MyUserName,RN

Thanks everyone for your helpful advice! I do appreciate it!

I hope somebody can give me some advice. I have 2 years of experience on a med/surg/tele floor and now have 2 years of experience in home healthcare. I have always had an interest in postpartum/mother-baby nursing. I just got into medical because that's where the road took me and I also wanted to have that experience before specializing. I have tried out home healthcare and have enjoyed many parts about it, but now I'm ready for a change. I've been thinking more and more about going into mother/baby. I really want to try to get onto a unit, but I'm worried that because of my lack of experience in that area that I wouldn't be considered as a candidate. Is there anything that any of you recommend I can do to make myself stand out? Classes I can take? What to put on my resume that this specialty would like to see? Is there anyone out there who also made this kind of transition? And if so, how have you liked the change. What do you like or don't like about mother-baby vs med/surg, etc.

YES! I have sent so many patients to the ER only of them to be admitted to the ICU. Very sick. I could not have done home health without my med/surg experience. You just have to have that nursing knowledge that only experience can give you.

So I thought I'd revive this thread again. I'm thinking of leaving my home health job. I've been doing it for almost 2 years now. Have really loved home health, but the charting, the never being "off" work feeling, I feel like I'm working so much that even though I'm making a lot more money than I did in the hospital, I think if I broke it down hourly, I'd be making a pretty low amount. I was very burnt out on working on the floor at the hospital and thought I'd never want to go back to that again. But it was my first hospital job. I never tried any other floors or any other hospitals. The things I miss about the hospital are working 3 12's and being off 4, when you're off, you're off. I feel like I had more free time for my family......so here's my day yesterday. I wasn't on my "A" game yesterday that's for sure, but here goes... Dropped my kids off at the baby sitters house at 745. Went to the coffee shop to connect to the internet and get caught up on some charting from the day before. Charted, ordered supplies, made calls to dr's, adjusted my schedule, called patients, calls to office etc, until 1130. (Working, but not getting paid for this time). Saw my first patient at 12pm....did not want to start this late, but had to get that stuff done. This visit was very involved, lots of wound care, picc line dressing change, calls made to MD. Spent an hour in home and didn't get any of pts charting done. Routine visit. Drove to next visit, was an admit, got to house, realized that I didn't have consent paperwork....great. Had to drive to the office to pick up paperwork before I could made SOC visit, this was 40 min out of my time. Called patients home, let them know I'd be late, they said fine...Drove back to patients home, arrive to do SOC, patient very HOH, very agitated, said he didn't want home health, refused my services.....Okay, so I just wasted at least an hour, maybe more of my day, for a SOC that I don't get paid for. On to the next house, this patient never answered the phone today, so I just showed up. She wasn't expecting me, but let me in anyways. Just a routine/sup visit, checked on meds, made sure she was taking the right coumadin dose that had recently changed, instructed on bleeding precautions. Everything was good with her and I was on my way. Still didn't get any of her charting done because I was in such a hurry to get to the next patient, by this time, I'm behind on time. It's about 3pm at this point. So I drive to my next house, routine/supervision visit with wound care. I arrive at home, nock and nock, nobody answers. Soon realize I'm at the wrong house. Lol! Go to the right house. Open my trunk and realize, I don't have my nursing bag!!! What!? I left it at the last house I was at....OMG! I have never done that before. Seriously, what else can go wrong with this day?! Drive back to the last house, pick up bag, go back to patients house and complete the visit....now it is 4pm. I called the next patient who hasn't answered the phone all day. Finally, somebody picks up. They inform me that patient has moved out of state with another family member and they don't know when patient will be back. Okay, so that's a non visit discharge....put that off till later. So I looked at the next days schedule to see if anyone else can be seen today. Move a patient over, go see her, take care of business with her. Day is over....except that I'm on call tonight and have an IV SOC that has to be done no earlier than 945pm. So I go to baby sitters house, see the kids for a little while, eat dinner, and then head out to the SOC that is about an hour away. Do the SOC, admin the IV, teach family how to do. Charting put off until tomorrow. Get home about 11 pm, kids stayed the night at baby sitters house since it was so late and had to drop them off early in am anyways. So that's my day yesterday. Oh and I stepped in dog poop. I didn't eat lunch, didn't stop to go pee and was busy all day long. It was a great day. (Sarcasm!) So looking back, I was working from about 830am to 11pm with a 2 hour break in between the night visit. So I worked for about 13 hours, still have tons of charting to do from yesterday, which will take me who knows how many hours to complete, but only got paid for 4 routine visits and a SOC. Now when I break that down.....the money is not very good. I know not every day is like that, but, it seems lately, I'm having more days like that than not. It's like a downward spiral, if one day is bad and you are behind on charting, the whole rest of the week follows suit. Anyways, as much as I love a lot of things about home health. I miss my kids. I hate being home and having to shew them away all the time because I'm trying to get charting done. Sorry for such a negative post. I just needed to vent.

I have been working as an RN case manager in home health for almost two years now. I'll preface this by saying I love almost everything about this job. Except for......the hours I spend on charting!! I know this is the unfortunate part of home health care, but I feel like there has to be a better way to do things than I have been doing them. Are there any of you out there who are able to do this job well, get your charting work done during the day, and not spend hours and hours each night and weekend away from family time because you are catching up on the never ending charting? This has been my life. It's starting to drag me down badly. So much so that I've considered going back to the hospital and that's something I never thought I would ever consider again. Please, if any of you home health nurses have mastered the skill of documentation and time management so that you still have a life, please, please, please let me know your secret! How do you usually organize your day, etc? I've heard some people say chart everything in the home, but honestly that doesn't seem realistic to me, especially for OASIS visits. Thanks in advance! I hope this post gets some answers!:)

I'm very happy to be a nurse. Have I had times that I felt like I might have made the wrong decision? Yes. Have I experienced burn out? Yes. Have I been so frustrated with healthcare admin in the hospital that makes being a nurse so hard sometimes? Yes. But I still am happy being a nurse. Because aside from all of those things that make nursing difficult and frustrating, ultimately, I love what I am able to do for my patients. That is why I became a nurse and that is why I will always be a nurse. I left hospital nursing after two years and my happiness with being a nurse came back after I left that environment. I am in home health care now and it's great. It has it's own challenges and frustrations, as every job does, but I am overall very happy to be a nurse to my patients and that's what counts.

Boy were you wrong! I went from a very hectic telemetry floor to home health care last September. Upon leaving my hospital job, I received comments that I would be bored or would lose my skills in home health care. Obviously, these comments were from nurses who have only worked in the hospital setting. I have learned so much more as a nurse in these past 8 months. I can honestly say that I love being a nurse now, especially a home health nurse. Yes, it is a lot of work at times, the first 6 months were up and down as I was learning the new charting and all the new rules and "ins and outs" of home health care. It can be stressful, but nowhere near as stressful or as soul crushing as working on the floor. I love the relationships I build with my patients, the teaching, the focus on the whole patient and not just making sure meds are passed in time and all of the other craziness that you have to put up with during a typical day on the floor. Plus, instead of losing skills, I have actually GAINED a whole lot of skills. First and foremost, your assessment skills really have to be top notch. Many times, you are the first line of triage. If somebody is having a problem, you have to be the one to catch it and respond in the appropriate manner, either calling the dr to get new meds ordered or knowing when it's appropriate to send the patient to the ER. Mainly, the focus is catching problems to fix them before somebody is so bad off that the must go to the ER. Next are all of the actual technical skills you might do in home health: Lab draws, foleys/suprapubic caths, ostomy's, patients on critical drips such as dobutamine, chest tube drainage/maintenance/teaching, specialized wound care/wound vacs...you really learn a lot more about wound care, diabetic and vascular ulcers and management, pressure ulcers, etc. Not only are you doing all of this wound care, but many times, you are the one to decide what kind of wound care a patient needs and makes the recommendations to the dr's...and more skills than I have listed. I can honestly say that I am never bored and have gained more skills than I did in the hospital and overall have become a better nurse and actually feel like a real professional part of the healthcare team. I think home health nurses have a bad rap for some reason and just don't really get the respect they deserve. Anyways, I just wanted to put this out there to nurses who might be wondering what home health is really like. **Edited to say that I'm not putting down working on the floor, I would not be the nurse that I am today if it wasn't for that floor experience. That experience has been invaluable to my success as a home health nurse. I do not think I would be able to do this if I hadn't already had that hospital experience.**

Maybe you should take your own advise hun. :) I asked what the difference was between CM in HH and in the hospital. I didn't ask how easy or hard HH is or to be told to lighten up when I wasn't even offended and all you could add to this conversation is that HH is not easy. You haven't added anything useful to this conversation, thanks anyways though. Have a good one!

MomRN, would you mind sharing your cheat sheet? I'm just starting HH and the charting is all electronic, but I'm thinking it will still be difficult to go through all the documentation in the pts home and I'm worried about forgetting something. Thanks!

Certain things burn if not diluted.

I dilute almost everything. It's just easier all around IMO and better for the pt too.

Thanks everyone for the helpful information and the positive outlook on case management. No this is not a home work assignment. I'm not in school presently. Just interested in what my future career opportunities may be. Thanks again everyone! :)

I knew exactly what you meant. I don't expect HH to be easy at all. Floor nursing wasn't easy either and if somebody made a comment like you did about it being an easy way to get started as a new nurse, I wouldn't take it as if working the floor was "easy". I think it's good not to be too sensitive about peoples word choices. Thanks for your info on HH and case management. :)

I read a book, it was titled something like, test taking techniques for beginning nursing students. I felt that it helped to prepare me for the nclex style tests that I was taking once nursing school started.

Nursing is hard work. I do not regret becoming a nurse though. I have been a nurse for 2 years now on a medsurg/tele floor and it is hard and there are days that I wonder why I chose to do this. Those are on bad days. I've learned so much on the floor that I am on and do enjoy being a nurse. But to say that it's always butterflies and rainbows and fulfilling would be lying to you. If you go into it with a realistic view ahead of you, you won't be as disappointed when you are in the real world after nursing school. Will it be tough? Yes. Will there be days that you feel defeated and beyond frustrated with all the demands? Most likely. Will there possibly be tough coworkers? Maybe. (But they can be in any profession) I've been lucky to have a wonderful team of coworkers which makes the day go by easier when you are in the trenches. The best thing I love most about nursing? There are so many different doors and opportunities. If you don't like one area, you have a multitude of options to expand and grow and do something new. I'm moving to home health soon and considering one day going into case management or utilization review which requires no direct patient care and will be good for me once I get older I think. You can specialize in anything, go into management/administration, case management, quality control, research, informatics/IS, sales. So many other options. If it's what you want to do, go for it. I came here before nursing school and during nursing school and also got very frustrated by the constant negativity about my chosen career, but now that I've been through it, I understand it, and mainly it's just a big vent session anyways. You probably will to. Good luck in school and for the future!