CookieRoo9413

Hi fellow nurses, so I am facing a bit of a dilemma and wanted to see if anyone had some advice. For most of my short nursing career (I'm a second career nurse, became licensed in 2022), I have mainly worked full time in urgent care and per diem in pediatric home care (PDN). I have a passion for home care (I also worked as a home health aide in nursing school), and I really love to help children (and adults) with medical needs and their families. As you know, there is such a huge need in this field, and so many families go without help (interfering with their ability to work and sleep). It's often overlooked too since it's not as prestigious as working in critical care. But I was hesitant to go full time since the pay is not the greatest, the benefits are terrible, there is a lot of instability, and it can be isolating since you don't have coworkers. But then a smaller home health agency close to me was hiring for their medical daycare, and I thought this would be the perfect fit for me. (I had worked in a medical daycare prior, but this one was closer to home, offered better pay, and was managed better). I was offered the position back in November, but they shared they had another candidate they wanted to hire as well, and they asked if we would be OK with splitting our hours between the daycare and home care. Both myself and the other nurse were fine with this. I honestly thought it would be a good mix, plus they offered me overtime, which I desperately need. So, I accepted the position and went per diem at my urgent care job. About two months after starting, I am told the census is too low in the daycare, and once the full time nurse comes back from maternity leave, they will have to move me over to home care full time. It was never expressed to me in the beginning that the position in the daycare was only temporary. I knew one of their full time nurses was going out on maternity leave, but they made it seem like they needed more nurses in general. I honestly feel duped, like they just needed temporary help, so they pulled us in by offering the daycare position, and now they got more home care nurses. If I had known this from the beginning, I never would have accepted the position. I can't even go back to my urgent care position full time because our volume is down there as well, so they basically eliminated my position when I left and never replaced me. To make matters worse, I had a freak accident in early February, slipped on ice and broke my ankle (at home so it's not WC), which put me out of work for a couple of weeks. Fortunately, they have been very accommodating, and I ended up taking on a trach/vent case for an infant recently discharged from the hospital since there wouldn't be any heavy lifting with my injury (I'm wearing a walking boot). I'm also doing overnights now, which is not preferred, but they are hiring a full time overnight nurse, and I will only end up doing 2 nights a week and will then return to my regular dayshift clients. So, now I will be doing days and nights in the same week, which is not ideal, but at least it will be more money (they are paying me a higher rate for overnights). I do love my clients, but I am just frustrated by the whole situation. I don't want to job hop though, so I feel like I should stick it out for a while. But I just am not sure if I want to do private duty full time indefinitely. I have been considering applying to a pediatric LTC facility where I could do similar work but have coworkers and more job stability. What do you guys think? Should I stay, or should I go? Thank you for any advice you have to offer!

Private duty nursing where you work 1:1 with clients with complex medical needs in their home (or even school) would probably be a great fit for you! There is a huge need for nurses in this field, and they are always hiring and would love to have you, especially with your experience. The pay is not the greatest, but it's less stressful than being a visiting home health nurse (where you drive from home to home all day and have a ton of documentation). In private duty, you work an 8 to 12 hour shift with one client and can document throughout your shift. No work to take home with you, and it can be pretty rewarding too if you work for a great family. It's also very flexible, and you can pick when and where you want to work for the most part. Bayada is a great agency to work for, but there are others. Just do a search on Indeed, and I'm sure you will find home care agencies in your area looking for nurses like you. Best of luck to you! ?

If you were going to say it's 7 days of 12 hour shifts, I would say that sounds horrible. But since it sounds like it's only from 8 to 5, that sounds completely doable and worth it. I've never done 7 on 7 off, but I have done 7 shifts in a row (and more) where some of the shifts are longer (12) and some are shorter (6 to 10). My only reward was extra money and a day or 2 off. I say go for it. Sounds awesome to get a whole week off, and 8 to 5 is not bad at all! Best of luck to you!

Hi Kay Bunny! I work as an RN in urgent care, and my only experience prior was home health, so no acute care experience was needed. I think it would be a great job for you as you work towards becoming an FNP! You will learn a lot that will be relevant to your future role and will work alongside providers treating common conditions. I can't say I do a ton of skills in urgent care though. We administer meds (IM, subq injections, PPD placements, PO meds, neb treatments, etc). We do IV fluids but not often so even though I know how to start an IV, I don't do it a lot so I can't say I'm really good at them (kind of hit or miss honestly). Lab techs do most of the blood draws, but we will help out with this from time to time. We handle phone calls and give people their Lab and x-ray results, so there is a lot to learn in that respect. It is a busy job, lots of people in and out all day so there is no time to get to know anyone. Most people are there for routine illnesses, like colds, the flu, sinus infections, UTIs, strep throat, etc or injuries, broken bones or minor lacerations. Anything more serious gets sent to the ER. We do get emergencies and call 911 on a semi regular basis. All nurses need to be ACLS and PALS certified, though this was not required prior to hire. My company had me take the class through them to get certified. We have a crash cart but do not use it often (and codes can and do happen, though rarely). All in all, I think it would be beneficial for you to try to get a job in urgent care. Maybe you could even work there as an FNP. It's definitely a tough job for providers though (long hours, having to assess and treat multiple people quickly, lots of liability). Best of luck to you! Let me know if you have any other questions. :)

Thank you for your input! This is so true. It all depends on where you work what skills you will actually need and use. My hours are a bit wonky, and I do wish they weren't all over the place so much. But they have been flexible with me regarding my other job and when I need to take my daughter to Girl Scouts so I can't complain too much. ? Thanks again for your response, and I apologize for my delayed reply!

Thank you so much for your input! You are absolutely right. My husband always says I worry too much about what other people think, and I just need to do what will work for me. I have decided to stay put where I am for now in urgent care (just got my annual review and will be getting the max 4% raise, yay!). I am also thinking of eventually picking up a more complicated case in private duty (trach/vent with an extended orientation), but I plan to get comfortable with my rather simple gtube case first. That way I will continue to learn more but at my own pace. ? Thanks again for your response. Sorry for my delayed reply!

Hi all, I am still a pretty new nurse. I graduated in August of 2022 and started out in home health as a visiting nurse. To be honest, I never really wanted to work in a hospital as the idea of unstable patients terrified me. I'm not an adrenaline junkie and do not feel that I would thrive in emergency situations on a daily basis. I liked the idea of caring for people in their homes, and I worked as a home health aide during nursing school and loved it. So I really thought this would be the perfect job for me - it was also part of a residency program through a reputable hospital system so I thought I would be getting the appropriate training and additional education. But it did not work out - I ended up hating it, realizing I was still not ready to be seeing patients solo, and there was no work/life balance as I was taking so much documentation home with me. So, I left home health and took a job working in urgent care, which has honestly been a good fit for me in a lot of ways. I am a second career nurse, and my first career was in office administration, so in a lot of ways, this job is a mix of office work and nursing. In home health, I picked up good skills in patient assessment and wound care, and now in urgent care, I've done medication administration (mainly IM injections and PO), IV starts/IV fluids (though we don't do this a lot so I can't say I'm great at it, but I can get the less challenging ones), EKGs, POC testing, assessing patients in emergency situations, phone triage, etc. But the doctors and PAs are the ones doing the actual assessments, and the MAs do most of the vital signs and rooming (though we do help with it). I had an MA who is about to start nursing school ask how I feel about not getting a lot of patient contact and how I am at the desk a lot, and she is not sure that she would want to work in urgent care as a nurse because she'll lose all that she is learning. (We handle a lot of phone calls, calling patients with lab/x-ray results, handling incoming calls for patients with issues, sending prescriptions over to pharmacies, etc, and we also scan physicals into charts and handle WC documentation). It just made me feel like an inferior nurse. Sometimes I feel like a fake nurse because our patients are typically pretty low acuity, although we do get patients that should have went to the ER (chest pain with cardiac history, respiratory distress, anaphylaxis, etc). And we did have a code in our center recently (my very first one ever, which was terrifying). My job is stressful because we work with people, but nursing wise, it is not too bad (aside from the code and other emergent situations that pop up here and there). And we see A LOT of people, well over 100 a day especially during cold and flu season, and it's honestly making me dislike people more. Urgent care feels a little bit like the retail of the healthcare world. The good part about it being a busy center is that I am usually working with another nurse for most of the day (though not always the whole day), so I often work with nurses who have extensive ER and critical care experience. But I also worry that one day our urgent care will get rid of all RNs like other urgent care centers have done recently. I was also working per diem in a medical daycare for kids with complex medical needs (mainly Gtubes, a couple of ostomies, and one kid had a trach, but I never got officially signed off on trachs to care for him). I ended up leaving because it was a far commute, and I had to regularly go on a bus into the city to pick up/drop off the kids and was in 2 vehicle accidents during the short time I was there (though no one was hurt). So, now I am going to work for Bayada accompanying a child with medical issues at a local school one day a week (in addition to my full time job in urgent care). So, my question is do I need hospital experience to feel like a competent nurse? Or is it possible for me to continue to grow in the settings I've been working in? I keep going back and forth in my brain that I need to get out of urgent care, stop being such a coward, and work in a hospital (once I get at least a year and a half to 2 years in - I've only been there about 11 months now, and I feel like a job hopper already). But then other days, I tell myself that it is silly to leave a job I don't hate because I am so afraid I will be miserable in the hospital setting. And my long term goals do not include hospital work anyway. I am interested in clinic work - possibly dialysis or a fertility clinic, or maybe as a nurse care manager in primary care or some other specialty setting. I have also considered psych, but I keep going back and forth on this one as well. My other interest includes working as an RN case manager or clinical educator for private duty home health. I was thinking of working in a long term care facility for pediatrics (there is one near me that has a good reputation and pays well). Part of me would like to do full time private duty peds, but the benefits are terrible, and I think I would miss working with other people. I have contemplated school nursing too, but as the primary breadwinner, I am not sure I could make this work unless I did school nursing along with another nursing job. I guess I feel like I'm driving myself crazy because I am so unsure of what to do. There are so many options in nursing, which is great, but it also drives my indecisive mind crazy! While I like urgent care, I think I miss being able to get to know your patients like you do in home health. Plus my hours are all over the place (we don't do 3 twelve hour shifts, we may do one 12 hour shift, one 9 hour shift, one 8 hour shift, and one 6 hour shift, and then it could be completely different the following week, it's every other weekend with a mix of day/evening shifts). So, should I try to get some hospital experience (there is a hospital near me that has amazing benefits and does not require a BSN), or do you think my urgent care and private duty/home health experience will set me up well for my future career goals? Thank you for taking the time to read this and for any advice you may have to offer!

I am not sure of the legality behind this, but I absolutely do think you should be getting paid for that time. While I understand you are not with the patient during that time, needing transportation back to your vehicle is a circumstance beyond your control. I would have a talk with the agency about this if I were you and see if you can go back to driving there yourself if they will not compensate you for the extra time. Good luck!

I am sorry you never received a response as I would love to hear what others have to say! I am curious if you ended up taking the position in the fertility clinic, or if you found a position elsewhere. While I do not work in a fertility clinic (I am interested in this specialty, however, as my daughter was conceived via IVF), I did not start out in a hospital as a new grad. In my area, it would have been easy at the time to get a hospital job since hospitals are so desperate for nurses here (and most of my classmates were able to get hospital jobs). But I went to nursing school during COVID and felt ill-prepared and honestly too scared to work in one. I also feared I would not do well in that type of environment. But now that I've gotten some nursing experience (first in home health and now urgent care and a pediatric facility), I wonder if I could still get hired in a hospital down the road. It does seem possible as hospitals need nurses. I think it might depend on where you live and what shift/specialty you'd be willing to work. L&D and postpartum are harder specialties to get into. Med/surg, telemetry, ortho, etc would be easier to break into, I'm sure. But if you don't think you'd like to work there, why not do the IVF clinic? It would be closer in line to where you want to work and could potentially open doors in the future, even if you have to move (not sure if that's a possibility for you). Anyway, hopefully you've found a job you're happy with! Would love to connect if you have the time. ?

Hey, Peachpit! Sorry for my late reply. But you are so right. There were nurses that I worked with that loved it, including my preceptor who was a tremendous help to me. But for a lot of us, it feels like there is no work/life balance at all. For anyone wondering, I did end up getting the job in urgent care and have been there now since April. It has been going very well! I took a slight pay cut, and the benefits are more expensive, so I also recently started a per diem job at a pediatric day care center for kids with complex medical needs. The jobs are very different from one another, but I feel like I'm getting a good, varied experience doing both. Since I'm working two jobs and my schedule is all over the place, I feel like I'm back to having little work/life balance. But at least I'm getting paid for all the hours I'm working, and my time at home is my own and can be spent with my family! Thank you all again for your input. ?

You could fit visits in between the hours of 9 am and 3:30 pm as a home health visiting nurse (most patients don't want to be seen prior to 9 am anyway), but you will most likely bring home a lot of documentation. I did it as a new nurse and was completely overwhelmed. I did not find it to be very family friendly. However, you have a lot of nursing experience, and there are many nurses who love it. If you are able to complete documentation in the patient's home (I struggled with that), or if you don't mind bringing work home with you, it could be a good option. Try to find a reputable agency that does not have you traveling too far. I often got home much later than 3:30 because I was traveling to homes that were about an hour away. It was not a good fit for me, but it could be a good fit for you! There is also the possibility of doing PDN in the school setting, and there are agencies willing to train. Do some searches on Indeed, and see what is in your area. Good luck to you! ?

Hi MeggyBeth, Thank you for your input! I am familiar with PDN because I worked for Bayada as a HHA while I was in nursing school, and I worked with some of the nurses there on a complex case for a client who was quadriplegic (with a trach and vent at night). I had seriously considered doing their nurse residency program but ended up taking the position in home health instead. I know the pay and the benefits in PDN are not the best, so I think doing it as a side gig is a great idea. It is definitely something I would consider. I appreciate your insight. ?

Hi Svit, Thank you for sharing where you're working now! So happy to hear you found a job that you love. ? I am honestly a little terrified to work in the ICU. It was one of the reasons why I chose home health. I always liked the idea of community nursing over acute care. But I am finding that it would be beneficial to have that acute care experience before seeing patients in the community, especially independently... A friend of mine that graduated nursing school with me started in the ICU, and she has been very overwhelmed there. I think she's hanging in okay though. Thank you for your well wishes on the interview! The interview with the HR manager went well. He told me he would send my application over to the center I applied to, and the manager there would contact me in about a week. Well, she contacted me that same day, so I have an in person interview at the center with her on Monday! It seems promising, and the pay was higher than I expected (only a little less than what I make now, plus I would get paid for all hours I'm working).

Hi BBP42, Thank you for sharing this! This is an awesome suggestion. I could probably handle my job a lot easier if it wasn't so many days out of the week. My big concern would be that I am a nurse resident, so they are expecting me to be full time. I also need to work full time, but if I could go per diem, then I could work maybe one day a week and one weekend a month and be full time somewhere else. I doubt they would be agreeable because I am not an experienced nurse (usually per diem is for more experienced nurses), but it does not hurt to ask. I just wish they would not have listed this job as hourly. It really is PPV or salary with an expectation of so many units in a day/week. I would not have accepted the position had I known it was set up like this. They are also requiring that I enroll in a BSN program within 6 months and have it within 3 years. I did enroll but ended up dropping it because I could not imagine doing school on top of all the hours I am working. Thanks again for your input!

Hi Svit, Thank you so much for your input! I am having similar issues with scheduling. I have been trying so hard to document in the home, but sometimes it's nearly impossible (when doing a wound vac for example). And then I will try to document in the car after I leave, but often I have to rush to the next visit because the schedule I hoped to have did not work out because I had to accommodate patient requests. We are lucky not to have on call because we have on call nurses. I cannot imagine doing that on top of what I am already doing! I can see why you don't miss it. Do you mind sharing where you are working now? I did end up applying to a couple of other positions, and I have a job interview with an urgent care center on Tuesday! Very nervous but hopeful it will work out. I am feeling so miserable in home care...