Holisticlifern

I picked up a per diem job last year and worked per diem home care for almost a year. I kept my full-time job at the hospital. As almost everyone has said, its tough and risky to give up the stability of hospital nursing. I resigned from home care because I just didnt have enough time to meet their minimal requirements, I wish I would have kept the position because I loved home care. If you are in search of a different type of nursing, I say go for it and as you are planning go per diem at your hospital job

Hi, I'm still working home health. Ive experienced very good days and some bad days. Im getting much better at admissions because thats pretty much all i have been doing. I love the patient/family interaction, most days when I work i feel like I'm just hanging out with nice people when I do visits. I feel much more respected and appreciated by patient and families in home health. the charting can be a little much but its getting better. Im learning to do the most of my charting in the home. I have a few other post about my bad days on the board in case you wanted to know more :)

I couldn't agree more! I have been working per diem home health since october and feel like i wrote this post myself! lol. My very first day in the field I remember saying to my preceptor "wow we are getting paid to teach this patient about his diabetes and meds" I really del like a professional! Yes we do patient teaching in the hospital as well but teaching is a huge part of home care . Im hoping one day I will do home health full time

No we still use paper to document. I never understood call either without records. The office is closed on the weekend and there's no way to access patient information. I've been with this company since October and have taken call a few times and this was my first time ever having to go out. Like I said in my initial post, I won't be taking anymore call without access to at least our census with PT dx

I just made my first visit on call. I received a call about a leaking foley catheter, initially the operator said the foley was out. When I called the patient he said "my catheter is out, its leaking" I asked him when was the foley placed, what reason, when is it supposed to come out, when is his next dr appt. He answers "it was placed a few days ago because I couldn't pee when I was in the hospital and i see my dr on tuesday to take it out" Today is saturday btw. Anyways since we hardly get calls to actually visit patients while on call there really isn't any set policies/procedures or anything. We basically get a call from the answering service giving us the patient name, number and issue. On hand at home, I don't have any charts or any patient information. Before heading off to see the pt I check my email to see if his name is listed as one of our recent (last 2 months) admissions. I don't see his name, but since I only work per diem maybe just never met him.... I call my on call director just to confirm whether or not we have this patient on our census but she doesnt answer, i leave a message and she didn't call me back. I arrive at the patients house and his foley is fine, he just didnt close it completely after emptying it. I ask him where is is paperwork(admission agreement, consent, visit notes) from other visits and he says "your the first nurse to come visit me"! Apperently he was discharged over a week ago and has NOT BEEN ADMITTED!!!! I am now very upset, because I feel like I was ignored by my director . In retrospect I realize my fault in the issue. I should have asked the patient when did we last see him or something like that. But when I got the call, all I could think about was if the patient was ok, i thought I could only determine that by going to see him. I was only in the home for maybe 5 minutes, when I left I texted my director and told her what happened and asked if she was aware of the patient. She immediately texted back and said "he's never returned our calls to set up admission and his Dr never agreed to sign orders".... NOW IM REALLY MADE:madface: This was a really long vent, I had to get it out. I plan on sending a nice email to my director and administrator demanding a on call policy and a list of current census for on call nurses. I refuse to take call again until they set something in place. I don't even think I can be paid for this visit???? I am known for being a little dramatic, please let me know if you all feel like I am overeacting?? Any ideas, advice, similar situations. thanks for reading :)

Thanks RN4life08 i actually did two more admissions since my post and they went well. I'm getting much better at the paperwork and was able to complete almost the entire oasis in the home. i learning its easier to just fill it out in the home because i was forgetting to assess so many things by "taking notes" i also had a day of revisits and that went smoothly. I'm starting to see the positives of home care again :)

thanks, my agency doesnt offer extended care cases.

I love homecare but after 6 months I'm beginning to see the frustrations with paperwork. I did two admissions today each of which I spend about 1-1.5hrs in the home. I only seem these two patients. I had to get home to pick up my kids. I only spent about an hr doing paperwork then It was time to get the kids. I spend about 2hrs with my kids then I started completing my admission paperwork all the while trying to manage my kids and German Shepard who were all running crazy . Here we are at 8pm and I am just finishing my charts but then I remember I have to be at my hospital job at 8 am so I won't have time to drop my charts off for homecare tomorrow I text my manager and she says to just email her my time sheet and the first page of oasis and bring the rest in Thursday. I spend a good 20 minutes trying to scan and email lol. Meanwhile my poor daughter is upset that we haven't spent much time together today I felt so frustrated and anxious trying to finish everything. I contemplated quitting home health but I love it and want to do it full time eventually. I'm hoping that the paperwork gets easier with time. I do notice I'm much better at it than I was a couple months ago. Please tell me it gets better! I'm seriously thinking about resigning homecare, but in my heart I know it's where I need to be in a year or so and I think the company I work for is pretty understanding and accomadting.... What's a girl to do? Thanks for listening

Thanks everyone, I feel a little better. After reading all of the replies I realize I would have felt much worst had I not sent her to the ER. I honestly thought about her and her family for hours after I left them, I had a feeling she wouldn't get " better" but I wasn't expecting her to pass that day .

There's a first time for everything. I'm a little traumatized. I admitted a 80yr old who was d/c from SNF the day before. Originally the patient had a fall that resulted in a brain bleed. I arrived to find her with a very wet cough, typical of end or life or bad aspiration pneumonia. Per her very optimistic children they told me she was the same way to at SNF. She had recently had pneumonia but a follow up chest X-Ray showed it resolved( per family) The whole time I was in the home I kept thinking to myself she could not have been discharged this way. As I complete my assessment she seemed to become more and more lethargic and was very tachypneic with sats ranging 88-92.I finally said to the family that I think she needs to go to the ER. The family wanted to take her themselves but I insisted we needed 911, theyalso asked if they could just take her to a minute clinic, again I said no. I felt so bad sending her in an ambulance because she just got home and her family so so happy to have her there. The minute I walked into the home and seen her I knew something wasn't right, but since I'm a little new to homecare I assumed she was well enough to be at home since she was discharged. Long story short I found out today this pt passed away, I believe it was the same day the the nurses at my agency assured me that this kind of thing happens. Sometimes often. I feel so bad, like maybe I should have called 911 as soon as I walked in I know it's not my fault but I just feel so bad and like I did a bad

I'm new to home health as well. Just last week I had to write orders for the first time. I just looked in the patients chart at old orders and used it as a template. It was a fairly simple order, I will give an example. I made a visit to check an INR, called the office and was told to have the patient take a certain dose for x/days, etc. here's how I did it dx: afib Summary: INR 2.0 md office notified. PT instructed to take 4mg Coumadin every night starting 4/11 until 4/13. PT verbalized understanding of medication order order: 4mg Coumadin every night starting 4/11 until 4/13. INR to be rechecked 4/14 to sign the order my office just rights the TVO by dr. Whoever (telephone verbal order) Hope this helps

Im fairly new to home health but I've been a nurse for 6 years. If I were you I would start applying for other jobs. You are not being treated as a professional or even a person for that matter. It sounds like you are handling the situation well as you can and still provide excellent care. You don't want the stress to get to a point where it starts to affect your patient care or your time away from work. I know you mentioned its a competitive job market in your area, but you are in a position to complete. I think working in home health and learning how to manage patients in the field all on your own speaks volumes especially as a new nurses nd handling the load that you have... keep up the good work, stay encouraged and please don't be afraid to apply and consider other jobs.

I work per diem in home health. I only do 1-2 days week and usually seen between 3-5 patients a day. We are paid per visit $48 and $78 for admission. Home health is very flexible and as long as you have care for your child during the day you will be fine. I however think it's hard to make money just working 1 day a week in home care especially per diem because if the census is low the full time staff has to take all the patients.... Which leaves the perdiem nurse with only a couple patients and eventually a small paycheck. I usually average around $380 biweekly but again I only see probably 6 patients we pay period. Also you may run into the same problem your having in the ER as far as not seeing enough. working per diem in home care it's been a little hard for me to get used to paperwork, policy's, procedures, and such. I often still have to ask questions everyday I work. Lucky for me the staff and managers are very helpful and don't mind. Whatever you decide I wish you well :)

Hi I am very happy to come across your post. I have been a nurse for 7 years and all of my career I've been working In the recovery room at a large teaching hospital. I've always been intrigued by holistic health and felt like I found my "place" when I discovered AHNA. Before joining I felt like I was all alone and that there was no way to incorporate holistic nursing into my current role. To make a long story short through reading AHNA publications, investigating their sponsored programs, and reaching out to other holistic nurses wherever I could find them, I decided to take a healing touch class last month. I also have been studying yoga for about 3 years and my coworkers have asked me to start teaching them poses, so each morning when we have time we do a few poses and breathing exercises :) I also recently took a per diem home health job as I am slowly trying to transition out of the hospital. my advice to you would to research! Even if there aren't classes near you look up other nurses who are doing things you are interested in and learn from them. Holistic nursing starts with the nurse and is all about putting the patient in the best position for healing and tons of self care. I don't think you need to move to start a holistic nursing career, you may be the resource Louisiana needs :) i want to write so much more to tell you about my journey but my 4 year old is requiring my attention right now. If you ever want to chat or have questions feel free to email me [email protected] by the way I live in Delaware. Take care

Ummm I don't think there's really a "routine" morning in homecare. From what I've learned you either call pts the night before and head out in the am whenever your first visit is scheduled or like me I have to go into the office in the morning and get my assignment. Most of the nurses are in the office by 830 but it's pretty flexible as to to what time you come in. I normally come in at 9 because I too have to get a child on the bus.