Emm_RN

"No thanks, I've had enough coffee for the day."

Thank you all SO much for your replies! I'm definitely a team player so I'm sure I won't have any trouble jumping in once I'm feeling comfortable. I just got Sheehy's and will be cramming just like I did for the NCLEX. Memories!

Hi all, thank you in advance for any advice/tips. I worked med surg for one year then ICU for 2. I have been in home health and hospice for the last 4 years and am now transitioning back to the hospital setting, but this time in the ER. I am VERY excited, because this is always something I wanted to do, but never had the courage to try. Now that I am 7 years into my nursing career, I finally feel confident enough to dive in and learn anything I possibly can. Has anyone transitioned from hospice to ER? Or any general tips for someone going back into the hospital setting in the ER? Any advice is appreciated. I am nervous but very much looking forward to this adventure! I love a good adrenaline rush and I get bored easily, so I'm hoping ER will be the right fit for me. I already have a few books on emergency care and tips for new ER nurses. Thank you!

Thank you both for your input, it is very helpful in making this decision! I can definitely see the benefits of hourly pay. Right now I do so much work that I’m not seeing compensation for. On call is 2-3 times per month at $20 during the week and $50 for weekends. My home-base office is on the same road I live on, and they have company cars. I am just nervous to leave a company I have been with for years, though I’ve heard so much good about the company I applied for versus my current company from previous employees.

Hi all, I recently interviewed for a rapidly-growing home health agency within my immediate area. I currently do work for a home health agency and I am paid salary. I am interested in the HHA I interviewed for, as they need a hospice nurse for my area and I have been itching to get working with another company for a change of pace (getting burnt out for multiple reasons which I won't go in to). My question is this, which pay is better in home health nursing? Hourly or salary? This job would be hourly around the same "hourly rate" I'm getting at my current job, and I do not want to be short on money. It is not pay per visit, which is good, but I'm not sure I completely understand how hourly pay works in home health. Does that account for charting, driving, etc..? I am shadowing this weekend so I will ask all of these questions then as well, just anxious/excited and looking for some answers. Thank you in advance!

Hemoglobin of 3.6 when I worked in the ICU. Could not understand how this kid was just slightly pale with no other symptoms. Cannot even tell you how many times we rechecked because everyone was baffled. Still to this day I wonder if we were in the twilight zone that shift.

Very informative article! I recently had a patient in homecare who had her knee replaced after YEARS of practically begging for it. It took them several years to even X-ray it. She said she always felt ignored. Meanwhile, a male patient I know who is obese is basically being handed a knee replacement and has not been asked to lose weight first.

Unisolve adhesive remover pads, and on a more strange note.. I LOVE the smell of a clean assisted living facility. Like you know what goes down there but the way they cover it up gives me such nostalgia about my CNA days! Relaxes me!

Thank you! I want to do the best job possible if I am given the opportunity.

I should have added that I have stepped in as interim manager a handful of times in the exact position that I applied for and the interviewing managers have been impressed and asked me to apply. I recognize the lack of experience however most of our issues arise with home health specific problems and I have often precepted in our agency so they are happy with my knowledge base. I’m aware I do not have a ton of nursing experience but I am always taking any opportunity I can to strengthen my knowledge. Thank you for the helpful input, it has certainly given me a lot to think about!

Thank you all for your input. I certainly would be willing to do anything to help the staff out, as those are always the managers that stick out most in my mind. I have been told that no other internal employees have applied so I don’t think that it will necessarily be an issue with seniority or anything like that. I had a stint in the office while I was on light duty and I got a lot of positive feedback from the staff I was managing. It’s looking like I’ll get it because they all but said the interview was a formality since they already know and trust me!

Hi fellow nurses, Just looking for some tips. I am working in home health and have just interviewed for a Clinical Coordinator position overseeing a team of nurses in a few different zip codes. I am going to be starting my MSN in Leadership in January. I have never been in a supervisor position before, and while I have no trouble with communication, I am concerned that because of my age, I may have to fight for respect. I have been a nurse for four years and I will be 25 next month. I'm perfectly qualified for the position, but I'm just not sure how some of the nurses will take it if they have someone so young overseeing them. Does anyone have any tips on how to be a good supervisor and gain respect from nurses who have double the experience and age advantage? Thanks!

I’ll start by saying I hate social media for these exact reasons.. also, it hurts my heart and terrifies me that nurses put so much time and effort into things that are not work related at work! My parents always raised me with the principle that while you are at work, you work your little butt off no matter what! I would never DREAM of pulling my phone out unless I’m on break and out of view of patients. I’m in my early 20’s and I can’t stand most of my generation. I can’t even think of a time when my phone or anything else was a priority at work. I feel terrible for the patients now and patients of the future.

I would probably recert this patient and put in a spaced out visit pattern, perhaps 2week1, 1week3 and encourage her to get a cuff to check on non-visit days and to call into the agency/doctor with abnormal readings. Once she is comfortable with that, BP is stable, and she is taking appropriate actions to maintain BP, discharge would be appropriate.

Thank you both for your input! I can actually completely picture the pantyhose trick and it makes perfect sense so I’ll give it a try! Thank you!

Hi all, I work in home health and have been a nurse for just around four years. The other day I had a few patients who had diabetic ulcers needing treated and they both had medigrips ordered to place over their dressings. This is more of a, 'is there an easier way to do this' question. They had both been getting calcium alginate to their wounds, wrap the leg with kerlix, then apply the medigrips. I struggled to get those darn grips on without bunching up the kerlix and messing up the entire dressing! Not to mention being panicked about having everything straightened out so they don't have more ulcers form. Does anyone know of an easy way to apply medigrips over a bulky dressing that doesn't involve the nurse sweating and the patient at risk for more skin breakdown? Thanks!

I'm looking for some honesty here, because I have a lot of self doubt. I had a phone interview for a telephonic care manager position which I'd love to have and be able to work from home. I was very caught off-guard, as I did not receive any notice of the phone interview. The supervisor simply called and began asking me interview questions. I'm a visiting nurse, and I was on my way to go see a patient who needed me as soon as possible for wound care, so I was driving too when she called. She was very nice, and asked me first why I was looking for a change. I told her that my hours have become unpredictable and that I'm looking for more non-clinical work aimed at helping patients with insurance needs, because I feel bad for how confusing and overwhelming it must be for these patients. Face-palm for telling her my hours had gotten unpredictable, although I did not trash talk my organization or boss. She then asked me about my strengths/weaknesses which I answered, telling her I was a very organized person and had good communication skills, and that my weakness is a touch of OCD which causes me to initially take longer sometimes due to double checking, but that I am working on it. She asked me about my daily duties on my job, I told her about seeing my patients and case managing, touching base with doctors/family, supply companies, etc. She then took the last half of the interview to tell me about the position, the hours, what a typical day looked like, and what orientation would be like. The do prefer someone with home health experience which I have over a year of. She said to look out for an email or phone call if they would choose to bring me in for a face-to-face interview, but I haven't heard anything one way or another. In our health system, we can go online to view our application status, and it says "Not in Consideration," but the last job that said that called me shortly thereafter to offer the job and said that the website wasn't always right. I guess I'm just worried since it's been a week and I haven't heard anything, good or bad, and why did I have to even mention my unpredictable hours at my current job?! I'm normally a very good interviewer, but I think I was so caught off guard and I had patients calling me on the other phone and I didn't have time to pull off because I had to go see this patient. I hope I didn't screw this one up, I've never wanted a job so bad before. Any thoughts- honest thoughts please- would be appreciated so that I can hopefully put my mind at ease until I hear, or don't hear, something. Thanks!

This couldn't be more spot on!

Thank you all for your replies. My manager and I have a fantastic relationship but the reason I am looking for a new position is due to health concerns. I don't think I told her because just in case I decided to stay, I didn't want to be known as that person who was looking to leave. I may just mention to her that I am looking because I do not want to have a bad relationship with her going forward. Thank you all for your input.

Hi, they are saying to essentially keep tension by pulling away from the babies. This is what needs to be done when the ET tube may be sitting just a bit too deep and may be positional, so by pulling a little bit of tension, the ET tube is sitting up high enough to be in correct placement. We used to do this by using the ET tube holders and turning them just a bit so that the ET tube didn't have much play. Hope this helps!

Hi, Not sure if anyone will know the answer to this. I've been applying for a few jobs within the health system that I've been employed by for over four years. I was told by a few people in my last job that your managers are notified when you apply within the system? Is this true? Isn't that an invasion of privacy? I have trouble accepting that they are able to see what you are applying for. I don't feel that it's anyone's business but your own until you get interviews and look to officially move on! Thanks!

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!

Hi, I am an admissions nurse for my home health agency. I have recently run into several patients with missing d/c paperwork. Yes, you can still admit a patient or do a ROC. It does feel strange to do, however patients often misplace or lose their paperwork, and not all d/c paperwork gets uploaded electronically to our system. What I do in these situations (and it can be a pain) is I get ahold of the MD office who will be signing their home care orders and I verbally obtain all orders if they are not uploaded in their profile. It can be very time consuming if they have multiple doctors with multiple specialties. The time this gets messy is if you cannot get ahold of anyone in the doctor's office. In this case, I would recommend calling into your office/branch to see if they have any documentation/referral notes or if they can get ahold of the doctor. Home Health nursing has made seeing discharge paperwork the most exciting thing!

Hi! I work full time in home health, I am not sure what the pay rate would look like for PRN work but certain agencies pay per visit and others are salaried. With bigger companies it is usually a salary. I love the independence and flexibility. It is really nice arranging your day, and sometimes the patients need specific times for certain things but for the most part the timing is totally up to you. I like that I can plan my visits around my appointments. If i want to take a lunch break I can, and if I don't want to, then I don't. I only had one scary situation where a patient's son was getting released from prison and coming to stay with her as he had tried to shoot her the last time he came home and she had guns in the house. I just called one of our security guards and he went with me for the few days I was there. The only thing I don't like is sometimes the case managing. We usually see 6-7 patients per day which is manageable, but with your personal caseload of patients it can be stressful following up with things on the days you are not seeing them. Hope this helps! All in all, it is the best job I've had because we truly get a lot of respect from our patients and managers!

I felt EXACTLY like this for the 3 years I worked in the hospital. I started working as a visiting nurse, it has truly saved me. I feel so much better, all the time. If you are anything like me, get out of the hospital. That's all it took for me to have a better outlook on life.