New RN looking to transition to HH

[FloridaRN96, BSN, RN]

TL;DR: I am a Florida RN with 1 year of experience interested in HHC, wanting to hear anyone's experience moving to HHC after a short in patient career- specifically financial changes and how it is working with multiple agencies if needed to get the schedule you want.

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I am looking into HHC (not private duty) as an alternative to traditional 12 hour shift work. What attracts me is the flexible work schedule and one-on-one time with patients, while I now have 4-5 PCU patients (in a situation where we should never have more than 4 patients- 80% reason I am considering leaving). I currently work on a floor that puts me in contact with wounds of varying sizes and conditions, mainly surgical wounds and pressure ulcers, but ostomies, feeding tubes, PICO dressings, and wound vacs still come around frequently.

Personally, I feel like HHC wound care nursing would be a good fit for my interests- and should I want to return to in-patient/change agencies/move, it would be a marketable skill. I personally know a great (infusion) HHC nurse who loves her job and works with 3 different agencies to get her schedule how she likes it, and she is able to give local company recommendations so I avoid any major bad apples. I never imagined myself dying at the bedside, and I have always been interested in home health, including palliative/hospice care, since before nursing school. An added benefit is that I might be able to avoid surgery on my foot! Walking 6-8 miles a night landed me in a podiatrist's office after only 6 months of floor work.

I am concerned about the cost of buying health insurance and the added 7.5% (I believe) I would need to pay to cover SS. Also, does anyone work per diem in patient occasionally for some variety, or anything else to give your work some variety? How did you find the pay compared to your previous job, and how hard is it to put together a schedule equivalent to full time or nearly so? Did you find the work-life balance better or worse? Any tips you would give someone wanting to go to HHC would be appreciated.

[Emm_RN, ASN, BSN, MSN]

Hi, home health has many up sides but can be time consuming if you are not very organized! I have been doing it about a year and a half and here's what I will tell you:

The Good:

You make your own schedule, I usually give each of my patients a half hour to one hour timeframe depending on how close together they are located. The pay is better than hospital work, but you have to consider that a lot of that is for mileage. In our agency we do 6-7 visits/units per day. An admission counts for 2, so you see less people if you have an admission or more than one admission that day. The freedom is great, you can schedule breaks throughout the day if you need them, in good weather it is fun to drive around, and you can unwind in between visits. You are generally in visits for about 30 minutes for a routine visit, and an hour or more for an admission. So, if you have a difficult patient or a messy situation, you can see the light at the end of the tunnel. You do not have anyone breathing down your neck, which is very nice. It forces you to use your resources and read up on things you are not familiar with, and you will learn a ton. We do a TON of skills, which people don't realize. PICC line care, blood draws, wound care/wound vacs, PleurX drains, feeding tubes, tracheostomy care, pigtail catheters, etc. I feel like I use my skills more now than I did in the hospital.

The Bad:

Hours can be unpredictable. While we say we are 8-4:30, depending on the skills you are performing, your travel, and the charting, some days you may be done earlier than 4:30 and other days you may work past 4:30. A lot of computer work, heavily regulated by Medicare. You are calling patients (at least in my agency we do) every evening to set up our schedule for the next day, which can take a while sometimes and can get completely thrown off by one person, making your following day longer. Patients will get attached, and some will call you. Frequently. Setting boundaries up front is important. I always give them the office number and tell them to call that number FIRST because they cannot always reach me.

Work-life balance is usually great. At first, it will be hard in learning the computer system and managing your time. Once you get the hang of it, for the most part, you will be done at a reasonable time. Good luck!