Please Give me a Reason to Stay in Home Health

Published

UPDATE: Changes: New Log In Requirement
Specializes in Critical Care.

After almost 20 years in the hospital as a PACU/PCU/Stepdown nurse, I finally made the jump into Home Health. It's something I thought I always wanted to do, but after just two weeks I'm honestly ready to pack it in and head back to the hospital.

The patient care itself is basically the same as the hospital except you're doing it all alone, in the patient's environment, without the support you'd normally have on a unit. Add in the hours of driving between visits and the endless charting, and it feels overwhelming.

I like the idea of home health, but the reality has been rough. Are there any seasoned Home Health nurses here who can give me a reason to stick it out?

2
Up Vote Up Vote ×

Sounds rough. I am not in Home Health - but I hope you do stick it out. We need more nurses in that field. Rooting for you ❤️ 

2
Up Vote Up Vote ×
Specializes in Critical Care.

Thank you, I'm trying my best!

ON MHFA said:

Sounds rough. I am not in Home Health - but I hope you do stick it out. We need more nurses in that field. Rooting for you ❤️ 

Thank you, I'm trying my best!

 

1
Up Vote Up Vote ×
Specializes in Certified Wound, Ostomy & Continence Nurse.

Hello AI RN,

Why Choose Home Care Nursing?

The first year in home care can be challenging—just like any nursing specialty, there's a steep learning curve. But with time, you'll gain confidence, speed, and mastery in your role. And the rewards are well worth it.

Here are some of the key benefits of being a home care nurse:

Focused Care: You care for one patient and family at a time, allowing you to give your full attention without the distractions and conflicting priorities common in other settings.

Autonomy and Control: You have the ability to structure your day and spend the time you feel is appropriate with each patient—within clinical guidelines. This flexibility empowers you to deliver truly personalized care.

Community-Based Practice: Instead of being confined to a hospital or facility, you work in the community, often in patients' homes. This setting offers a more personal and holistic view of your patients' lives.

Efficiency and Routine: With experience, tasks like documentation and infection control become second nature. Even the OASIS assessment—yes, all 179 questions—will feel manageable and familiar.

Flexible Scheduling: You can often arrange your visits around personal appointments and activities. As long as your work is completed, your time is your own to manage.

Meaningful Impact: Home care gives you the chance to make a real difference. While not every situation is ideal, the moments when you truly help a patient or family are deeply fulfilling.

Best regards,

Jbudrick

7
Up Vote Up Vote ×
Specializes in Critical Care.
jbudrick said:

Hello AI RN,

Why Choose Home Care Nursing?

The first year in home care can be challenging—just like any nursing specialty, there's a steep learning curve. But with time, you'll gain confidence, speed, and mastery in your role. And the rewards are well worth it.

Here are some of the key benefits of being a home care nurse:

Focused Care: You care for one patient and family at a time, allowing you to give your full attention without the distractions and conflicting priorities common in other settings.

Autonomy and Control: You have the ability to structure your day and spend the time you feel is appropriate with each patient—within clinical guidelines. This flexibility empowers you to deliver truly personalized care.

Community-Based Practice: Instead of being confined to a hospital or facility, you work in the community, often in patients' homes. This setting offers a more personal and holistic view of your patients' lives.

Efficiency and Routine: With experience, tasks like documentation and infection control become second nature. Even the OASIS assessment—yes, all 179 questions—will feel manageable and familiar.

Flexible Scheduling: You can often arrange your visits around personal appointments and activities. As long as your work is completed, your time is your own to manage.

Meaningful Impact: Home care gives you the chance to make a real difference. While not every situation is ideal, the moments when you truly help a patient or family are deeply fulfilling.

Best regards,

Jbudrick

Thank you for your encouragement.  I am going to try my best to stick it out.  I appreciate your thoughtful reply.  I can see the benefits and I  understand, it's a learning curve.  I'll keep you updated.  Thanks again!

 

2
Up Vote Up Vote ×

Sorry to say but if you work for an agency I can't think of a good reason.

If you can connect with a family/patient and get paid directly or bill medicaid (New York lets you do this) then it can be extremely rewarding.

5
Up Vote Up Vote ×
Specializes in Psychiatry, Community, Nurse Manager, hospice.

I don't want to talk you into it, because it sounds like something is wrong. I don't believe in just steeling yourself indefinitely. 

Instead I would encourage you to figure out whether the problems you  are experiencing are fixable, or not fixable. Then whether the people that can fix them will fix them. It's not immediately apparent to me that what you're dealing with will get better with time. I didn't work home health, I worked in hospice, with a lot of nurses who came from home health, and the paperwork was unbearable for most of them. That has been an issue for many years.

I enjoyed hospice when I wasn't overworked. It went downhill. I still like the model of care, but there were too many issues that I couldn't fix.

I really like the advice that Abigail gave you too, if that's feasible for you.

4
Up Vote Up Vote ×

I think any area of nursing is kind of scary for the first several weeks. I do community health nursing, which is also seeing patients in their homes.  The relationships I've developed with my patients remind me why I became a nurse all those years ago. 

3
Up Vote Up Vote ×
Specializes in Med-Surg, Home Health.

My experience is a little different. I did home care for 4 years. I'd still be doing that but a back injury and subsequent surgery pretty much stopped that. 
I worked 7 on/7 off, on call, nights. I did mostly admissions and would get calls for mostly urinary catheter or other tubing malfunctions and wound vacs. I loved it. 

Did you have a mentor or preceptor? I had one for the first 4 weeks during the day and then another 2 weeks at night. They gave me a lot of tips and tricks on how to proceed. If you don't feel comfortable maybe you could ask for more training?

Working at night with no one in the office was a challenge only a few times, when supervisors couldn't be reached. I always had my mentor as a back up to call if I had a question. But once I got the hang of it I didn't make a lot of calls for help. 

The charting could be a little rough but you can actually get through a lot of it while you're asking questions of the patient as most of the answers are just clicking a box. After a while you'll remember where those boxes are and you get quicker. Your written note can wait til later. 

My office always tried to assign cases so that the nurses were seeing patients in their own "territory" so that they weren't all traveling here, there and everywhere. That didn't work for me because with emergencies, you don't have a set territory and I was traveling all over the map. But driving at night, no traffic, was great.

I think giving it a little more time and maybe asking for more training might be helpful in seeing if you truly don't like it or maybe you'd find that you absolutely love it.

Like I said, I loved it but I came from an Obs/tele floor in an inner city trauma hospital with 7:1 ratio and management talking about 8:1 ratio when I left. One on one in home health was a dream for me.

Good luck to you!

2
Up Vote Up Vote ×
Specializes in Home Health.

As an RN I have done home health for nearly 30 years.  At first, doing home health was not a job, it was a hobby.  HOWEVER, in 1998 came the OASIS Documentation.  That certainly changed the direction of home health FOREVER.  OASIS is how Medicare and insurances decide whether to reimburse or not, or taketh away funding.  Over the past 20 years, the OASIS paperwork burden has quintupled and there has been absolutely ZERO increase in the pay per visit, salary pay nor hourly pay to do home health.  It is IMPOSSIBLE to complete your documentation in the patient's home.  Patients and families simply don't want the nurses sitting there for 2-3 hours on the computer!!  This is something management refuses to pay attention to.  Finally, for me at least, I am sick and tired of needing to do all of my documentation on my 2 days off.  I can't even clean my house, make other plans because of all the *** paperwork that is due.  Yes, we use tablets but still it is overwhelming.  In the next year even though I am turning 65, I will be transitioning out of home health in order to try to have a life.  Yes, there is flexibility, HOWEVER, it comes at a price.

6
Up Vote Up Vote ×
Specializes in Med./Surg., Diabetes, Med. ICU, home hea.

Although now retired, I have done 3 stints in home healthcare over the decades.  As others have posted, knowing what I know now, I would not have chosen to leave hospital based nursing for that specialty, at least for agencies.  One responded about the OASIS, if one were to follow the training videos, your first visit as an RN would take an entire day or more; it is an invitation to "cut corners."  Secondly, working for an agency, most of your visits will be "opens" (start of care) and recertifications for those cases where LVNs will be performing the visits; this is difficult as you'll not remain intimately knowledgeable about the case, will need to be updated by the LVN and to read up on much of the cases.  Lastly, once out of hospital practice, perhaps a year and definitely by 2 years, it will be virtually impossible to be rehired to acute care facilities.

In my opinion, most agency based home healthcare are scams; you will be pressured to justify every visit remotely possible, every recertification and squeeze every visit possible.  Perhaps the 3 agencies I worked for throughout the decades was just "bad luck," but they were all agency companies and not hospital based.  I've transferred care to hospice agencies/departments, that type of practice might be something to consider if you're SURE you'll not be trying to return to hospital based care in the future.  Best wishes in your decision!

1
Up Vote Up Vote ×
Specializes in Home Health.

Yosemite RN is absolutely right in his/her statements.  Absolutely EVERY visit must be justified.  Over-utilization will NOT be reimbursed by Medicare/Insurances.  The much-maligned OASIS Documentation was implemented in 1998 to help curb fraud and abuse of Medicare where home health visits were padded with untrue data by agencies and clinicians.  When home health nursing and therapies in home health first started coming into place in mid 1980's those who worked in home health care earned a lot of money.  In many instances just as much, if not more than physicians earned in a year.  Well, no doubt that was not going to last long, and here we are.  In TWENTY YEARS the pay rate has NOT increased.  Medicare keeps taking money away.  I finally figured out that I am earning probably just under $30.00 an hour when I factor in ALL of my documentation time spent on my days off to complete the necessary documentation required for my job.  I am definitely looking for something else with higher pay and not such a daunting documentation requirement.

3
Up Vote Up Vote ×
+ Join the Discussion