NurseFries

I have worked HH and documentation is very important just like anywhere else. Sounds like this nurse needs someone to help her manage her time better. Maybe cut down on her caseload? Sorry to hear her case manager is not up to par either. I would express my concerns to the manager above the case manager. Sounds like they both need more training, reminding, and so on. I would also include both their names in the complaint or no one will know who needs help or more training.

I recommend you chose the least expensive and flexible program especially if you want to start having kids during it. I wouldn’t worry about school pedigree. That doesn’t seem to matter in what I have seen. What I have seen in my more than a decade of nursing is that higher education is more important than the school chosen. Don’t feel guilty for choosing another program over the one associated with your hospital. You don’t owe them anything and it won’t matter in the grand scheme of things. With that said, having a child is a lot of work, a lot of sleep deprivation, and childcare is expensive. Make sure you have childcare worked out. Make sure you have your schedule worked out so you don’t miss time with your child. You won’t get that time back. Don’t spread yourself too thin. It’s not worth it. School will always be there but the years caring and watching your child grow and learn won’t. Take care and good luck.

Go to your managers boss and express your concerns. If your practice manager (who is probably not clinical) isn't going to support you, then go above her head. Document everything you told you manager and all the issues you see.

Hello, I work at an outpt clinic in a huge medical organization that is VERY understaffed. I work 3 days a week and another nurse works 5 days a week. We are currently looking to hire another part-time nurses like myself and a full-time nurse to take the place off the other full time nurse who got promoted. Us nurses do all the phone triaging, refills, prior auth medications, answer email messages from pt's, prepare orders, preop pt's for procedures, admin sedation in the procedure room, and monitor/post op pts. We do a lot of other things as well. We do not have a call center. We (nurses) take about 40-70 calls a day and have anywhere from 3-6 procedures a day. There are usually 2-3 docs in a day who see anywhere from 12-22 pt's day each, plus procedures. There are 4 - 5 Fellow MD's a day too. The MA's only room pt's and do UDS. They can do a lot more, but are not reliable. We are working on that. So, my questions is this. How does your clinic run and what are the nurses responsibilities? I am looking for examples for our clinic. I am seriously losing my mind due and feeling burned out. I feel like I am doing task after task and working at the bottom of my license. Thanks!

Hi, I started a new job in March (part-time)in pain medicine at a teaching hospital back in March. I worked in pain medicine and orthopedic ambulatory as a preop/postop nurse for 4 years prior. My new job entails triaging calls, medication PA, preop/postop, and administering sedation during procedures. I love the preop/intraop sedation/postop, but the triaging is burning me out!!! The M-F nurse who has been there 8 years hs been out recovering from surgery. Me and another part-time nurse (we work together 1 day a week) have been the only nurse there. We get upto 40-60 calls a day, plus online patient portal messages. I've been working 1.5-2hrs overtime with no additional pay b/c I'm salary and exempt. I know the full-time nurse will be back in a couple of weeks, but I'm seriously losing my mind. My manager says "it's really hard to find coverage, I'm trying". We live in a huge metropolitan city. I don't understand why it's so hard. The pt's calls are burning me out!!! They just don't stop. They call and vent and won't stop talking. As soon I as hang the phone up to write the note, the phone ring again. Constantly!!! The Fellows don't help as much my patient portals either and the practice is growing. Ug! Help!

Yes definitely!

Yeah, it is emotionally exhausting. The nurses I work with are wonderful though but there is no support.

Hi, I just started working as a new pre-op/PACU nurse part-time at a small pain clinic. The first couple of days were crazy!!! I received about 2 hours of training and told I will learn as I go. I have learned a lot, but I do not receive the support I need at times. The medical assistants are rude and act as if I am bothering them when I ask them a simple question. They do not communicate properly. For example, I asked one of them where an instrument was and she waved her hand and said "over there". What does that mean??? I asked her specifically where and she acts like I am asking her to do my laundry or something. Then the CRNA is breathing down my neck and keeps bossing me around like she is my employer. She has been rude to me in front of patients and told me to my face that I need to get my "**** together". I have worked there a total of 5 UNCONSECUTIVE days in 1 month. I am doing my best. I told her never to ever speak to me like that and to stop disrespecting me in front of patients. I do not have a problem standing up for myself. I have spoken to the office manager and both physicians about my concerns. They seem very supportive and said they will talk with the employees causing issues. I consider myself a gentle, compassionate, and kind nurse. I am respectful with everyone I work with. I have noticed that this "group" of co-workers take kindness for weakness. I need some advice on how to handle all these issues and gain my respect as a nurse back. I do not like having to constantly put people in their place. We are a team and we need to help each other out.

That's is exactly what I was thinking. Some of my friends and family members keep telling me to just quit because they think a 6 month job on my resume would not matter. I have a gut feeling it would matter and would help me more than hurt me. I would not be the first or last nurse to quit a job in less than a year because it was a bad fit. I will have my school as a good excuse as well. I would love to work at a facility that would pay for my education. That was my goal when I graduated with a ADN, but I moved to a new city that was over saturated with new nurse grads who had their BSN. That goal seems to be shot to hell, but I will continue to try. Anyways, thanks for the advice :).

Hi all, Ok so I recently relocated to a new city and I got a home health private duty job since I have home health experience. The private duty agency I work for specializes in pediatrics. I have come to the conclusion that pediatric home health is not a good fit for me. I actually cannot stand it. I thought I would like it because I love kids. I went from 30-40 hrs a week to per-diem 3-4 days a month because I thought decreasing my hours would help. It hasn't! It is really depressing me and the families are frustrating me. My past home health population was with geriatric patients. My 6 month mark is coming up and I have decided to quit. I am going to go to school full-time to obtain my BSN but I want to find a job that I can work 1-2 days a week so I can keep my skills up and not lose my sanity due to school work. Will putting a 6 month RN job on my resume hurt my career? I was going to quit sooner but thought it would be better to wait until the 6 month mark so it shows I worked somewhere and there is not a huge gap on my resume. Or does it even matter and I should quit now? Thanks!

Great tips, thanks! :). Unfortunately I did not find a OR class in my area. I am in the same boat as you Rabid. I have an ADN and no hospital will hire me either. I am working towards my BSN online and will hopefully be finished by the end of the year. It s so frustrating!

Hi, I just got a job part-time position as a pre-op and recovery nurse at a small pain center. I LOVE IT!!!! My past nursing experience has been mostly home health (visits & private duty) and pediatric/adolescent care in a foster group setting. I have realized that I really like the OR setting since starting my new position. When I was in nursing school I had a clinical observation rotation in the OR and loved it. Unfortunately I do not have any hospital experience. I would like to work at a same day surgery center because the hours are usually better. How can I get into this specialty? Will working as a pre-op and recovery nurse help my chances of becoming a OR nurse? Are there other avenues I could take to expedite my chances of becoming an OR nurse? I have finally found my niche in nursing. :) Thanks!

Thanks, I will try :/

Hi, I have posted about my anxiety and depression before on this site. I am taking medication and seeing a counselor but I still wake up crying and anxious every morning. I was offered a great job as a home health hospice nurse with 6 weeks orientation but passed on it because my gut instinct was no and I felt I was not ready to work alone yet in that specialty yet. It has been 2 months since I passed on the opportunity and I am full of regret and sorrow. No other nursing job has ever offered me 6 weeks orientation. I have only been in a nurse for over 2 years but have over 10 years experience in the medical field (medical assistant). Most of my nursing experience has been as a private duty home health nurse with geriatric patients and as a clinical nurse in a foster care group home setting. I currently work as per-diem as a home health pediatric nurse and I do not like it at all. The kids are cute, the agency is great, and the families are very nice but it is not a good fit for me. Working with medically fragile children in the home health setting is completely different than in the hospital and I now know that I do not want to specialize in pediatrics. Seeing the kids with trachs and on ventilators makes me sad and anxious. All my anxiety and depression increased since I relocated to a new city with my husband. I feel like I have lost all my confidence as a nurse. All my patient's and supervisor's say I am a great nurse and competent in what I do, but I do not feel that way. I feel lost. I also feel like I will never get a nursing job that I will like and be passionate about. When I graduated school I had to move to another city b/c of my husband's new job and I couldn't get into a residency program to save my life. Luckily I got a job in home health but that it not what I want to do. My passion is cardiology and nephrology. I have applied to 100's job postings in the city I live in now but keep getting rejection emails stating "you will not be considered a candidate". I am losing my mind. What is wrong with me??? I am also afraid of the 6 month gap on my resume from relocating. I am going to quit the pediatric home health job I started 4 months ago soon but I am also afraid of how it will look on my resume as well. This job is the only short-term job on my resume. I am very scared and anxious that I will not get a nurse job that is a good fit for me. I feel like an idiot passing on the home health hospice position. I feel like I will never be offered a nursing position with adequate training and friendly co-workers. I feel like my career is over. I feel hopeless.

I am sorry . I felt the same way during my clinical rotations at the LTC's. I learned from it and do not apply to them. I hope you feel better soon.

Hi all, I did not take the hospice position. I thought about for MANY days and just did not feel ready for it. My heart said "yes" but my gut said "no" right now. I initially applied for the inpatient unit but the DON offered me the home health position because of my experience in home health. I felt very sad for about a week after, but I feel I made the right decision. Honestly, every time I thought about going to a patients home and calling a death it freaked me out. I do not think that is a good sign. I want to learn and gain more experience about end-of-life in a controlled setting with more support before I go out on my own. The DON was very understanding and the lines of communication for future nursing positions are open. Thanks for all your input and support. :)

Thanks everyone! I have to let the DON know my answer by tomorrow. Some of my friends say wait until I feel better mentally and get more RN experience. Then other's (passed co-workers and friends) say "Do it, it is not as depressing as you think it is. You will feel wonderful helping people." I'm scared to take the plunge. I feel like I would be great at this speciality, but nervous. I know it's natural to be nervous doing something new. I keep going back and forth about this position b/c I do not want to leave it after a couple of months if I do not like it. That would be a great disservice to my patient's and my agency. My depression although it is getting better with my new meds has really put a lot of doubt in mind about my nursing abilities. Maybe this position will help me grow as a person and a nurse as well as helping my patient's be as comfortable as possible.

Thanks for the reply :) I feel comfortable making some decisions independently, but not all. That is actually one of the my "fears" of working in home health. It is very nerve wracking not to know what to do or say. I wish I could have had more training working with critically ill patients though. After I graduated I tried and tried to get into a multiple residency program at the local hospitals so I could improve my critical thinking, assessments, and skills. As you are probably aware, new grads are having a lot of issues finding jobs. Anyways, the agency that offered me the position is aware that I will need a lot of time and that I will have a lot of questions. The DON is not expecting me to learn everything during my 1 month training. He said it may take months to years for me to feel comfortable in this specialty. He said that he see's a lot of potential in me and is willing to invest the time needed. I am glad to hear that you are enjoying your new job. I hope I feel the same :) If you have any suggestions or information to share about hospice HH, I would love to hear them.

Hi, I have been offered a position as a hospice home health nurse. The agency said they will provide me with 1 month training where I will be paired with an experienced hospice field nurse. I have only been a RN for 2 years. I have worked in home health for most of it, but have not been working for 6 months d/t relocation and traveling. I had a couple of hospice private duty cases in the past and I really enjoyed it. It was very rewarding to provide comfort care and support to the families. My new position will be as a visiting nurse/case manager. I know there is a big difference between private duty and case managing b/c I have done both. I have depression/anxiety and I am being treated for it. I am worried my depression and anxiety will exacerbate while being a hospice nurse. I know hospice is sad, but it can also be very rewarding. I also know there will be steep learning curve since I do not have a lot of experience with terminally ill patients or case management. Do any hospice nurses suffer from depression and/or anxiety, but are not affected by hospice care? Is this the wrong specialty to go into for a RN with only 2 years experience with depression and anxiety? Thanks!

Thank you :/

Hi everyone, I have been sick to my stomach about this. I had a HH visiting RN job and quit after 3 weeks because the pt population was depressing me. All the calls and paperwork I had to do was overwhelming me as well. I have done HH in the past, but mostly private duty. I felt really bad quitting the job after only 3 weeks but my gut was telling me it was not going to get better. I gave 2 week notice because I did not want to burn any bridges. The DON was really sad I left and even gave me a big hug. I just moved to a new city and have been suffering from facial nerve pain for the last 6 months. During the 3 weeks I worked for the company and visited pt's my pain and anxiety increased and I was sick to my stomach about going to work. I recently took another HH job, but it is a private duty and not visits (need the income). I thought it would be less stressful than juggling multiple patients during my facial pain. The private duty job has been "ok" but the pay is lower. Now I am regretting quitting the other job. I regret it b/c I did like visiting different pt's verses 1 pt per day, although the population was depressing me. I like the flexibility in my schedule as well and not being "stuck" in someones home for 8-10 hours. I don't know what to do. I feel like I made a bad choice and don't know how to fix it. Should I call my old company back and try to get my job back? Did I just ruin my nursing career? I think the pain, anxiety, and feeling disconnected from moving to a new city contributed to my quick decision to leave the HH visiting job and prevented me from rationally thinking it through. I need some advice. Thanks!

I think it maybe all 3. Home health visits are not for everyone. I worked as a HH visiting nurse and quit after 3 weeks because I was so tired of seeing patients and then coming home and charting late into the night. I started off with 10 patients a week, but I knew my patient load would increase soon and that caused me a lot of anxiety. I loved the flexibility at first, but then I felt like I never had time to take care of myself and my family. I loved the autonomy but I also missed the social aspect and the support I received from colleagues. I also felt like I was doing the job of 3 people. I had a lot of anxiety and was scared my license would be taken away if I forgot the littlest detail. You may want to look into private duty HH nursing. The pay may not be the same, but you would take care of 1 patient per shift, chart, and go home. The nurse manager/supervisor would also do the case management for the patient which equals less stress for you :). I personally do not like case management. I recently took a private duty HH nurse job which does not pay much, but it is less stressful. I will continue to look for another job while working. HH jobs are a dime a dozen. Many nurses do not like working HH b/c of the constant change in the environment and driving all over the place. I suggest you look for another job STAT b/c it will probably not get any better. Good luck :)

Hi, I am having a complete brain fart about how to chart via teach-back method. I haven't charted in over 6 months so I feel rusty. I taught a patient how to use his home B/P machine today and he demonstrated it back to me twice. Is this this correct: Educated pt on how to use home B/P machine. Pt demonstrated using home B/P machine twice by placing cuff on correctly, turning machine on, and verbalizing systolic and diastolic numbers. Your input will be greatly appreciated! Thank you!

I guess I am really nervous about working independently and not having any support with me. I used to rely on my nurse supervisor to make the final decisions, but now the tables have turned. I also have not worked in 5 months because we moved to a new city, traveled for a month before settling in, and I had to wait for my license to transfer. I feel like a new grad sometimes. It's an awful feeling.

Hi, I just started at a home health agency that requires ME to open cases, recert, and discharge Medicare patients. The home care agency I worked at before was private duty nursing and my nurse supervisor would do all of the above. I would follow the plan of care, educate my patients, and alert my nurse supervisor about any changes to my patients status. I am very nervous and feel I am not competent in my nursing career to open cases, recert, and discharge patients. I told my new agency that I never done any of this before, but they said I will get the hang of it. I have only been a nurse for 2 years and I have never worked in a hospital. I was trained for 1 week by the nurse I am taking over but it was not very thorough and the LPN that works at the retirement center I will be providing care at is not helpful at all. How do I know when to recert patient? For example is educating the patient about their disease and medication enough to recert? My DON works out of the corporate office which is 30 miles away. She said I could call her with questions anytime, which I will but I do not want to appear incompetent. Are there any online resources about this or can anyone give me some pointers. Is there a list of skilled nursing cares I can use to justify the need for an RN visits? Thank you!