New Nurse Needs Advice on Home Health

[Kim, HHRN]

Does acute care in the hospital setting really prepare you for home health? The reason I ask is that I hate being on a med surg floor. I thought I would get more opportunities to start IVs, do wound care, work with NG tubes and feeding, etc. I feel that all I do is administer medication against the clock. Truthfully, I would rather clean a patient and change dirty linens than trying to deliver meds to a bunch of patients on time. I feel that as an RN I don't get much opportunity to spend with the patients.

Because I like to spend time with patients, I feel that home health would be the way to go. I love educating, spending time with patients, and can write good care plans - so paperwork does not really bother me. I also like the idea of working with OT, PT, RT, and docs.

Would I be a good fit as a home health nurse? Should I get into home health with a good orientation or should I wait and get a year of experience in acute care? Will a med surg floor really prepare me for home health? Thanks in advance.

[KateRN1]

To be prepared as a home health care nurse, you need to be familiar with a variety of conditions and their treatments, with an emphasis on chronic diseases. You need to have excellent assessment skills, problem-solving skills, and organization skills. You must be able to identify which things need to be reported to the doc immediately, which can wait until tomorrow, and which can simply be noted.

Ability to communicate with many different kinds of people without taking or giving offense is extremely helpful. And you have to be able to communicate with the patients, too.

Organization is probably the biggest hurdle, as there is a lot of inherent disorganization in home health care. The ability to work on the fly is a must, as is a great deal of flexibility. Attention to detail is crucial. I cannot stress that enough.

You must be able to teach to the patient's (or caregiver's) level, even though that may not be the ideal level of care (in your expert nursing opinion). And you must be able to accept that sometimes, no amount of teaching will get through--and let it go.

I know Caliotter is going to come in and suggest this, so I'll beat her to the punch. If you're a reasonably new grad, you may do better in extended visits, also known as private duty, or shift work/visits. You have one stable patient, one note, and lots of time to learn. I heartily believe that Medicare home health (intermittent visits) is not for new grads, or anyone with less than 2-5 years of full-time nursing experience (preferably more).

[Kim, HHRN]

Thanks Kate for your reply and willingness to share about home health. I was thinking of doing home health on the side prn in addition to the hospital setting to see if I would like it. Since I really don't know all the terminology that goes along with home health, is prn work the same thing as the shift work/visits that you are talking about? And is the Medicare home health the same thing as what an RN/Case Manager would be doing?

Thanks again.

[KateRN1]

Basically, there are two kinds of home care: shift work, where you spend a designated time with a stable patient who needs routine care, and intermittent visits (Medicare home health). For example of shift work, a pt with a g-tube who needs meds crushed and administered, plus a vent that needs to be monitored and treatments given, as well as bathing, range-of-motion exercises, transportation to doctor visits, etc. Most often, these patients will have a "Case Manager" in the office who takes care of other issues.

Medicare home health is where you make intermittent skilled visits to patients who have recently been released from the hospital and need follow-up teaching for things like diabetic education, CHF monitoring, home physical/occupational/speech/cognitive therapy, medication teaching, etc.

If you are only interested in PRN, then you would not be assigned as a Case Manager as that is a full-time (and then some) position. In my experience, not many places will hire a PRN home health nurse who doesn't already have experience. It costs too much to train a nurse to do OASIS assessments (which is what most PRN RNs are used for), when you can get an LPN to do revisits. You will most likely be better able to work PRN with shift work.

[caliotter3]

Yep, Kate said it before me. A new grad can be "trained to the case", to work an extended care case, and will probably not have any or many problems. Everybody needs to start somewhere and this is the best venue for new grads or those with little experience. No matter what kind of hh job you get though, you need to be proactive to get the orientation you need to start to feel comfortable doing things on your own. Do not ever hesitate to call your supervisor to ask how something is done or to get advice on which way to go with a situation.

[DIVA_NURSE405]

I'm currently an RN working in med-surg.I'm also an Home Health RN prn, but I have over 2 yrs exper in HH before going prn. Working in the hosp will help u with skills such as wound care, wound vac,education on diseases & meds,care plans etc. Learning the OASIS is on the job training, you will not learn this in a hospital. I love home health & currently considering going back FT after I have my baby because of the flexibility. I really hate the paperwork in HH, but the pay is much better than a hosp. You also have to consider that you will be the only person there with a pt and your assessment skills have to be up par because sometimes you are the only health care professional that pt sees in between DR visits and outpt wound care visits. Many HH agencies will not hire new grads.

[Kim, HHRN]

Caliotter, thanks for the answers. I hope I can be trained to the case, like you are saying.

My friend told me about HH she recently started to work for. They seem to be a great company and I found out they had PRN RN in my area so I applied because I know I don't want to stay in the hospital. That really never was my plan. I want to eventually become an NP.

I decided to take a position on my med surg unit just because for I was told it is best to start out in med surg which at least has a variety of disorders to deal with and not the same thing all the time ~ but at the same time it seems quite overwhelming to the point that I don't know if I am gonna be able to handle a whole group of patients all by myself in a couple of weeks. It is such a juggling act. I am so afraid of getting fired for not being able to keep up. The hospital is so fast paced.

On the other hand, I am not afraid of my abilities to assess a patient. (I don't want to be over confident because that can be dangerous but I really worked hard during school to study the patho so I would be prepared to take care of my patients and I have a year's experience in assessing patient while working as an intern. Because of that, I feel that I know what to look for. Plus, I have family members who have had complicated health issues that I feel has prepared me in assessments.) I've already encounter a few acute situations and believe I acted in a prudent manner to save patients.

Any other feedback would be greatly appreciated.

[Kim, HHRN]

I'm currently an RN working in med-surg.I'm also an Home Health RN prn, but I have over 2 yrs exper in HH before going prn. Working in the hosp will help u with skills such as wound care, wound vac,education on diseases & meds,care plans etc. Learning the OASIS is on the job training, you will not learn this in a hospital. I love home health & currently considering going back FT after I have my baby because of the flexibility. I really hate the paperwork in HH, but the pay is much better than a hosp. You also have to consider that you will be the only person there with a pt and your assessment skills have to be up par because sometimes you are the only health care professional that pt sees in between DR visits and outpt wound care visits. Many HH agencies will not hire new grads.

Diva, thanks for the input. Congrats on the baby. When are you due?