redfoxglove

I tried to "reply" to a comment but it comes out as a new comment...stupid

Just following up since something came in my email from this thread. Above comments are right on: organization is key, having a system for keeping track of your to-do and done. Also, a key part of what you learn in the first year is what is the priority for the home health service. In other words, what are you going to do for THIS patient? You do not have to address every single comorbidity in your first cert. We have a meeting with all staff every week, and I pick the brains of the more experienced nurses on priorities. I think a key factor for the whole of nursing is us nurses need to set clear boundaries and stop overdoing. We need to speak up about the work load. I have begun doing so. There is definitely a way to get all the work done during the shift. I am getting closer. It takes practice. Keep trying!

Let's be clear, home health is not private duty nursing. I can only speak to home health. The admitting nurse meets with the patient and/or family at SOC, and there is no "good fit" discussion, it's either the patient wants our services or does not. Our agency covers a large rural 2 county area. Our average daily drive is around 100 miles. I am "PRN" that is, I get paid per visit. Our agency has 2 full timers and 3 PRN. If the visit time is extended or there are complications in getting orders, or other case management time requirements, I can charge some indirect time. The nursing skills in our demographic are repetitive: blood draw, catheter insertion, wound care, O&A, teaching, med rec. Home health is not for everyone. It is challenging, can be frustrating, and is not an easy stroll down the garden path. But, I like it.

I work in home health, not private duty. I see several patients in a day. Our agency requires us to carry various things and have a clean and dirty side. I don't have a favorite bag yet, though I do have one from Hopkins (I think). It's the best I've found so far but leaves a lot to be desired, mostly because by itself it weighs quite a bit. In my trunk I have a 3 drawer organizer to keep all the extra stuff. Into the home I carry this nursing bag, and we are required to put down a paper barrier, not set the bag down unless it has a barrier under it. I have looked at some diaper bags but they seem pretty flimsy and I don't care for the cutesy design fabrics either, though some "dad" type diaper bags looked ok. Sigh. Let me know if you find the most excellent nursing bag ever! Oh yeah, scrubs definitely, especially for wound care patients and also because people's homes are not that clean sometimes. Also, I don't want to associate my regular clothes with nursing. When I take off the scrubs it sets a limit for me. Work is over with for now.

WOW cool idea, fishing stool, I am going to look into it. In many of the homes I visit there is no good place to sit down or it is filthy. Thanks for this idea!

Agree with Kel above. Don't give the patients so much of a range. Give the patient a choice, morning or afternoon? 8 am to 10 am or 10 am to noon? In our agency RN sees the patient every 2 weeks if they have wound, a bath aide, or something complicated. Otherwise LPNs do the weekly care. We increase communication via email, a bimonthly meeting with the DON, and a weekly all staff meeting. It's still not a perfect world, but we work at it.

Here's my perspective, after one year of working in home health. I was a new grad just 2 years ago, spent my first year in a nursing home. When we graduated the eight positions open in our rural hospital were given to the young grads in their 20s. Us more mature grads got jobs in other than the hospital. After a year in the nursing home, my DON took a chance to hire an inexperienced nurse into home health. I have had a steep learning curve. Her famous phrase is, no matter what your background, no matter how much experience you have, it takes 3 years to grow a good home health nurse. I spend an average of 1.5 hours in the patient home doing SOC, ROC, and recerts. In that time I am able to get through the entire assessment tool. It takes 90 minutes to do the clinical note, phoning the doctor, completing the orders, and other followups. If you were an excellent hospital nurse does not guarantee easy street in home health. The challenges are there. It is not transitioning to an easier job. It takes about a year to get comfortable just with the basics. Then it's going to be another 2 years before you are really good at it. That's what my DON teaches, and so far as I can tell, her version is accurate. What people love about home health, that I can tell, is you have more autonomy. Which means you have more responsibility. The big challenge with home health is that it is largely funded by Medicare and Medicaid. So the agencies have smaller profit margins. So there is more demand on the field clinicians to produce. I am not a salaried full time nurse, but a part time nurse. The salaried ones, as far as I can tell, are very stressed about the workload and appear to me to be expected to do 1.5 jobs. Maybe that's throughout nursing. My work schedule is Fri-Mon, so 4 days, and I am pretty worn out at the end of those 4 days. Another challenge with home health is that due to changes in politics, more budget cuts are going to be made very soon. How is that going to affect the employing agencies? Unknown at this time. Bottom line, don't get into home health thinking it's a free ride or an easy job. It is not.

Thanks, Lynn. Yes, I've looked at two that advertise on this site. One is either onsite or online training, with required (recommended) reading from about 8 books. After taking the 5 days of hands on training, you sit for the exam. The cost is around $3500 plus the fee for testing. Another one is just online and does not require/recommend reading from various current textbooks and such as listed in the above option, and does not appear to require hands on clinical. It also does not require sitting for a test. I don't know what the cost is because after i realized there is no certification test, I lost interest. Hoping that someone out there in the webiverse has some actual experience with a cert program for ADN-RNs (who are in the numerical majority at this time). We ADN-RNs are on the front lines of wound care in the community. I see a lot of wounds in home health. Saw a lot of them in long term care. So far the most credentialed person I've encountered was an RN who was the rep for the wound care supply company.

I am 56 years old next month. I graduated from nursing school in June 2011. It was the most difficult challenge I've ever faced, but so worth it. Not only do I make a nice income, but I grew as a person through the process of nursing school. Just don't fall for all the high minded propaganda they feed you with at nursing school. It's gritty work. To get a job, go to the local employment office and take advantage of the awesome services they offer to write your resume and practice interviewing techniques. Put yourself ahead of the crowd by investing in these tools of getting hired. Good luck, stay strong, make up your mind to do it and just go for it. Seriously, 32 years of age not too old for anything!

Hello nurses, Anyone have any experience with wound certification training for RN with Associate's Degree? That is, not a Bachelor's in Nursing? I see a couple advertised on alllnurses site. Looked into a couple. One requires a certification exam, another is just online self paced and no exam. They require a considerable investment. Anyone here who has pursued this avenue and has comments to share? Thanks

Laughing out loud! Of course, pressure ulcer, not decubitus. I must not have been fully awake!

Thanks for your comments, ladies. I've been thinking about it, and I am going to seek more clarification tomorrow. I am sure that certain decubiti have extensive damage to the nerves and are not painful. However, when the skin over a Stage II (closed) looks like small blisters and is opening again, I don't think it's accurate to say it is a skin tear. I think it is a Stage II (formerly closed) that is reactivated. The skin, in that case, may sting when cleansing agents are applied. That does not make this lesion a skin tear. It is a reactivating Stage II. If there is no history of a Stage II there, open skin over the ischial tuberosities may be a skin tear, simply. Or, it might be the first sign of a decubitus over the tuberosity. I think the preceptor may have hastily interpreted some information that had been passed to her by the team leader. It's worth more clarification. All this to say, I noticed on this website a certification course for RNs who are not BSNs. I think I will look into it. Thanks again.

While doing field orientation for home health, my preceptor quoted our team leader as follows: When the skin opens over an old, formerly closed, Stage II decubitus, the defining factor as to whether it is defined as a skin tear is if it stings when cleansing solution is applied. According to the preceptor, a skin tear will sting and a decubitus will not. I am only out of school for a year, but to me, this sounds arbitrary and inaccurate. To my recall, the most current evaluation criteria of decubiti is, they are never reverse staged. Once a lesion, always a lesion, and it is either closed or open. I have never heard of the "stings or not stings" discriminator. Comments?

Steeleworks, thanks to your prompting in one of these columns, I went back to my old copy of Your Body's Many Cries for Water by Dr. Batman. Over 3 weeks I have healed the edema in my legs and feet. Now noticing edema receding around my eyes and face. Also have dropped 6 pounds. Oh yes, I did stop taking the hydrochlorothiazide too. So I am my first patient in this water cure. Yes, I totally agree on your comments about massage therapy. Not every massage therapist has a holistic approach. Many massage therapists do the same as nurses -- they give, and give, and give some more without ever giving to themselves first. Not to be too religious, but Master Jesus told us to love one another as you love yourself. What could that possibly mean, if you don't love yourself? Self care is the prime directive! For me, I find out if the practitioner I'm thinking about engaging with does their own self care. If not, it's just more of the same old, same old, Do as I say, not as I do. Doesn't work for me, either! Such good results you have achieved on dropping the unneeded poundage! I had a similar experience, after "gestational diabetes" at the age of 40, my weight went up from 160 to 250+. I stopped counting after 252. Made various changes in eating pattern and activity level (an ongoing art and science) and have dropped down below 200. Now I am experimenting with the water cure and adding minerals. Also looking at acid/alkaline diet. I think I will contine to see poundage transformed into energy for current projects. Oh yes, I will be teaching these things as I go. I am intrigued by your specific suggestions as to the use of salt, something that Dr. Batman (and other authors) are vague about. Namaste

Steeleworks, you are an inspiration. I've commented on this subject in another thread somewhere in this specialty section. Just to add to the conversation here, I'd like to introduce myself. I'm a licensed massage therapist since 1993, an RN since 2011. My holistic health practice has been in effect since my initial licensure, and now I'm incorporating my nursing training to provide an expanded scope of practice. I could not agree more with Steeleworks' opinion that nursing is far from a holistic practice in the mainstream. However, I believe that many nurses have a holistic heart. My encouragement and support goes out to any nurse who is being called into the holistic health circle. One perspective I would like to offer here is to ask each one to meditate on exactly what do you mean by "holistic"? And in doing so, there is one more question to ask: are you applying to yourself the principles that you wish to teach others? In other words, are you the first patient or client in your own practice? We have studies to show that as a group, nurses are at the top of th list in terms of ill health. What are we doing about that? Now in the way of encouragement, I will offer this: to be called into a holistic practice is a gift from the Universe. If you follow that calling, and apply to yourself first, the things that you learn, you will be blessed in ways that you can't really imagine right now. In doing so, the circle of holistic health will continue to expand, until everyone stands in the circle with hands joined. Resources for interested seekers, check out the website for: American Massage Therapy Association (includes online courses, e.g. "when medications contraindicate massage" or something like that) American Holistic Nurses Association (includes online course links, also has student or recent grad membership rate) National Association of Nurse Massage Therapists (some online courses, a handbook for nursing documentation) National Certification Board for Therapeutic Massage and Bodywork Jin Shin Do Bodymind Acupressure Foundation A suggested way to get started: source out a "holistic practitioner" of some variety in your local community and book an appointment. Naturopath, chiropractor, reflexologist, acupuncturist, acupressurist, bodyworker, qi kung, iridologist, herbalist, etc. etc. See what the Universe provides for you in the way of inspiration and guidance. In other words, get out of your head and into your bodymind. Just do it! Start where you are. Namaste.