April Rowe

Excellent article!

I always told my patients that it's OK to go. I'd tell their family members to say it too. I think what we say, like your little prayer, helps them move on and let go of this life. Love your Word Slinger! ????

Oh man! BID visits? That's rough.

First Off, Going into the Homes of Patients First of all, you have to ask yourself if you would mind walking into the homes of strangers over and over again. We go into many different types of homes. There are beautiful and clean homes, and homes in deplorable conditions, with bug or rodent infestations and/or animal waste. If you don't particularly enjoy going into people's homes, do not fret, it is something you can get used to. Do not let unsavory homes scare you. Dirty homes really do not bother me anymore. You go in, you get your job done, and you head off to the next home. One of the biggest challenges of providing nursing care in the home is that the environment is not controlled as it would be in the hospital. Let's say that you need to do a sterile PICC line dressing change and the patient has terrible lighting, cats are wandering around, and it is all cluttered where your sterile field is supposed to be. It can get tricky, but you make the best of the environment you are in. This is why Home Health nurses are rock stars! Not only are we expected to perform nursing skills that are not usually done by a floor nurse in the hospital setting (implanted port access, wound vacs, leg wraps, venipuncture), we must perform them in uncontrolled environments. We are alone and without anyone around to ask for help if needed. Clinicians who decide to try out Home Health will not only greatly improve their nursing skills, but will master critical thinking skills, along with time management skills. Common Nursing Skills Performed in the Home So, what exactly does a Home Health nurse do all day? We perform comprehensive head-to-toe assessments and obtain vital signs on everyone. Some patients are only on Home Health services for education on disease processes and medication management. The focus for these patients is education on their diagnoses, symptoms, treatments, and discussing things like why eating a low-sodium diet helps with hypertension. There's A LOT of educating in Home Health. Other patients require skilled nursing procedures. Wound care is a very common skill performed. You don't know anything about wounds? No worries! You will be trained, and you will learn how to perform wound care well. Wound vacs are also common in Home Health. Leg compression wraps/Unna boots are another common procedure performed. Other types of skills include central line dressing changes and lab draws, venipuncture, catheter changes, pleurX draining, ostomies, and let's not forget, implanted port access. The first time I jabbed that giant needle into someone´s chest was quite nerve-wracking, but now it's like a day in the park! Wound care really scared me at first. It grossed me out too, but now I am used to it. I did not have any prior experience and most hospitals have a wound nurse who gets the job done. I did not know how to describe wounds, stage them, or know how to treat them. There is a lot to learn about wound care. Although you will be trained, you will continue learning as the years go by and research is constantly changing policies and procedures. The Home Health Schedule I work for a hospital Home Health. There are also private Home Health companies. Each company does things a little differently. For my job, our schedule revolves around a point system. I am expected to complete 6 points in a day. For example, standard nursing visits are 1 point, start of care visits are 2.5 points, discharges and re-certifications are 1.5 points. I usually do not see more than 6 patients in one day. In order to be able to get my kids off to school and be home for them afterward, I have become very efficient. I usually see my first patient around 9 am and see my last patient by 3 pm. I always chart when I'm in the visit so that I am not charting when I get home. This helps to keep me sane. Be efficient with your charting and your time, and you will enjoy Home Health! You will always have some lingering charting, emails to address, chart reviews, and looking at your upcoming schedule to do at home, but at least you are at home when doing so. If you are unorganized, and spend way too much time talking in a visit instead of working and charting, you will fall behind and spend your entire day seeing patients and then have to complete your charting at home. Multitasking is your best friend. You can chat about all kinds of things while you are getting vitals and doing an assessment. There is A LOT of charting in Home Health. Getting into the habit of completing the charting for routine nursing visits before you drive off to the next house is the best way to go. Certain types of charting take a lot longer to complete. For example, the start of care charting will take at least an hour to finish. I usually complete these at home, in my pajamas. Pros vs. Cons Home Health nursing has one of the most flexible schedules in the field. Being able to schedule your patients around your life is one of the perks and is surely one of the reasons I am a home health nurse. I am able to get my kids off to school and be there for them afterward. This type of schedule is not easy to find in the nursing world! Driving can either be a pro or a con. It depends on the person. I enjoy driving, so it is not a con for me. Companies should be paying mileage reimbursement. The current going rate where I work is 62 cents per mile. You will keep track of your miles each day so that you are paid accordingly. Rain or shine, you will see patients. For me, this is a pro and a con. It's wonderful not being stuck inside all day with your only excursions being a trip to the bathroom, break room, or cafeteria. I enjoy being out and about in the sunshine. If I can squeeze in a stop at Target on my way to the next patient, fabulous! I know nurses who go to a restaurant every day to eat, relax, and enjoy their break. They schedule that time into their day. Depending on where you live though, you will also be faced with being exposed to the elements. I recently moved to the South and have gotten used to getting wet during rainstorms. We also have the rare occasion of icy/snowy conditions. Having a good car and all-weather tires is a plus. You will spend a lot of time in your car, so keep that in mind. Keeping your car clean and organized will help keep you organized. A definite con is the fact that you will no longer have trunk space! You are required to keep supplies in your car. This is why keeping it clean and organized is important. If I am going on a road trip, I will remove my supplies until I return and head back to work. Finding clean and available bathrooms is certainly a con. There is nothing worse than being a Home Health nurse and having an upset stomach! This is why it is smart to carry a small cosmetic bag filled with useful items. I have one with lotion, bug spray, eye drops, headache medications, Imodium, and Febreze fabric spray. I have found my favorite gas station bathrooms that I frequent often. Starbucks is another great option for clean and safe bathrooms. When in doubt, you learn to hold it! A pro is if your company supplies you with a cell phone to use. You will call your patients the night before to schedule them for the next day and you will also be calling doctor's offices, DME companies, etc. It is best to have a company phone so that you are not bothered with calls on your personal phone. A Typical Day for a Home Health Nurse Around 5 pm, I look at my schedule for tomorrow, use the map app that is within our charting system, and determine how I will schedule patients. You want to plan your schedule around addresses and patient needs. Sometimes I start my day with a Zoom conference call that we do every other week to discuss our patient's needs and any issues, then I hit the road and see patients. Here's an example of a typical day: 0815 - 45 minute Zoom meeting every other week. 0900 - PleurX draining that is done weekly 1000 - Wound care patient 1100 - Acute Kidney Failure teaching patient 1200 - Patient needing education for new insulin regimen 1300 - Foley catheter change that is done every other week 1400 - Wound care patient Be home by 1500 There are days when my schedule ends up changing or being delayed. Being adaptable is crucial. You may have a patient cancel on you, and then you are asked by the office to see a different patient at a different time. It happens. I go with the flow. If I am unable to be flexible that day, I simply explain the situation to the schedulers at the office. In Conclusion: Why Home Health Nursing ROCKS! As you can see by my schedule above, the Home Health schedule is amazing, but you have to help make it this way by being efficient. I feel like I am actually helping people. Your patients allow you into their personal space and open themselves up to you. You get to know them and see their progress and then discharge them. It's almost always a happy ending. Your nursing skills, time management, and critical thinking will be TOP NOTCH after working in home health. Home Health is not easy, but it is worth it. Some days are more stressful than others. Some patients create problems, while others are absolutely wonderful to deal with. You spend a lot of time getting to know yourself. It's just you, your car, your music, your snacks, and the patients you see that day. Home Health nursing is challenging, but it is also fun and rewarding. Give it a shot and maybe you will find your niche in nursing!

There are many nurses who remain in one specialty until the day they put up their stethoscope and finally set sail on the ship of retirement. Good for them! For those who like to change things up whenever they feel the need to, nursing is a great career to consider. Choosing Your First Nursing Job Once you get through the daunting task of finishing nursing school and the even more daunting task of passing the NCLEX exam, your next step is deciding which area of nursing you want to start out in. The best advice for choosing your new-grad nursing role is to ask yourself which clinical rotation fascinated you the most, or which disease processes you find the most interesting. Landing your first nursing job in a department that interests you will greatly improve your overall nursing experience. Many experienced nurses recommend starting on a Med-Surg floor. Learning the art of multi-tasking and time management are essential to succeed in nursing. You will need to practice and then master common nursing skills like placing IVs, foley catheter/drain care, medication management, comprehensive assessments, etc. I started as a new grad in the NICU. I was 100% sure that I would retire as a NICU nurse and would never need to find the "wink" on a female adult again! Little did I know that after ten years of working my dream job as a NICU nurse, I would be switching things up and having to re-learn nursing skills and disease processes that I hadn't dealt with since nursing school. I finally understood why so many nurses recommend starting on Med-Surg or a similar unit. What you learn there is invaluable and will continue to guide you throughout your entire nursing career. Each Area of Nursing is a Specialty The truth about nursing is that each unit is its own specialty. A trauma ICU nurse with 20 years of experience could be floated to the NICU, and they wouldn't know where to begin. The expression "a nurse is a nurse is a nurse" is completely false and don't ever let anyone tell you otherwise. Even if you start out on Med-Surg, you cannot transfer to the OR and immediately jump in. You will have months of training! This is why changing departments or specialties should not be dismissed due to the fear of the unknown. It is the same for all nurses. If you accept a new position, you will need to be trained. Switching Things Up This is why nursing is so amazing. There is a wide range of options from which to choose. Tired of being an ER nurse? Well, by golly, transfer to labor and delivery and feel like a new grad all over again! The only downfall of switching things up often is not being able to fine-tune your skills and become very knowledgeable in your field. Although, healthcare is always evolving. Once you think you know something, policies change, and therefore, nurses are ALWAYS learning and growing. If/when the day comes that you no longer relish in your nursing position, there is a myriad of choices to turn to. Maybe you will want to take a stab at school nursing, the cath lab, remote patient care monitoring, legal nursing, and so on, and so on. Continuing your education is another great way to open new doors for yourself. You may be ready to become an advanced practice nurse or move into a management position. Taking the Plunge As long as you put your heart into it, switching things up in nursing is a fun, challenging, and fulfilling way to expand your resume. Try it, and if you are not pleased, you can move on to your next specialty of choice. If you need a change in pace, try a new type of nursing before you decide to leave your nursing career completely. Chances are, you may just reinvent yourself!