Patchouli

It’s hard enough to keep up with the documentation in home health admissions, along with phone calls, communication, etc. The patients these ALFs are taking are absolutely not appropriate for their facilities, but all their administrators see is dollar bills. They throw home health in to manage wounds, foleys, chest tubes, etc, and they don’t even bother giving the home health agencies proper background, or useful information such as date of Foley placement, urologist name, or even telling us they have a Foley if we are ordered for wound care or physical therapy… They have minimal staff, and we can’t even get assistance with checking bottoms on hoyer patients, and when we come in to do wound care, we’re stuck doing full care because they haven’t taken care of their residents basic toileting, or peri cleanup, even though we don’t work there, and have 6-8 other people to see who could be 20-30-50 minutes apart. Report, communication, background, information all basic nursing stuff. Whoever does intake at these ALFs needs some serious education. It’s getting old, and I for one am tired of going above and beyond, only to have it happen over and over. Tired of having people thrown to us to figure out when we didn’t get the information they did. I was at a home health opening for three hours because I wasn’t informed of amount and severity of wounds, even though I called the night before with questions, and was given false/inadequate information, and wasn’t informed wound care would be daily, wasn’t informed they had a catheter, wasn’t given surgeons name, wound care orders, or date of f/u appts. We are all tired but this is ridiculous. Do better or get out before you take others down with you. Your coworkers, residents/patients, and outside assistance such as home healthcare nurses, and physical therapists deserve more.

Time to leave. Home health is challenging enough with the paperwork/computer work, without adding more personal time into it. With what you’re describing, you’ll have zero personal life.

The skills I learned working in the acute care setting have really assisted me in the home health setting. It's the charting and insurance regulations that have made this job a challenge. I enjoy my work, but don't go into it thinking you are working less. Right now, I am working more. Sure, it's charting, but it is immense! Still, to be appreciated for what I do, to not be pulled in a million different directions at once, to be paid fairly, it is worth it! I cannot wait to have my year in. Imagine how much more I will know! My goal is to possibly go into travel home health, but not till I get more time in. Congratulations on your new endeavor! I know personally how hard it is to leave the hospital for a position like this, it shows resilience and adaptability. Most of the nurses I worked with in the hospital would never leave, the fear of the unknown, the comfort of the familiar, no matter how terrible, keeps them there. The worst parts of the job so far are charting, traffic, and bad weather. Nothing like the organized chaos that was once my life in the hospital. Welcome to home health!

I started HH a few months ago. Most of my patients are 1-2x a week for 4-6 weeks. I generally see them twice a week and either d/c on the last scheduled visit, or earlier if they are ready. Most are med management with recent CHF, COPD, DM, wound, surgery, etc. I also have once a month cath changes. I work five days a week, and typically schedule them either Mon and Thurs, or Tues and Fri. Wed are a shorter day for me. So, what I don't understand is who only gets seen once a week. We can't really stay in for only med planner fill or syringe fill, so what patient qualifies for once a week, but not d/c? I'm trying to figure out how to plan my week so that my days are more evenly dispersed with visits.

Trying to schedule appts with elderly pts that are HOH, and do not own an answering machine. Phone just rings and rings. Emergency contact is hubby, same darn number!

That sounds better than the LTACs I'm accustomed to. Is there a way for you to tour the floor for a few hours, and maybe ask the staff questions?

I used Epic in my last hospital position. Large system, but user friendly once you know where everything is.

IMHO, if you really want a hospital gig, go into med surg. If you want something a bit more challenging start out on a Tele floor. I would stay far, far away from an LTACH. If they offer techs, that may be better, but if not, no way with 1:6 ratio!

ICU pt's on vents are typically sedated, only there for a short time, and you get a 1:2 ratio. Stepdown a little less critical, but typically a 1:4 ratio. You can get LTACH pt's on the stepdown unit when they leave the ICU. They are usually the most demanding, and the sickest. LTACH pt's are the ones requiring the most work. Constant turns, clean ups, TF, wnd care, never ending call lights, etc. Do you get any techs in this LTACH, because you're going to need them! I would often take them on my Stepdown unit because I had ICU experience, but let me tell you, they can really be challenging. Both physically and emotionally. Often the families of these poor pts are the ones that keep them going, full code and all. I can tell you a great portion of them do not want to live like they do.

LOL, that's definitely a different story! It was only half an hour late? Then he needs to chill. Most of the time you won't get regular draw results back before 30mins anyways.

Oh no, not this again!!!

I agree, but ultimately we are responsible for missed orders and labs. Even in the best hospital, most physicians don't grasp the concept of juggling multiple pt orders/labs/care/I&Os/ etc...

I would suggest a PICC line on a pt that is a difficult draw that has a necessity to get frequent labs/possible blood. Getting q 6 H&H's is not enough reason to warrant a CCU. Med/Surg nurses are fully capable of drawing from a PICC and giving blood.

Join the club. Has ANY hospital received top scores on this. Just think hotel. These are the same type of questions asked during hotel surveys. Ridiculous if you ask me. You cannot run a hospital like a hotel.

Home Health Case Management is a pretty good option if you have a bad back. There are a few times when I need to roll or assist a pt. ambulating, but this is very infrequent.

One major reason I finally left the hospital. Giant leap for a nurse that has only done acute care. Low moral, low wages/no raises, increase in workload and patient ratios, no techs, etc. Nearly everyone I worked with was sick of it, but not everyone was ready to make that change.

Maybe they are afraid you will not stay. With all your experience, maybe they consider you a hire risk since you are applying for a job below your credentials. That you'll get "bored" with the position in which you are applying for.

Scrubs and Nurse Jackie are the only two worth watching that don't irritate the heck out of me. Nurse Jackie is the most realistic, and even it has unrealistic moments (like going out to eat regularly with her doc friend, or finding the time to have sex with the pharmicist during her shift). However, it is a TV show, so... Scrubs is just so full of comedic goofieness that it's hard to take seriously. Hawthorne is deplorable... Your typical sterotypes with the one nurse in pink being a flirt, the two male nurses, one wanted to be a doc but couldn't get into med school, the other is gay! Then the manager is running the floor with her nurses, and answers to docs like they are her bosses!!! Ugh! House ticked me off years ago when he asked a kid to help him with a LP, and the kid was like "shouldn't a nurse help"? House was like, you'll do a better job than a nurse...... Blah! No nurses, unless they are changing bedpans. Docs doing ALL of the work, and maybe two nurses in the background in most of the shows.

Received and thanks!

Kc87t I wanted to thank you for all the info you added. I have a few questions about travelling myself. I plan on traveling when my youngest daughter is out of high school (about 5 years from now). I may go sooner if I can. Anyways, I have done tele, pcu, and step down. I'm getting ready to put in apps at my hospital for a ER position so that I can have that option when traveling as I heard ER is available frequently, and pays better. I was wondering what one does for retirement benefits. I have a 403b thru my hospital, so what do you recommend for travelers? You mentioned getting an outside resource for your medical and dental, whom would you recommend as the best with family rates and coverage? Do you find it difficult to obtain positions when a contract is nearing completion? I guess you probably bring a laptop to do future interviews, do most places have high speed? I have a home here in my home state that I plan on keeping to help with taxes. How do you keep up with ACLS and CEUs? Do you pay for these, or does your agency? How about extra licences? I plan on driving to my destinations, and I would like to take my partner and dogs with me, is that doable? I am going to purchase the book you recommended as well. I am very excited about this... I am going to want agencies that provide me with the highest pay, best contract, and most locales as I have many places on my list... Hawaii, Alaska, Colorado, Arizona, Austin TX, FL, Seattle WA, Portland OR, New York, etc. Is that possible? How many agencies should I apply to? How does "clocking in" at these hospitals work? I am nervous about the PBDS testing. Do you find that to be commonplace, and is it true that if you fail you're stuck out of state without a job? Anyways, sorry for the long post, I'm just very excited, and nervous as well. Thank you!

The best ER nurses started out on the floor, learning the big pic, and the reasons why we do what we do... IMO.

This is not as big a deal as you are making it, lol. You are going to be fine. Like you said, slow down, and make sure you have everything together before you make calls. Good luck!

Quick question for you Frontier students. I'm a little confused on the required math for this school. It's not covered anywhere on their website. With an ADN, college level algebra was not needed. Would this need to be obtained before applying, or is it not necessary with their program?

I love how no matter our nursing specialty, we can all relate to this tumblr. Love it! Thanks for sharing.

she's probably angry cause she flunked out of nursing school. if you read through some of her prior posts, they are pretty immature and crazy.