Personal experience translating to HH?

[kaliRN]

Hoping the collaborative expertise of this forum can help me. I am a new grad RN, facing a very difficult market as I am sure most of you are aware. Home health nursing is something I desired doing, but felt a "foundation" in the acute care setting should come first. Now, I have decided to apply to home-health and would like to share aspects of my personal experience in my cover letter.

My father 56 this year, had a 3.5 cm basilar artery cerebral aneurysm, first embolized in April '07. Two craniotomies have been performed, the first to embolize, the second to clip (Dec '08). He is bedbound and has a tracheostomy and PEG. Outside of the hospitalizations centered around his surgeries and an admit for pneumonia, he has always been cared for at home. I have developed a skills sets in the two+ years that I've cared for him. Administering bolus tube feeding and medications, tracheostomy care and suctioning, nebulizer treatments, ROM and contracture management, PICC line administration of medications and dressing change, and unfortunately wound care. I understand the significance of coordination of care and reimbursement (and because of the side of the equation I am on, creativity and patience). I've had a glimpse of the magnitude of an intermittent care HHRN. I haven't had any direct experience with private duty or shift care, though I've learned much from reading on this forum. I didn't choose nursing because of my father. In fact he wasn't diagnosed when I started my nursing courses, but I thank God everyday that I became an RN. I don't know that we would have been able to keep him home otherwise.

My goal is to include this set of skills in my cover letter, without sounding pretentious. I get that taking care of one person does not equate to the vast amount of knowledge an RN with two years of experience with a variety of different patients has. I understand that performing the skills I have described can be learned (and is most often performed by) an LPN and then family member. That it is my ability to assess and educate that matter most, but I believe being a caregiver has expanded those skills as well. We have had some horrific experiences getting him the care he deserves. I shudder to think of the hoops we have jumped through to get the DME we needed at home and the things I caught that another caregiver would not have (like scrips for Mucinex and Oxycodone ER by G-tube). I could give an inservice on troubleshooting home suction equipment. But it's WHY these things matter so much that I think I could really give something to the agency and patients I worked for.

I know how devastating it is to have someone you love develop a decubitis ulcer, I stood at the bedside and wept, when I realized what appeared to be a "stage II" had tunneling and a sinus tract and was truly a stage IV. I cry just thinking about it. So I know the sense of responsibility and overwhelming need a caregiver has for support. I know that there needs to be reconciliation between "hospital protocol" and home-care supplies - taking evidence-based practice and applying it in a realistic manner. I understand that people come home with varying degrees of education on discharge. I never missed an opportunity to participate when an experienced RN was teaching or to teach a colleague to refine my own skills.

I think that being a caregiver, especially to someone with my father's acuity, gives me assets that are disparate from other new graduates. I am also deathly afraid that I will convey a sense of arrogance. I read posts from SNs and new grads all over this site that turn my stomach. To be too self-assured with so little experience in the field of nursing is a recipe for disaster IMHO.

I get that this a HUGE responsibility. I do understand why orienting in a less autonomous environment like a hospital or LTC would be better for a new grad RN ... but I also know to always seek guidance and education and admit when something is beyond your capabilities. I would never risk a patient's safety to keep a job or stay with an agency that made me feel like I should.

That novel to ask, is it okay to include my personal experience in my cover letter? When I do, are there red-flags that would make me sound arrogant or off-putting?

Thank you for your feedback.

[caliotter3]

I go to home health agencies with my employment documents in hand, ready to interview. I usually am hired on the spot and get set up with a case or an appointment for orientation. Or, I am given an appointment to come back. Your personal story might be better saved for the interview, when you will have a chance to gauge whether it is being accepted or whether it is best to steer clear of personal issues. Putting all of that in a cover letter, I believe, would be a mistake in many instances. Do not get personal until a more appropriate time presents itself. Home health jobs do not usually require more effort than bringing in your paperwork with a proper attitude, or calling to make an appointment, at which time you will be interviewed and almost always hired immediately.

[kaliRN]

Wow, thank you caliotter3, I had no idea the hiring process was so different for home health agencies. In the acute care and even LTC arena - getting an interview is more than half the battle. And trust me, delving into the detail I did here was never my intention. A few concise sentences on my relevant skills was what I would have extrapolated. I'm very encouraged by your post (especially because we live in the same region).

[nursel56]

I agree with Caliotter that it's probably better to wait for the interview to discuss that, but as a general rule I would say personal experience as a caregiver is relevant and something that will be a plus for you.

I would add that beyond the technical expertise of trachs, wound care, ROM, etc., it's extremely helpful to have had experience on the receiving end of HH care. As I've mentioned a few times here, I've observed that new HH nurses have what I call a "hospital mindset", and there are skills you need in HH that you don't need in acute care. There's a nurse who posts here sometimes that has had a child who needed HH care and her insight is very valuable from the standpoint of the giver of care and the receiver of care.

Something I found very surprising was the extreme differences in agencies, in the same city, even. When you go for your interview, you will likely be able to tell quickly whether your interviewer can understand and appreciate what you are saying. In other words, if your first interview is with the person who makes sure your car insurance is up to date and takes the photocopy of your license, I probably wouldn't bother with the details.

If your interview is with a DON or equivalent right off the bat, depending on his or her personality, you can go into whatever detail you feel comfortable with that person sharing your family's situation.

Best wishes, and btw you are an awesome daughter. . I hope you are getting adequate help for your dad . don't burn yourself out. Burnout tends to creep up on ya. . .:)

[caliotter3]

Wow, thank you caliotter3, I had no idea the hiring process was so different for home health agencies. In the acute care and even LTC arena - getting an interview is more than half the battle. And trust me, delving into the detail I did here was never my intention. A few concise sentences on my relevant skills was what I would have extrapolated. I'm very encouraged by your post (especially because we live in the same region).

I have talked about personal experience during job interviews or an interview for a volunteer position. It backfired badly for me and I learned the hard way, that while they may encourage you to talk about yourself, it is never wise to do so. Just from my own experiences. Others may have had different experiences.

[kaliRN]

Thank you nursel56, I appreciate your insight, and the kind words. My father is an amazing man, he raised my sister and I from early childhood on his own. It's an honor to be capable of caring for him. The only thing has held me together some days is prayers, but I believe enough in our capacity to care for him, that I wouldn't want it any other way.

I have definitely gained insight into the challenges of the caregiver. I would really love to integrate that knowledge into my practice. It is tempered by a respect for understanding the experience an RN needs in the home health arena. We rarely have home health involved, but they generally have so much to contribute. One suggested condom catheters - what a simple solution - no "hospital" nurse (including my instructors) had suggested this before. Can you imagine, the strain that reduced on us from changing him every two hours, to his skin, to reducing his infection risk? There is a disparity in practice - to the benefit of the patient in this practice.

I do see now, how in the context of evaluating attitudes before delving into my personal experience, waiting for an interview is best. Again, thank you for taking the time to respond.

Again, calolitter, thank you for your response. I have seen your posts on this board and in a few other places and it seems you have had a rough run of luck with your employers. I definitely see how there is a double-edged sword by opening yourself up from a personal standpoint. I am a single mother of two young children. I was pregnant when I started nursing school, you can believe I never let anyone see me until I had a very official acceptance letter. I have been denied jobs because of a budding pregnancy and wouldn't dare offer information about my children. Protected and personal information is just that. My hope is that when working with the "right" agency in the "right" interview process, an individual would see the relevance of my experience.