New RN that has a first job as a HHC

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Hi Everyone! I am new to this forum, new to nursing (as a RN and not a student nurse anymore) and my first nursing job is going to be home health care for a quadriplegic trach patient on a vent at night... I know that HHC is not typically where new nurses should start, however I feel that I am competent in the areas of trach care and general patient care enough to be able to take this job. I will have some time under the current RN who does the night shift, which is what I will be working, and the agency is going to provide me with vent training since I got very little experience with a vent while in nursing school. This patient, I am told, is stable and just really needs someone to monitor him at night and assist with general patient care as needed throughout the night. Family lives in the home, but they cannot adequately take care of him by themselves is how it was explained to me.

So, my concerns are - where should i start to look to get some good, current information regarding home health care, and what do I need to know or ask of the agency prior to going into this person's home? I have orientation this coming Thursday. I don't have a definite start date yet, but I am guessing Sunday or Monday shadowing the current nurse. Any help or advice or suggestions that anyone can provide would be greatly appreciated. While this is not where I thought I would start my nursing career, I am excited to get working. My shifts are 8 hour shifts, 11 pm - 7 am, and every shift is with the same patient. Also, I am concerned that by not working in a hospital right out of nursing school, is this going to hurt my chances of finding a job in a hospital later on if I decided home health care really wasn't for me in a year or two, has anyone experienced this? Thanks for the help and information in advance, I am going to love this forum I think!

Dee

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Worry about getting a hospital job when the time comes. Now you are fortunate to have this job. Get the number of the nurse who is orienting you so you can call with questions, otherwise you can ask the nurse supervisor or the family members. Read the vent info in the sticky at the top of this forum. Mainly you will be monitoring that all settings are as ordered, and the patient needs no suctioning. There should be a vent flow sheet where you record the settings and other pertinent data at the beginning and end of your shift or whatever interval specified by your agency, or, minimum of every four hours. Suction if necessary. Give inline breathing treatments during your shift if ordered or PRN. Empty water accumulated in the tubing as needed. Do trach care at the end of your shift. Clean and/or change the circuits according to the schedule. That is about it. As you said, if the patient is stable, this should not be a difficult job. Almost forgot, go over emergency procedures in your head so you are not caught by surprise, mainly bag the patient as you look to correct any problems and call 911 or have the family do it if necessary.

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Specializes in RN/BSN.

I originally wrote out a long post for you and my pc lost it!! I dont think Ill do that again lol. Im new to home health too! I love it its the best job ive ever had. I worked LTC and MED/SURG and its not what its cracked up to be. Well not for me anyways..I thought if I was a hospital nurse that that would make me look smarter and be more marketable but its just not soo. Not to mention my ideas of being a nurse that helped heal the sick, teach and be the comforting nurse that i envisioned.. Those were basically fairy tales. Real world hospital nursing= in my situation: terrible team work, nasty attitudes from Dr's and families, neverending shifts, being a doormat, maid, and cook, only getting to see my patients for 5 minutes. and leaving every night feeling like I was a crappy nurse bc I didnt have the time to sit with my patient and help them with their feelings about losing control over their lives. Collaboration from others was a thing of the past. Yea I became a great pill pusher and organizer but big whoop! lol In home health I am the nurse,teacher,comforter,shoulder to cry on, I have respect and autonomy. I dont have to worry about call lights going off in my dreams, worry about if the Dr. is in one of HIS moods today. Bottom line is I am appreciated. Not that I wasnt before, but in a different way. I have more self respect bc I have the time to be the nurse I am supposed to be. Dont be afraid about being new because everyone is new in the begining. Best advice I can give is if you have that little voice in your head saying somethings not right then 9 times outa 10 you better listen to it. :) Also during orientation take many notes and ask lots of questions. GEt preceptors phone number. Dont worry about looking like you dont know something bc you shouldnt be expected to know everything right away. If your not comfortable with a procedure right away ask for a demonstration before trying it. Try not to sound unconfident in front a pt ( fake it until you make it :) ask questions in private if your unsure about something. If you worry about losing your skills in home health, you wont! I do everything a hospital nurse does but in a pt's home. Good Luck! Youll do GREAT!!! :yeah: I think I got a bit off the subject sorry about that... :))

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Thank you guys for the replies. I am excited to start this job and I am looking forward to getting my nursing career underway. I originally thought I wanted to be an ER nurse, but that may change depending on how I like home health care. I believe you are right Scatter, I will have more patient care and support time doing home health than I would in the hospital as I didn't have all that much during clinicals, and we weren't doing near the amount of work that a true hospital nurse has! This is still going to be experience and as I pick up more shifts or clients through the agency, that is just that much more experience I am exposing myself to as well, so I think it will be good. :-) Thanks for the good luck wishes, and support!

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Good luck to you! I love private duty/home health. I started as a new grad LPN doing this and learned so much. I enjoyed it and missed it so much that I am now doing it again as an RN. You'll discover with a little time whether it is for you or not. (some people prefer the crazy, fast pace of the hospital or a LTC facility. I personally enjoy the 1:1 care much more!).

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