NurseCard

So backstory... I've been going back and forth between Med/Surge and Home Health for about the past 10-12 years of my 22 year nurse career. Most of my Med/Surge career has taken place at a small Critical Access hospital. I love this hospital, love the staff, have always felt appreciated there... It feels like home. However I've always worked nights. Most of the patients are there for "rehab". After I've been there awhile, I start getting tired of cleaning butts and taking people to the bathroom all night. I just get tired of it. So I decide to go back to Home Health for "one more go". I've always rejected the idea of working day shift at this hospital. There aren't many good day shift opportunities at this hospital other than just working the floor. So I always return to home health, because I basically love it. Love the freedom. Love driving around all day listening to music, podcasts, what have you. Love being by myself. Love the one on one with patients. Love the patients that I get kinda attached to. The things that suck about Home Health, eventually get to me so badly, that I have to throw in the towel. This time, the things that have gotten me this time.... The fact that it's 5 days a week for one thing, and I get a lot of pushback when I ask for time off. The amount of phone calls I have to make. The phone calls to doctors offices are neverending, and it's hard to find time for all of them when you spend all day driving around trying to see your patients, chart. I'm not talking about calls when there is something wrong or abnormal. I'm talking about having to call after every OASIS visit. Having to call everytime a wound has healed. Having to call to increase or decrease visits. Call, call, call.... But the straw that broke the camels back happened Friday... Getting handed patients that are just not appropriate for home health, and having to be the one to make that decision. Getting pushback when you DO make that decision, or when you call your manager and tell them you are uncomfortable taking on this patient that YOU, the field nurse/CM, are going to be mostly responsible for because you're the ONLY nurse in this particular county, no other nurse gets sent here unless you're sick, so you're on your own. The patient has a PICC line with antibiotics, a wound vac, a catheter, a colostomy. Having said all of THAT... the actual straw didn't happen until this past Friday, a week or so after we started this patient. I went alone to put this guys wound vac on. He has three rather large stage 4 wounds on his backside. I was there four hours. I was there four hours because the guy informs me that his mom, who had been helping with wet to dry when needed, has moved back home way across the state and he has no one to help with wet to dry. His daughter does come and help him every day, but he won't let her do any wound care. Did I mention... This guy is 50, can get himself in and out of bed, is actually rather mobile in spite of paralysis, and he's even more of a challenge to keep a wound vac on because he is SO mobile. Anyway I finally had to do the wet to dry. Put wet to dry on him, left, and sent in my notice. Going back the the hospital, but on day shift. I asked the guy on Friday, if going to a continuing care hospital like Select, was mentioned to him when he was in the hospital. He said yes, but he didn't want to go there, he wanted to go home, so they sent him home. I hope I survive day shift at the hospital. I think I will. I think I'll actually be happier. I hope the pay cut doesn't kill me. That was about my fifth try at home health. I literally keep forgetting about what all I hated about it. I've lasted about a year and a half this time! The idea of it, the things I love about it, keep drawing me back. The things I hate about it eventually finally just get to be too much.

At my agency, we are told not to admit the patient/finish the admission visit, but to do a "non admit" due to lack of nursing skill or need or what have you, then notify the clinical manager and I guess the PT's visit is changed to a "PT00" or whatever. Are the visit codes universal? :)

I once worked in a LTC facility as a Shift Supervisor. There were nights when I was expected to perform my supervisor role AND take a medication cart. I lasted two months in that job.

Okay. Consider this. My husband is currently trying to finish his Bachelor's Degree, at 55. In order to finish a BA in University Studies, he needed to take a number of online, 300-400 level courses. He's taking like, 5 nursing courses. BSN courses. My husband, who has never worked in the medical field. The difference between an RN and a BSN is a lot of classes that a guy with no medical experience can likely ace.

Update. LOL. Left HH again back in April and never going back... Not to a permanent position anyway. I'm now a traveler and I will never rule out the possibility of doing a HH contract, but it would only be temporary of course, and the pay would have to be right. ? Currently in a hospital. ?

So I just started traveling after 19 years of being an RN. Currently doing a contract in a fairly small but very busy regional hospital. I'm not here to make friends... But at the same time... I tend to be really quiet, especially around large groups of women. The last hospital where I worked a permanent position, was a very small critical access hospital.. Very small group of employees. I was much more comfortable in that environment and made some great friends. Im just venting because I miss having friends at work. Im traveling because of the money, because I do tend to burn out easily, and just for the fun of seeing different places. I would love to stick to critical access hospitals. Are there many out there that use travelers? Thanks! ?

Well, I'm back! Back to allnurses after about a 3 year absence... And back to home health. I did home health for about 2 years about 7 years ago, then left, returned to it in 2020, left again, now I'm back for one more go at it. I've been at it four months this time and I'm already ready to quit again. I'm already burned out. I'm a field case manager. At last look I had about 45 patients to my name. I keep getting 2-3 nurse evals or RN01 every day. My LPN failed to get the NOMNC signed for a patient that is ready to discharge, she wants to monitor and educate the patient one more cert. Why??? Patient is doing fine. Granted we've only seen her for one cert period. How long are we supposed to see a patient for monitoring and education if nothing is changing and the patient is fine?? Im one of only like, seven or eight full time field RNs/CMs for an office that serves a city/county of about 300,000 people, plus about ten counties surrounding. Our office staff doesnt do enough to help us. I missed a patient's recert a week ago. Been asking for help getting this patient straightened up and back on service and not gotten the help. Was sick the other day. Thought I might have COVID. Called in. Got tested. Negative. No one to cover my patients. Explaine the situation to a patient's wife and got told off. Theyd been waiting over a week for a nurse to come out. This job takes over your life. This time I actually decided to embrace that fact. I don't have much of a life anyway so why not???... It isn't working right now..... I feel like im never off. Even on my weekends I feel like Im not off.

Huh? Explain.....

*Hand up* yep, me too! I've been working a lot lately and am definitely feeling the compassion fatigue setting in. I feel a strong need to take off to Margaritaville.

good for you! ? I'm still waiting for mine. I think everyone on my floor has gotten one but me. Must be my sunny personality.

So true. So many of us find ourselves asking "Hey! Why is that dude's heart rate 130?"... because he's withdrawing, that's why.

You know why this is scary? This is scary, because I work in this itty-bitty hospital with one Med Surge unit, no ICU... and at night, about 8-9 people in the whole building. We do CIWA protocol and admit patients for alcohol withdrawal. Yeah. Oh, and I didn't mention... little to no Crisis Intervention training, and little to no training on the emergency use of restraints. We do have a policy and we have been educated on it.. but as far as physically restraining someone... we've had a little bit of training, but not enough IMO.

Myself, I call in if my head feels like it weighs 2 tons, if I have a fever, if I just overall FEEL horrible and weak, or if I can't leave the toilet for five minutes without something wanting to come spilling out of me. Either end. I have gone in with a HORRIBLE head cold, mucous mucous mucous!... or a chest cold... as long as I feel okay OVERALL, and no fever, I go in. Wear a mask.

Yeah, that. I've been at my current job for almost three years now, and am truly truly starting to feel like it's time to move on to something different, at least for a while. My goodness, I know I'll miss this place though. So, I feel for ya, in a way! As far as the "right" nursing field... in sixteen years, there really has never been ONE "right nursing field" for me. I've tried several different things. Right now I'm simply working on a small Med/Surge unit and I loved it for quite a long time, but a lot of things have changed, I'm not loving it quite as much, I'm feeling quite burned out. Time to move on, possibly, to something or somewhere different. Could see myself coming back here, if they would ever have me, after a bit of a break.

The possible problem is... if you start sending your resume to places NOW that you might like to work in in the future... they are going to get it in their heads right NOW, that you are a possible job hopper. What you might do is include a cover letter that says something like "hello, my name is nurseX23, I am currently employed at Wrongway Regional Medical Center in Podunk IL (that's humor), but may be interested in your facility at some time in the future. Thank you for viewing my resume". Or, instead of sending your resume to individual facilities, you could truly put it "out there" as in, put it on job search sites such as Indeed. The problem with that is, you tend to get inundated with requests to interview, and often from places that you would never want to work in a million years. I'm with everyone else for the most part; try to stick it out. You aren't going to lose your license as long as you are doing everything that you are supposed to be doing, to the best of your ability, and DOCUMENTING everything. Good luck!