SWRN84

Agree with everyone else. Definitely not homebound and no skill. We would not admit this patient.

I graduated from Mo Bapt in 1984. I have been in home care since 1987 and have often thought of taking the refresher course the institue offers, to try to get back into hospital nursing. Glad to hear you are doing so well. Do you think the refresher at the nursing institute will prepare you adequately to work back on a unit?

mrob.....where are you taking your refresher course? How long have you been away from acute care nursing?

I have been working in home health for 20 years now. Over the years, I have seen the pay scale/type change back and forth. I worked 5 years for a hospital based agency, but the remainder has been with an independent privately owned for-profit agency. Prior to PPS, the nurses were all paid hourly. When PPS came into existence, our agency made a total change and all visiting staff were made per visit....mileage was cut. This lasted a few years. Now we no longer have per visit case managers....the only staff who are per visit are the contract staff, or prn staff. We have some nurses who are paid hourly, and some who are salary....just depends on their situation, hours worked, etc. The home health industry is ever changing and some agencies have to make changes in order to stay in business. I don't think you can generalize where every agency is headed, but I do think every agency is different.....much depends on owner status, independent vs. hospital-based, for profit, or not. Your best bet would be to investigate fully in each agency you are interested in. What are their expectations in relation to the type of pay they offer, etc. I have worked salary, per visit, and hourly....benefits and problems are associated with each type of pay. It all depends on what you need, what you are willing to do, and what you want to get out of your position, not only with pay, but with job satisfaction associated with it. I have not worked in the acute setting in a very long time, so I don't have anything to compare it to as far as money.....just from what I have read, home care pay is lower than acute care. But the rewards are many! And I live in the midwest, so our pay scale would be different than Florida I'm sure. Hopefully, someone from the Florida area can give you some advice on what the average pay scale for home care is in your area. Good luck.

As of March 16, approx 4700 home care agencies registered to participate in this initiative. I am responsible for some of the QI implementation in our agency, including outcomes. I registered the first day. The first implementation package was sent in March....it has to do with hospital risk assessments. We already have in place many of the best practices they will be dealing with, but I am hopeful we may gain an increase knowledge, or maybe just be able to tweak our processes a bit. Our goal is to make our outcomes for ACH even better. We shall see.....it surely can't hurt and doesn't cost a thing.

We have always flushed ports once monthly if they aren't being used. They may last longer than that without flushing, but in the 20 years I have been doing home health, both agencies' policies have been monthly flushes for those ports that aren't being accessed on a routine basis.

I worked for Intellicare in the disease management division.....I trained in the St. Louis call center. I worked for 2 weeks in the call center then went remote at home. At the time I was told the triage nurses stayed working in the call center until they met the time metrics. So not sure if I can help you with the triage part of it.

23 years ago I started as an RN at $7.77/hr in a small rural ICU in Missouri.

What state do you have your license in?

Yep Christine, I do know exactly where you are. I was over in Warrenton just the other day. I was doing home health visits and worked my schedule to end up there so I could make a visit to the outlet mall. Didn't find what I was looking for, but I still like going there once in awhile!

I have been working in home care for 19 years....staff nurse, case manager, supervisor, now am working prn 4 days per week. Home health is a great place for a nurse to really develop different skills and is truly what nursing is all about. Your patients generally love you and rely on your visits and teaching. The pros are as mentioned: one on one care, developing close relationships with your patients and families, feeling like you really do make a difference. Cons: on call...weekends can be hairy depending on the size of your agency and how many nurses take call at one time; paperwork....very much paperwork which can be overwhelming to learn and incorporate into your daily care of patients. You have to be able to utilize your thinking skills, have great assessment skills, and also be able to perform independently. Many patients come home sicker....we see everything.....you will have post surgery patients requiring dressing changes/staple/suture removal.....blood draws, port/central line access, tube feedings, vent patients, iv infusions/pca infusions....just about anything you can think of and have to learn to manage those independently. There is much teaching involved in home care and you have to involve caregivers as much as possible to try and get these patients back as independent as possible. It's a whole different type of nursing, and I do believe you either love it or hate it....there's usually not a whole lot of in between, but like any other nursing position, it takes a good year to feel comfortable.

We use INRatio fingerstick machines for most of our patients in home health. We started using them a few months ago. Prior to that, though, I have occasionally had a patient where the blood would not entirely fill the tube to the line it was supposed to. In that case, the lab told us we could use pediatric blue top tubes for those INR's. Do you have access to a fingerstick protime machine in your agency? If so, I would definitely get an okay from the physician to go ahead and do it that way. It would save you a lot of hassle and the pt a lot of sticks. So far we have had very few problems with inaccurate results. The physicians we work with have basically said use one or the other...either fingerstick or venipuncture...but do not alternate between the two.

I live in Lincoln County....approx 1 hour north of St. Louis. RN since 1984.....most of my time has been spent in home care....now I'm at the "I don't know what I want to be when I grow up" stage....still in home care and needing a change I think. Born and raised in Missouri.....have never lived in another state. I've always thought it would be nice to live somewhere else for awhile....but I do love the change of seasons here. The weather this week is heavenly!

I think it depends on how your assessment skills are....what type of nursing you did prior to leaving to raise your kids. If you are confident in your nursing assessment skills, that's half of it. You have to be autonomous, use critical thinking skills.....good nursing judgement. If you have all that, plus a lengthy orientation, you should do okay. You cannot learn home care quickly in my opinion. I would say it takes about 6 months of steady working to feel somewhat comfortable in home care, and at least a year before you start to feel confident. As far as flexibility...it all depends on the agency you work for...and if you are a case manager or prn nurse. I worked as a case manager throughout the entire time my kids were babies and small children. It's flexible but you still have to take call, work some weekends, and some holidays, but it's totally different than working in a hospital environment. The flexibility all depends on the agency and how they work.

We also use the machines where you collect in capillary tubes after the fingerstick. We use a machine called INRatio. I have been lucky this week....2 days in a row I was able to get orders right at the patient's home.....that doesn't happen too often. I know what you mean about nurses fighting over machines! We only have 2 in our agency so far and it's a circus sometimes. They say whenever the time comes for us to order new strips we will also get another machine. Can't wait for that!