the car after I leave, but often I have to rush to the next visit because the schedule I hoped to have did not work out because I had to accommodate patient requests. 

We are lucky not to have on call because we have on call nurses. I cannot imagine doing that on top of what I am already doing! I can see why you don't miss it. Do you mind sharing where you are working now?

I did end up applying to a couple of other positions, and I have a job interview with an urgent care center on Tuesday! Very nervous but hopeful it will work out. I am feeling so miserable in home care... 

1
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Specializes in Urgent Care, Pediatrics, Home Health.
BBP42 said:

I was able to find a home health position which gave benefits for 24 hour employees at a slightly higher cost than those working 30+. I chose to work 3 days on salary with the ability to pick up extra patients on other days at a per diem rate. Often I ended up working 2 half days and 3 regular days, but it was my choice. If I felt like 4 days off every week I could do so. Other employees negotiated 4 days at 7-8 points (30 total) for a 40 hour position, 5 days at 4-5 points for part time etc. to get the balance they needed between personal time and $$ and keep benefits. As you said, they have a lot invested in your training and might be willing to be flexible about how to spread out your points rather than lose their investment. Maybe it is worth a conversation with management 

Hi BBP42,

Thank you for sharing this! This is an awesome suggestion. I could probably handle my job a lot easier if it wasn't so many days out of the week. My big concern would be that I am a nurse resident, so they are expecting me to be full time. I also need to work full time, but if I could go per diem, then I could work maybe one day a week and one weekend a month and be full time somewhere else. I doubt they would be agreeable because I am not an experienced nurse (usually per diem is for more experienced nurses), but it does not hurt to ask. 

I just wish they would not have listed this job as hourly. It really is PPV or salary with an expectation of so many units in a day/week. I would not have accepted the position had I known it was set up like this. 

They are also requiring that I enroll in a BSN program within 6 months and have it within 3 years. I did enroll but ended up dropping it because I could not imagine doing school on top of all the hours I am working. 

Thanks again for your input!

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Specializes in Rehabilitation,Home Health, Neuro ICU, PACU.
CookieRoo9413 said:

Hi Svit,

Thank you so much for your input! I am having similar issues with scheduling. I have been trying so hard to document in the home, but sometimes it's nearly impossible (when doing a wound vac for example). And then I will try to document in the car after I leave, but often I have to rush to the next visit because the schedule I hoped to have did not work out because I had to accommodate patient requests. 

We are lucky not to have on call because we have on call nurses. I cannot imagine doing that on top of what I am already doing! I can see why you don't miss it. Do you mind sharing where you are working now?

I did end up applying to a couple of other positions, and I have a job interview with an urgent care center on Tuesday! Very nervous but hopeful it will work out. I am feeling so miserable in home care... 

Hi, Cookie,

Currently I work in post anesthesia care unit in hospital surgery. Love it, 2 years soon.

If you like complex care, you may try ICU.

After ICU you with have all doors open before you.

I liked working in neuro ICU. Human body fascinates me. A little bit hard on your body- taking patients to CT/MRI with all the equipment they attached to. Job for young, Ib say.

Good luck with your interview.

 

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Specializes in care manager, peds, PDN.

Hi Cookie - hope your interview goes well!! 
You might also want to look into an agency that specializes in wound care (wound vacs are my all time favorite LOL) or an agency that provides Private Duty Nursing. PDN is similar to home health but different at the same time. 
CONs to PDN that I've experienced - pay is usually lower because medicaid doesn't reimburse as much for a home nurse. The agencies tend to be smaller so they can't afford bigger perks & benefits.
PROs - scheduling is flexible (and usually done for you). The agency I work for does monthly schedules so you know where you will be well in advance. You work a regular shift too, usually 8, 10, or 12hrs in the home and documentation is all done on shift in the home. 

PDN can also be a nice little side gig. You get 1-on-1 patient care in a laid-back home setting, but your main job can provide you with your medical benifits, tuition reimbursement for BSN & such. 

If you have any questions about PDN I'd be happy to try and answer them.

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Specializes in Urgent Care, Pediatrics, Home Health.
Svit said:

Hi, Cookie,

Currently I work in post anesthesia care unit in hospital surgery. Love it, 2 years soon.

If you like complex care, you may try ICU.

After ICU you with have all doors open before you.

I liked working in neuro ICU. Human body fascinates me. A little bit hard on your body- taking patients to CT/MRI with all the equipment they attached to. Job for young, Ib say.

Good luck with your interview.

 

Hi Svit,

Thank you for sharing where you're working now! So happy to hear you found a job that you love. ? 

I am honestly a little terrified to work in the ICU. It was one of the reasons why I chose home health. I always liked the idea of community nursing over acute care. But I am finding that it would be beneficial to have that acute care experience before seeing patients in the community, especially independently... 

A friend of mine that graduated nursing school with me started in the ICU, and she has been very overwhelmed there. I think she's hanging in okay though. 

Thank you for your well wishes on the interview! The interview with the HR manager went well. He told me he would send my application over to the center I applied to, and the manager there would contact me in about a week. Well, she contacted me that same day, so I have an in person interview at the center with her on Monday! It seems promising, and the pay was higher than I expected (only a little less than what I make now, plus I would get paid for all hours I'm working). 

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Specializes in Urgent Care, Pediatrics, Home Health.
MeggyBeth said:

Hi Cookie - hope your interview goes well!! 
You might also want to look into an agency that specializes in wound care (wound vacs are my all time favorite LOL) or an agency that provides Private Duty Nursing. PDN is similar to home health but different at the same time. 
CONs to PDN that I've experienced - pay is usually lower because medicaid doesn't reimburse as much for a home nurse. The agencies tend to be smaller so they can't afford bigger perks & benefits.
PROs - scheduling is flexible (and usually done for you). The agency I work for does monthly schedules so you know where you will be well in advance. You work a regular shift too, usually 8, 10, or 12hrs in the home and documentation is all done on shift in the home. 

PDN can also be a nice little side gig. You get 1-on-1 patient care in a laid-back home setting, but your main job can provide you with your medical benifits, tuition reimbursement for BSN & such. 

If you have any questions about PDN I'd be happy to try and answer them.

Hi MeggyBeth,

Thank you for your input! I am familiar with PDN because I worked for Bayada as a HHA while I was in nursing school, and I worked with some of the nurses there on a complex case for a client who was quadriplegic (with a trach and vent at night). I had seriously considered doing their nurse residency program but ended up taking the position in home health instead. I know the pay and the benefits in PDN are not the best, so I think doing it as a side gig is a great idea. It is definitely something I would consider. I appreciate your insight. ? 

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You posts is exactly why a lot of nurses, even seasoned ones, end up leaving HH.  Myself included. The points/productivity and user unfriendly HCHB/promisepoint is just chronically stressful and there is no balance of work/life. 

I have found that HH nurses are similar to hospice or dialysis nurses in that they either love HH and don't care about the work load during and after work hours or they hate it and find something else. 

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Specializes in Urgent Care, Pediatrics, Home Health.
Peachpit said:

You posts is exactly why a lot of nurses, even seasoned ones, end up leaving HH.  Myself included. The points/productivity and user unfriendly HCHB/promisepoint is just chronically stressful and there is no balance of work/life. 

I have found that HH nurses are similar to hospice or dialysis nurses in that they either love HH and don't care about the work load during and after work hours or they hate it and find something else. 

Hey, Peachpit! Sorry for my late reply. But you are so right. There were nurses that I worked with that loved it, including my preceptor who was a tremendous help to me. But for a lot of us, it feels like there is no work/life balance at all. 

For anyone wondering, I did end up getting the job in urgent care and have been there now since April. It has been going very well! I took a slight pay cut, and the benefits are more expensive, so I also recently started a per diem job at a pediatric day care center for kids with complex medical needs. The jobs are very different from one another, but I feel like I'm getting a good, varied experience doing both. Since I'm working two jobs and my schedule is all over the place, I feel like I'm back to having little work/life balance. But at least I'm getting paid for all the hours I'm working, and my time at home is my own and can be spent with my family! 

Thank you all again for your input. ?

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