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.

Here ya go! Hope it helps excuse the quality I just took a pic of it with my ipad

I'm new to home health as well. I work per diem so even though I started in November I still feel like everyday is my first day. As far as oasis I just looked over the form before I used it the first time. But when I went to fill it out I was overwhelmed because it's so long, each time I do an admission it's easier. My preceptor all gave me a cheat sheet to make the care plan. I've been thinking about buying the book as well but haven't had any feedback from nurses that actually use it. as far as supplies I was given the basics like gauze tape, saline, etc. most of our visits are teaching visits so I normally only carry supplies to do vitals. I also keep extra forms in my car to keep me from running back n forth to the office

Hi are you an ahna member? If not than it's the American holistic nursing association and they list a variety if programs that provide contact hours, if you become a member you will also receive the beginnings magazine and the journal of holistic nursing, both publications provide contact hours with each issue and you can access them online as well. i recnetly took a healing touch class which provides 16 contact hours. i eventually would like to have my holistic nursing certification as well, so the things I've mentioned are helping me get there :)

My first admission Yesterday I finally did it! I did my first start of care (SOC). My day started with our required care conferences where we discuss all of our patients, and then we had a staff meeting. I was annoyed because the meeting was almost 2 hrs ! I wanted to see my patient as early as possible because I knew it would take me a couple hours to do the full admission. After the meeting I scheduled my patient who said I could come at 12, this gave me over an hour to make sure I had all the paperwork and enough back ground info on her to do a good job. I arrive at her house and she and her family were lovely and inviting. Unfortunately, this patient was pretty young and had a recent craniotomy (procedure involving the brain) to remove a mass. She was left with some physical limitations after the procedure which made her home bound. I started the admission with making sure she understood what our company offers. Sometimes patients think they are receiving around the clock nursing care, maid services and all kind of crazy stuff. Lucky for me she was well informed and knew exactly what we were offering, so we went ahead and signed consents. After the "business" part was complete I went ahead with collecting her medical history. This conversation tool a good 30-40 minutes and discussing her medications took just as long. Lucky for me, she wasn't on a ton of meds, because I have to document every single med she takes. Once I gathered all my information, I started my assessment which didn't take more than 5 minutes. I Tried my best to chart as much as I could while I was in her home, but I'm not familiar with the paperwork so it would have taken way too long to do it in the home. The total visit ended up being 1hr 40minutes. We are paid a flat rate and admissions are supposed to only take 1 hr.... Lol Now the hard part was waiting for me. I had to get all the paperwork completed and be out of the office by 3:30 to meet my daughter at the bus stop. I get back to the office and no one was available to help me because one of the nurses went home sick and my preceptor had to take her patients. My DON (manager or director of nursing) couldn't help because she was in a meeting. I was left to figure it out on my own. Most of the OASIS wasn't bad at all, I just had to simply fill in my assessment. I notice questions were asked over and over, and that was annoying. But I know it's made that way to make sure we are being consistent and honest... I guess that's why. Finally at 3pm my manager was available to help, so she was able to help me with some of the documenting. But it was now 320 and I had to get ready to leave. Before I left the offic I called the patients DR and made sure she would sign our home care orders. I spoke with the secretary and was told they would call me back with an answer. I make in home by 340 and just sat in my car until my daughter arrived. I was just about done the chart! After my daughter arrived we went to pick up my son. Once we were all home it was 4pm and I had to take the chart back by 5 for payroll!!!! I was really stressed now, because I knew I had to finish and my kids were being normal kids harassing me lol. I had to keep telling myself to get it done and if something is wrong I can always fix it later ( that's what my manager told me) this eased my anxiety and stress levels . By 440 we were leaving the house to drop off the chart. I made it back In perfect timing and handed the chart in and again my manager assured me that it was my first admission and I shouldn't worry. She said we would go over it together next week :) Now that I think about it, I had a pretty stressful day but in the end I was able to pick my kids up and take them to the office with me. I still got my work done. I'm pretty sure it gets a little easier too. I spent the whole day working on this admission,but I'm glad I finally got to do one. I'm sure the next time I do one I will be much more comfortable. I'm so excited to learn to be a proficient home care nurse. Right now I'm in the phase where I don't trust my assessment or anything I do. I think I'm doing an awful job and question whether I am really helping my patients. I haven't received and negative feedback so I guess I'm doing ok,but I know I have so much to learn. For the first time in my nursing career,I really want to take my own time to invest in educating myself on my new role. I'm thinking of ordering a home care reference book to help with documenting. I may had said it before that this home health company teaches just by doing and doesn't t really rely on polices or written guidelines. It worries me a little bit, but I also look at it like there's room for improvement and I would like to help with that :)

I say follow your heart, I know that sounds cheesy lol. I am in a similar situation as I've been at my hospital job for 8 years but started per diem home care in November. I too love homecare for many reasons, flexibility so being the biggest reason. I think you should do what's best for you and your family now as the future is not promised. I'd much rather be there for my kids while they are kids because that time goes way to fast to miss those precious moments. On the other hand, I hear full time home care can be very stressful and demanding and you may not have the same love for the position being full time vs perdiem. Personally my plan is to decrease my hours at my full time job and pick up an exta day or two doing home care. That may be a good option for you especially since you can get medical insurance from your husband. best wishes to you!

Hi everyone! Have any of you heard or considered Healing Touch? It's a modality endorsed by the holistic nurses association. I just registered for a level one class. Classes are held through out the country and from my personal research healing touch seems to be an emerging modality. I guess to explain it, it's closely related to reiki and other energy based therapies. According to info I read healing touch helps with anxiety, stress, pain, etc and a lot of hospitals and cancer centers are offering it.

Hi congrats! I know most would suggest you first have hospital/long term care experience before home health but I don't think it's necessary. Yes in home care you are on your own, but so far from my experience home care reminds me a lot of nursing school with regards to creating care plans and really using your assessment skills. You rely on your assessment of blood pressure the old fashioned way, really checking pulses and listening to heart and lung sounds. I feel like in the hospital we rely so much on machines for assessment that we as nurses somewhat lose our basic nursing skills. i hope the company you may work for provides lots of education and support for you as a new nurse. I can comment on the rates as I live in DE

I recently started per diem for a small home health agency, during my interview I asked how many patients I'd be required to see, if pay is per hour or per visit, what kind of orientation is provided, what is the call requiremtn. ive been at my agency for about 2 months and I enjoy it. Initially I thought I wanted to do home health full time but after actually working I think I will stay Per diem and keep my other job a little longer. Full time staff seem overwhlemd and complain that it's too much paperwork and that they often are charting at home till 8 or 9 at night. As a per diem nurse when I come in I tell them how many patients I'm willing to take that day. I usually do 3-4 since I'm just starting. We are paid per visit so if I don't finish my charting I don't get paid to do it at home or In the office. the pay rate for me is $48 visit $78 for admission and 50 cent for gas mileage. My agency does a pretty good job of assigning patients geographically so I hardly ever drive more than 10 -15 miles between pts. I hope you enjoy home care :) oh yeah orientation for me was pretty nonchalant and randomn. But somehow I think I learned enough to get the job done safely and correctly

Hello all! I've been stalking this forum for months now as I have been preparing to start my new position as a home care nurse. I graduated nursing school in 2008 and was very fortunate to start in the PACU as a new grad. I work at a large teaching hospital and have learned so much over the years. I applied for a home care job because I moved and now have a 1 hr drive to work (hospital) I am also getting tired of 12hr shifts and not seeing my kids for days at a time some weeks I am also very much into holistic health and feel that the hospital isn't really the best place to practice holistically. Anywho, i am starting this thread to share my journey. The home care company I am working for is a small company, there's only 4 rn's 1 Lpn, and 1 aide. I will be working per diem as I am not quite ready to leave my hospital job. already I have learned that home care is a completely different world than hospital nursing. Even though I have been a nurse for a few years and take care of critically ill patients in the PACU, I feel like I don't know anything when it comes to home care. I'm so used to another nurse or md being available to offer a second opinion or answer a question,but in homecare you Are one your own... I must say I for once feel like a professional however in homecare as there's no time clocks, or managers breathing down my neck. My first visits alone i couldn't believe I was getting paid for what I thought was not a lot of work. I went to see a patient to teach him about Zantac! Now of course he had a whole lot of other things going on, but my assignment for the visit was to assess him and provide education. i almost wish I still had care plans from nursing school, because in homecare we rely heavily on creating care plans. The nurse makes out the care plan which again, I find impressive and makes me feel like a valued professional . i think I've blabbed enough for now, but again i wanted to create this thread to share my journey and hope to get advice on how to succeed in homecare. :) thanks for reading

hi, i don't have any real advice for you as i am kinda in the same boat. I am a big believer in yoga/holisitc health and alternative medicine. eventually i want to leave the hospital and possibly be a nurse coach/yoga teacher or something like that. Im planning on taking yoga teacher training and eventually teaching yoga (hopefully) while keeping my full time job until i able to work for myself. I think as nurses we are in a great position to use the flexibility nursing offers to pursue holistic modalities