Kyasi

I got that call too. I did a little searching and found this link. https://ch.tbe.taleo.net/CH11/ats/careers/requisition.jsp?org=HUFFMASTERS&cws=1&rid=453

mumarada, You don't mention how much hospital experience you had before you started working for the doctor's office. I had 5 yrs of hospital experience in ICU, CCU, Post Pump, and Labor and Delivery and then took 4.5 yrs off completely to have my kids. I had no problem transitioning to HH after not working at all for over 4 yrs. I think if you have hospital experience as well as MD office experience, you will do fine in Home Care. It is very different though from what you are used to. I remember the biggest shock for me going into Home care was the lack of sterile technique in a home. (my first patient's suction catheter was kept on the carpet and the dog was walking over it!) I had to learn not to be "Nancy Nurse". You can't go into a home and treat it like a hospital and tell the parents/family all the things they should do differently (although it's very tempting!) If you can change your mind set a bit, respect the family/patient, you can do home care. That first patient's family finally did start keeping the catheter wrapped in a clean towel, something I gradually implemented. Good luck! Kyasi

Ditto that! I have patients report every so often that one of my office staff or one of my Nurse Case Managers was rude. I apologize profusely and then we all laugh about it because I know it isn't true. My office is right there and I can hear most of the communication. Even if I didn't hear it, I'd believe my staff. I was doing a supervisory visit once and the patient's girlfriend overheard the patient tell me that he liked my new hairstyle. I said, thanks, and that was the end of that discussion. Girlfriend was extremely jealous and called the office and said she wanted me off the case because I was the rudest nurse she had ever met. I got back to the office and everyone, including my boss, was laughing and asking me what I did to tick her off. I didn't even know the girlfriend was upset. She was standing in the hallway out of sight when he said it and I didn't even talk to her. Now if I'd have gotten a write-up for that, I'd have walked right out of the office door! Having faith in your staff's integrity is a good way to keep good employees. To not be given a chance to tell your side is so not fair to you and it says a lot about the company you work for. Go to where you are treated with dignity and where there are more benefits. It's a no brainer! Kyasi

I totally agree with Ash2012. You really should get some hands on clinical experience before you go into home health. In a hospital setting there is always someone to consult or to act as a preceptor when you are faced with new experiences. Most HH Agencies require experience before they will hire you. Mine requires a year. You will feel much more confident out there on your own if you have some experience under your belt. Good luck to you as you start your career! Kyasi

Sorry to say, but this may come back to haunt you. I would definitely consult a lawyer. Even if you were able to get your license, getting a job may be a problem. We have a question on our application asking if the applicant has ever been arrested or bonded. I always ask the question verbally during an interview even if they write in 'no'. A few weeks ago, I had to stop the hiring process because the applicant lied and told me she had not ever been arrested. We ran her background checks and found that she had been arrested for theft, convicted and rec'd a 24 month sentence, 23 mos suspended, which meant she spent a month in jail. I couldn't hire her because we won't hire anyone who was convicted of theft for home care but also because she lied to me during the interview. Sadly, this all happened 12 yrs ago and she had turned her life around and would probably have made a good employee. I have hired people who have had convictions in their past when they were truthful with me during the interview. Every employer will have different standards but you should find out if this will affect your ability to be licensed before you continue your education.

I made a transition 25 yrs ago to HH from hospital nursing. (ICU, CCU, PPU, and the Delivery room) I did hospital nursing BC (before children) and switched to HH AC (after children.) I started doing home care when my youngest son was 4 months old. I would nurse him before I left for a 4 hr evening case at 7pm and would be home to feed him again at 11pm. My husband was home with the kids and I worked shorter shifts, part time. My Special Care experience was very helpful and I worked on High tech Pediatric cases. As my kids got older, I moved into doing visit nursing. (dressing changes, med fills, blood draws etc) I would drop the kids off at school and be home by the time they got home. I never missed a field trip and I volunteered in the kids classes regularly. Basically, I arranged my work schedule around my life instead of the other way around. When the kids got older and into college, I started full time and never had a problem getting enough hours. I could have worked 80 hrs a week if I could have cloned myself. Now that I have an empty nest, I work in management for a home health agency. It's a stressful job but it will be my last job. It's meeting my needs at this stage in my life and I plan to retire in a few years. I read a lot of negatives about HH nursing on this site but for me it's been great and I wouldn't change a thing. I have had much more flexibility than I would have had in a hospital while raising my family. I really did name my own hours until I started my current job. Good luck to you! Kyasi

My agency has a policy against staff caring for their immediate family and I believe most agencies do also. Our Aging Agency has what is called Self Directed Care where a patient can hire family for Attendant level care. But as you said, the waiting list is quite long and the screening process is stringent. There have been so much abuse of this program by family members that I doubt the program will continue for long. Kyasi

Nanny, I didn't see this post early enough to give you any pointers but hope your interview went well. I have been in HH for 25 yrs and as in all fields of nursing, there is good and bad. In my case, it's been a very positive experience and the good far outweighs any of the bad. So if you get the job, I hope you will like the change. I wish you the best! Caliotter3, If HH has been so negative for you, why are you still in this field? Kyasi

Ventmommy, I am so very sorry! Your son may have had a rough beginning but he had a very loving end. You have been my favorite homecare Mom and I've never met you. God bless you and comfort you at this time. Kyasi

Because that was how the agency I worked for wanted us to chart. We were to begin with 'On Duty' and end with 'Off duty'.

I always started with, "On duty, report received from Dad. Child is asleep with Pediasure feeding infusing at 100cc/hr/pump via GB. Assessment completed, vent check done." I did not repeat my assessment in my narrative because it is already on my assessment sheet along w/vital signs. I know from our state audits that the condition the patient was in when you arrived and when you left is very important and also who you reported off to. I always spelled out exactly how I left my patient. "Client is secured in w/c watching a video, smiling and in no apparent distress. Pediasure feeding infusing at 100cc/hr/pump/GB. Tvent on over trach, respirations are regular/nonlabored, biox 94%, diaper dry. Report given to Mom, off duty. I also made sure I had a head to toe assessment done just prior to my leaving.

Unreal! Between myself and my office nurses, we read all documentation before it's put into the charts. I wouldn't want to be in those supervisor's shoes when they have a state audit because the auditors do read it all!

The advisory board meeting isn't for several months. I did talk to my clinical director and they all agree that befriending a patient is against our code of ethics. But getting employees to comply is a totally different issue. If they password protect their accounts, nobody will ever know.

If this nurse worked for me she would be rewriting her charting to make it patient focused. I'm the one who has to face the state auditor when they come and there is no way that I would allow this kind of charting to remain in a client's chart. If a nurse has a problem with the care being given, a patient chart is not the appropriate place for her to vent. If she did it again, she'd receive a disciplinary write up. What she wrote is totally inappropriate and I would hope a supervisor would be reading the charting whether you gave her a heads up or not.

Oh, got you. Thanks for clarifying Ms Bee.

Just to emphasize, I no longer take care of this child or work for the agency that handles her case and have not for over 6 yrs. So any relationship I now have with mom is completely outside of any policy/agency constraints. She does live in another city but we do try to get together once a year or so. I never socialized or went anywhere with her during the many years I was employed and her child was my patient. So I'm not sure where the huge liability is?? Also, to clarify, I made sure the clinical director of the agency was aware of the issues in the home and although I was supportive of her mother, if I thought the patient was being neglected in any way during her crisis, I would have reported that.

It's a fine line. I took care of one child from the time she was born until about age 8. That was the case I was referring to when I mentioned transporting the child. One nurse on that case often took the child for weekends at her own home and transported her. (12 hr shift paid for by the agency, 12 hr at night unpaid) Can you imagine the liability if something had happened to that child in transport or at her home off the clock? The relationship I had w/ the mom was a friendship although we didn't hang out together. I was a support person to her when her marriage failed. One day I came to the home for my shift and found the mother w/ the divorce papers that had been served hours earlier, clutched in her hands, and she was crumbled on the floor in a catatonic state. Her daughter was crying and needed a diaper change. So I tended to my patient first, calmed her down, started a feeding and then put my arms around her mother and let her sob in my arms. I couldn't not help her in her time of need. Was it crossing the line? Maybe. I considered that in helping mom, I was indirectly helping my patient also. But despite how well we knew each other, she knew I'd never not follow the agencies policies in the care I provided for her daughter and she never asked me to. I don't work for the agency anymore and I'm still a friend of the mother. She is in a different town and we meet for dinner occasionally, and she is my Facebook friend. Someday, when I don't work full time or when I retire, I intend to care for her daughter, so mom and her husband (they worked it out and got back together) can go on their first ever vacation. But now I can do it without compromising my professional standards. As I said, it's a fine line and there are no easy answers.

I posted a question about this a month or so ago to get everyone's opinion. I have found out that lots of my HHA's have friended their patients on F.B. (most of them don't have privacy settings on their accounts) We have a Code of Ethics that states that a caregiver will not share personal information, religious/political views, personal problems etc with their patient. All this is shared on F.B. and more (sexual preference?) Our Code of Ethics was written before F.B. was popular so doesn't expressly refer to that. My feeling is that it is crossing professional boundaries in every way. Ventmommy, the nurse you friended is no longer working for you, so I don't think that is a problem. I did PD nursing for 20 yrs and I understand the relationship that develops w/the families. It's difficult to keep that line from being blurred but you really have to. Every time you allow that line to move back, the professional relationship is compromised and eventually someone, the patient or caregiver, gets uncomfortable with it. I see this all the time. There were things that I knew other nurses would do on one case I was on. (ex: transporting the patient from a grandparents house to her house (while the mother was gone) I just wouldn't break policy no matter how close of a relationship I had with the parent... no way, no how. Always error on the side of caution. Kyasi

Our agency does not allow 'dead weight lifts'. We insist on a hoyer even if the nurse feels able/competent to do the lift. We have paid out way too much for workman's comp claims and it's just not safe for the patient. Always protect your back. Kyasi

I agree, not to send your condolences after you were caring for the child and were in the family home for so long way seem like you are trying to hide something. A simple 'sorry for your loss' card will only show you cared. You said you worked the 2 nights before this happened. Was the child asleep the entire time you were on duty? If so, it would be difficult to place any blame on you. Also, it would be hard for you to assess lethargy/level of consciousness on a sleeping patient. And unless you checked pupils before she went to sleep and this was done routinely, you wouldn't have picked up on a problem there. I would guess if they are looking to blame someone, those who were around when she was awake should be more concerned. Just my opinion. It's a sad and I'm sure a very stressful situation for you though. I'm sorry you are going through this. Kyasi

Our agency's Code of Ethics clearly states that no employee will reside in a client's home. End of story. These rules are made for a reason. My last few weeks at work have been consumed with the end results of the things that happen when an employee decides to not follow these professional guidelines. (Online state incident reports, APS referrals, reporting employees to the Licensing Board, write-ups, and a few terminations) It gets very ugly. Just when I think I've seen it all, something new happens to totally astound me. Some 'professionals' are sitting on their brains. Can you tell I've had a bad day?? Kyasi

You may want to check to see if there is a weekend requirement. You may not have an option of saying you don't want to work weekends. Each agency is different in regards to their requirements, so don't sign on the dotted like until you have all the information you need to make an informed decision. For the most part though, home care is very flexible which is why I've been doing it for so long. In my case, I chose less pay for flexibility and I've never been sorry. For a very long time, I worked 3-13 hr shifts/wk on M,Tu, W and had a 4 day weekend. When I wanted to take a vacation I worked Su, M, T and went on vacation Wed-->Wed and worked Th, F, Sa the following week. I didn't have to even use my vacation pay most of the time. Loved it! Kyasi

Congratulations on the baby and best wishes. Enjoy every minute you are home with that new baby. I hope you return with your batteries recharged!

Just my 2 cents... Don't ever think you aren't learning and gaining valuable people skills because you are on the same case for a long time. I had several cases with longevity. (9 yrs on 2 cases I did at the same time and 13 yrs on another) There was drama, dysfunction, and lots of BS to put up with. I used to think I'd stagnate and die doing the same thing forever. Those long years paid off in my being qualified for the job I now have and never thought I'd ever do. (in management) I never realized how dealing with all that would prepare me for what I now do. So don't shortchange yourself. You are learning tact, diplomacy, how to maintain professional boundaries despite the dysfunction you are dealing with. Plus, you probably know that patient like the back of your hand and are using and honing your assessment skills without even realizing it. So hang in there... you will know when the right opportunity presents itself and it's time to make a change. And when you do, you will be ready for it. But don't just make a change just for the sake of change. Do it when it's a step up to something better. Kyasi

Getting them to update/change a policy is not easily done. I'm just now making 'the powers that be' aware that this is an issue. My immediate boss isn't familiar with Facebook so she doesn't even understand the extent of what people share there. I plan to bring it up at our next Advisory Board meeting when all the people who can bring about this change will be there. In the meantime, I just wondered if anyone else is having an issue with this.