RNcsemgr

I am an RN who worked for over 20 yrs. in MA home care. There are some things to be aware of. If you work in a VNA vs. a proprietary business home care agency, you will probably receive lower pay, but perhaps a better caseload in a pre defined travel area. Otherwise, the proprietary home care companies will require you to do more travel and accept cases further apart to just be sure all referrals are seen, so that no business lost. You may be paid better. If you are salaried, you will not be paid hourly, but over all pay may be lower/hr. If you are per diem, then you are given a per visit rate and hopefully mileage between visits, but you will probably receive less over the entire day, unless you can get a good number of visits close together. Per visit rates can vary from between $35 to $60, depending on geographic area. Admissions can take over 2 hrs. or more with the visit and then the paper work. You will have an OASIS data base to complete with each admit. So there are a few variables to consider. It would be best to check with other visiting nurses in your area before jumping in to a home care job. But yes, there are also many positives to home care. You have opportunities to teach clients in the setting in which they are most comfortable--their own home. You will also need to remember that it is their home, and they have allowed you as a professional guest to come in. You cannot force them to do things your way, you are offering them professional advice. This will be different from working in the hospital, where they are a patient, and where they are more dependent on you to care for them. But, I don't want to ruin your excitement. I hope it all works out well for you. Best wishes on your new focus on home care.

I have been an agency nurse in the past X many years. I worked primarily 3-11 shift. Let me add a few good tips to what's already been suggested: carry a clipboard to keep your papers together. Take careful notes from report for pts. with problems and place little square blocks on your sheet for important checks (labs, antibiotics, pain issues, etc.), last FS results and which need 4PM FS, be sure that PTs are in for those on coumadin (sometimes labs are late, and you need to give MD call to get coumadin dose), after report gather CNAs together and give quick report so no surprises later (pts. out on MD appts, off floor for whatever reasons, those who need wts., etc., then obtain the 4PM FS and give covering doses, start 5PM meds, check diet slips for meals on meal truck, finish 5-6PM meds, supper break by 6:30PM, return and flag treatment book, do treatments which don't require bedbound, start 8PM-9PM meds, after finished then complete PM treatments, complete nursing notes and other documentation, give report to 11-7 nurse (and supervisor if required). Hope this helps. Don't forget to check those records flagged with MD orders if they sneak up to the floor while you are on the med cart---I know they are capable of this.

Yes, I can empathize with the nurse who has over 20 yrs. experience with a Bachelors and a Masters. I am having the exact same problem. I have been looking for over 6 months and sending out many resume with emails. I often receive no reply other than an email note saying resume received--thanks. There seems to be tons of partime or per diem listings. Employers want you but don't want to pay for benefts seems to be the problem. I'm on unemployment now and having problems with that. I should have opted for direct deposit from the beginning, but once on it I was getting a check right on time 2 days after applying for my weekly benefit. That was until last week, when it never arrived (that was the week the Northeast had that big blizzard) so probably now lost in the mail. So now I'm minus $500! How can I pay rent, since I depended on that to come up with enough. On top of that I went to apply this A.M. for my weekly benefit as always and found out it was about $200 less than before, and they claimed my initial benefit claim was now finished!! I was to have 4 more benefit checks before I had to apply for extension benefits. So now I have to go in first thing tomorrow to an office near me to straighten it all out. What a mess!! Never expected this to happen. It is the 1st time on unemployment, since before always got a job within a month or so. NOT THE BEST WAY TO START A NEW YEAR:eek:

I may be able to shed a little light on subject. I worked in an in patient detox unit near a large city on the evening shift. We had a 30 bed capacity usually only 3/4 full. I was required to either do admissions (and that's all I would do and quite busy) or on floor detox assessments and then give medication based on the assessments. Each client would be catagorized by type of substance being detoxed: either alcohol or benzodiazepine (heroin, ativan, clonopin, etc). They would then receive a score base on the assessment for each side effect found. They would receive a detox dose for each assessment of either methadone (for benzo substances) or librium (for alcohol detox). Total dose for methodone detox was 30 mg./6 day stay; for librium it would be 25-100 mg./2 hr. period based on detox assessment. We had to obtain VS each assessment and also provide "comfort meds" if their score did not fall into a detox med number, or they had already met their methodone or librium dose for that period. The clients were often "hard core" addicts who had returned in the past once they had been rehabed, and then returned to their addictions. You needed a great deal of patience to continue to work with them and support them--helping them to believe that it is possible with detox rehab to overcome their addiction and get back to the road on which they wished to travel.

Yes, I have a great book you might want to get---it's a paperback available on Amazon.com for very little $: "Straight A's in Pediatric Nursing, 2nd edition by Lippincott. It is a very comprehensive, yet easy to follow, covering eveything from growth/develop. through each alteration in system functioning. It provides a great overview, even if you have had very little pediatric background. I also needed to brush up with Pedi, since I did some Pedi private duty with very sick children often with trachs, GTs, and even vents. My previous background was older adult care as well. Hope all goes well for you.

Well having been a home care nurse X 20 yrs., here's a few: climbing up 25 or more stairs to the walk up apt. of your client with your bag and all your equipment, or diggin yourself out of your snowed in parking spot or the ditch into which your car slid, or beding down to your bedbound client lying only a few inches off the floor (no hosp. bed) to change his/her dressing, or walking 50 ft. down a long driveway to visit a client who requires you to use the back door only. This is just a few. If you're small and slight of build, you'll be fine.