pblottRN

There are lots of great CE programs out there that would be amazing for newbie HH nurses to have, including advanced physical assessment, all types of pumps and interal/parenteral therapies, any type of specialty you'd see yourself doing (can go for certs in psych, onco, peds, etc and one HUGE area for HH now and forthgoing will be coding in the homecare arena. Ever changing and different from any other setting.) The one certification I like to see is a certified OASIS nurse, but you will HAVE to have experience with the OASIS assessment to get this. Coding and OASIS are both bears, because there's so much room for interpretation. But the above would be my advice for a newbie. Get some CE's under your belt that will make YOU most confident in the field, then work toward one of those two, if not both. WOC is also a great certification and will allow you to specialize/garner more money, but again, it's very indepth certification and requires a good bit of experience.

Our agency is paid per visit and mileage generally starts at the first patient's home, unless the nurse/therapist starts from the office. Rates vary, and should be competitive with your area. Get your boss to do a salary study (or the company's HR dept) and set a scale from there. We pay a little more for weekend/holiday and after hours visits. Drive time and documentation time is included in the visit rate. The admission visits pay substantially more and are weighted at an equivalent of 2 visits, when figuring efficiencies. Recerts are 1.5. Post hospitals are 1.5. We also have multiple skill/extended visits for high tech/lengthy visits. If you are the only RN, then you will likely be the one doing the coding, and it is different for home care than any other area. There are great coding books strictly for homecare and software packages that will check OASIS for discrepancies/errors, etc. We use PPS+ software for that side of it. For the coding side, get some courses lined up quick. I've been doing this a long time, and the guidelines change frequently. Please feel free to message me if there's anything I can help with.

I've been a home care admin for about 17 years now, and I can tell you that my BEST nurses are usually ones who have had either good, fast paced gen med-surg experience or a great telemetry experience. The biggest thing is that you need to be very capable and confident in your assessment skills and communication with MD's. You are their eyes and ears and they have to trust you, so you have to trust yourself. I've seen so many new nurses want to start out in homecare and get so overwhelmed and burned out. There is a lot of paperwork, even computerized. And you HAVE to make them give you a great orientation. Don't let them "turn you loose" too soon, no matter how aggravating it may seem at the time. As I've said, I've been doing this a long time, and we still run across new things every day that we have to talk through. The nurses I have the most respect for are the ones who know that they aren't sure and will ask. Simple as that....if you are not sure, pick up the phone and ask. Don't let anyone tell you that homecare isn't "really" nursing. We do everything except surgery, pretty much, in the home nowadays, and we are truly one on one with the patient and their loved ones. To me, this is nursing at it's finest and I've left it a couple of times, but always find my way back for that very reason. Best of luck to you!

Outpatient mental health facilities are extremely recovery friendly and also allow for a LOT more, continued personal growth. Good luck, and keep on keeping on!!!!

All I can really add to this is, the sheer look of relief on the face of our neurosurgeon when he was explaining that our son had failed his apnea testing miserably (still had great upper brain function, but had multiple midbrain and stem strokes; locked in) when I stopped him and said "Well, I need to let you know that he had chosen to be an organ donor and I guess we need to start making those preparations." was unreal. He was so relieved. I know that he thought he was looking at a very healthy 17 year old young man/athlete who was locked in and hoping and praying that we didn't decide to prolong that. I had already refused a feeding tube the day before because I knew what we were looking at and didn't intend to have the issues with removing nutrition. Because of the upper brain activity, the neurosurgeon took the step of resorting to an old but still recognized apnea test to determine brain death, taking those decisions essentially off our shoulders. The folks who came in to start all the testing and prep work were evidently not accustomed to dealing with family members who wanted to remain close to their loved one. The family liason who has been put in place was wonderful, but still very obviously grieving her own daughter's death. I guess what I'm getting at it, from the "other side of the bed", please make sure that you really want and can deal with the intense emotions surrounding these situations and remain sensitive. Had my son not already made his wishes clear (and I believe that is because we've always been very honest and open about even the painful conversations in our family, and I am SOOOOO very thankful for that!) I can see where this would have been an unbearable time for us. Had I not been a nurse with an understanding of what was going on, I would have seen my family completely lost and confused. Had I not begged for sedation for him, the team would've not paid attention to the fact he was locked in, and thought I was insane when I asked for propofol and versed. They gave it, but I had to explain the situation to them. I, in no way, envy them at all. I admire the work they do. I am thankful for the transplant coordinators who've worked hard to connect my family with Alex's organ recipients. I just see a whole lot of room for improvement. I realize that there has to be emotional removal and compartmentalizing to just survive. I do understand that. But now that I've been on the "other side of the bed", I see so many things so differently. Just my thoughts....

But then again, our other vehicle has a "Bronze Star" tag on it. My hubby earned that bronze star in Iraq, and we're pretty proud of that, too. I guess it's a matter of pride for a lot of folks....and I find it REALLY funny the number of folks who think military tags are free for us! BAHAHAHAAA!!!!!

Our state actually has a great nursing vanity plate, and the extra funds go into our state nursing association fund for scholarships for nursing students. I think it's a great way to show pride in what we do, and to lend a helping hand to the new nurses following behind us. Pretty cool, if ya ask me. It's amazing to hear how much money we've been able to give to help "make" new nurses every year.