pacu nurse to hh

anh06005, MSN, APRN, NP · Jan 14, 2015

Ask the home health agency if you can do a ride along. My agency let me to get a feel for it. I couldn't help but think "this is what they do all day???" It's a great area that gets underestimated I think. I love it when what I'm telling the patient finally clicks!

So, no, I'm not a PACU turned HH nurse....but I did go from cardiac/stepdown to HH so it was definitely a bit of a change for me too.

Good luck in a decision!

Let me also say some agencies are in it just for the money. My agency actually wants to help patients as best as they can. There is another agency in my town that has a horrible turnover rate for nurses because they do it for the money most likely.....

Sweet Tea RN · Jan 14, 2015

That's a great idea. I will definitely be asking for a ride along. Thanks!

Libby1987 · Jan 15, 2015

I wouldn't leave a good job for a shaky agency, make sure they're solid and legit.

The learning curve is hard (paperwork, learning your resources and being responsible for knowing reimbursement criteria) and if they are paying you hourly they're going to expect you to be productive at some point. You have to be okay with dedicating a year to getting on your feet with catching up on charting in the evenings and weekends.

Otherwise home health is great.

Gooselady, BSN, RN · Jan 15, 2015

I did home health right out of nursing school (not exactly recommended, but possible), and it worked great for flexibility I needed with my two young children (single mom).

I spent the last six plus years in medical oncology (acute care) and am now going back out into the community doing private duty with nationwide agency. I did my homework on the agency itself (eek) and had to ask myself what my actual priorities are. Basically, they need to pay me what they said they would, and include me on their schedule of available nurses. My expectations are low, not that this will work for everyone. I am quite laid back, Type B I guess, and have a good idea of what I can and shouldn't do.

This is how I conceptualize acute care versus 'home' type care, your mileage will vary. Acute care needs nurses to be more 'aggressive', the patients are on YOUR turf, and the power dynamics put you as the nurse in authority over the patient. In hospitals, patients get things DONE to them. In home care, you are on THEIR turf, and the power dynamics or 'authority' is more collaborative. You can't burst into the patient's home like you can into a patient's room and 'take charge'. You'll be sitting in your manager's office with a list of complaints against you. If the patient is at home, they don't NEED you in quite the same way as when they are hospitalized. In most cases (except for total care peds/adults who have nurses in shifts at home) the patient can take you or leave you. So you find yourself working a lot more WITH the patient, and learning so much more about them as a person that you'll finally think OMG, this is holistic care I'm doing!

Professional boundaries are a much more difficult thing in home care, as you sit on their comfy couch and pet their poodle while discussing last weeks blood sugar elevation. One patient had a cup of coffee ready for me when I came to visit, and I got to know their families, grandkids, even the neighbors sometimes. Out of the hospital environment, you find yourself discussing very different things, much more personal. You'll want to say "No kidding, my ex husband was like . . . " and pretty soon they have your cell phone number. Professional boundaries are much more difficult and an ongoing issue that no matter how good you get at it, you can still cross that line and find yourself overly involved.

The paperwork demands are extreme, but I don't know how much electronic charting is used in home care. I'll be going from EPIC to old fash paper charting. We're always charting/doing paperwork anyway, and the requirements are more weekly rather than q4.

Definitely shadow a HH RN, I think you'll either be inspired or not, fairly quickly, and good luck :)