CFLA.RN

I agree you should spend some time finding your place in the nursing world before trying to go for an advanced degree. Where you start out in nursing is not always where you'll be happiest. I started in the hospital on a transplant unit. I loved it and thought I would be there forever. Over time I found that while I enjoyed the hospital and transplant unit, my skill set and passion is in wounds and geriatrics - two areas I never thought I would practice in. My advice is to work on your BSN and spend time working to see what you want to do with your career. I don't think every nurse needs to be an NP, it doesn't guarantee a greater paycheck but it does guarantee more responsibility.

Work/life balance is a struggle for the majority of home health nurses that I know. The best days I have are the days where I charted completely in the patient home during the visit, at least everything except the narrative note. Over time you'll learn to get faster with charting and it really makes a difference. My first company used HomeCare HomeBase (HCHB) and in the beginning it took 30 minutes for me to chart a regular visit and about 1 1/2 hours to chart an admit. After a year I was able to chart a regular visit in 6 minutes and an admit in 30-45 minutes. The key that helped me was copy/pasting common teaching guides for the narratives. I had a desktop folder with every medication I ever taught on so that I readily had access to teach the patient and had Medicare approved documentation for charting. I also learned to go into a home and tell my patient that the first thing we were going to do is run down the assessment list so that I could put that in the computer and then we could address everything else. Some patients don't like that but the majority of patients would rather let you spend 5-10 minutes doing your assessment and charting so that you can spend the rest of your 20-30 minutes completely focused on them with your device turned off. As far as points - 27 points shouldn't be too many visits a week. Most home health nurses don't know how to say no and end up picking up more than the requirement. Learn to say no if that's the case. It's important to create healthy boundaries with your employer because they will always work the "yes" people to death. It takes a good year to get into a routine with home health, there will be days that even your best intentions with charting fail and you spend all weekend catching up. But then there will be days when everything works beautifully and you find yourself at at 3 with nothing to do but relax.

There's a difference in acute pain vs chronic pain...I would treat acute pain first then the constipation. Chronic pain and constipation...would have to look at other factors, especially the site of chronic pain and the onset of the constipation.

FNP programs have considerably large application pools, often twice as many (or more) as AG primary or acute care applicants. I looked on nursingCAS at all the schools with applications available and started the process for whichever ones I thought would work out. I had no idea there were so many programs available, some with revolving start dates. It is discouraging to be rejected but you have to remember that it's not personal, there's only so many open seats and an over abundance of applicants. Good luck.

How are BSN nurses trained to prioritize any differently than ASN nurses?

Depends on where you work. I worked a year in the hospital and then went PRN in home health. I don't think any place will let you not work in the summer and then come back in the fall, you would definitely have to keep a minimum of visits or a new PRN person will get preference over you.

Got my acceptance into AGPCNP program today! I'm in Arlington. Glad to see I won't be the only one in this area.

I love home health and the patients, I hate the charting that is never ending. There's an immense satisfaction in teaching people how to manage their disease processes so they can stay out of hospitals and stay home with their families. But there is also frustration when I have families that won't help out or seeing how isolated some of our elderly truly are. I love the autonomy and independence of home health, but it can be lonely at times too. Every time I swear I hate it and am leaving it for good...there's a patient or family that shows so much gratitude that it reminds me not only why I do home health but why I'm a nurse. Charting and lack of family time (due to my own inability to say no to extra visits) led me to leave full time but I still work PRN at two home health companies and one hospice. Its a love/hate relationship for me.

What part of Texas? I know one of the companies I work PRN, they hire LVN's for different shifts so people have some flexibility. I worked home health as a single mom and never had trouble with child care. When she started school I worked from drop off to pick up and then charted after she went to bed. Also a lot of opportunities for on call/weekends in home health or hospice.

HHC is all about the narrative too. It's where you document the skilled service you provided. Check boxes are nice but don't "paint the picture" that Medicare wants to have. I learned to copy/paste teaching guides from NIH to the notes and use those for teaching guides for patients. It cuts charting time in half and gives you consistent teaching info, especially for meds and common chronic illnesses.

I don't know what area you're in milesims but I've never seen a HHC position that offered less than the hospital, at least in my state. I went from making 19.50/hr bedside to 35/routine visit and 75/admit (9 years ago). Current rates in my area are 40-50/routine visit and 100-125/admit. LVN's are making around 35/visit. Salaries can be low but a lot of companies are moving away from straight salary and paying on visit or point system. The lowest paid salaries can be supplemented working PRN with other companies. Its easier to pick up extra visits in HHC than it is to have to pick up an entire shift at the hospital, especially if your visits are grouped together. Companies in this area sometimes pay 1/2 point or visit rate for traveling over a certain amount of miles. Sometimes they offer company cars instead. Benefits are not always as comprehensive as the hospital (insurance is more expensive, very rarely has tuition reimbursement, etc) but that's the trade off for having more flexibility. And I definitely wouldn't say you'll see so many different types of patients - you'll see mostly COPD, CHF, HTN, Ortho, DM, and wound care. You'll talk a lot about medications and managing chronic illness.

How long did it take for you to get your acceptance letter/email after you applied?

Go the ADN route and do RN-BSN online while you're working. You'll be getting the work experience you need and a lot of employers will provide tuition reimbursement for the BSN. It will also give you time to decide which area you want to be in, the field you think you want now may not be were you end up.

Home health can be amazing at the right company. It's important to have the right training because it is very different from floor nursing. You have to remember that it's only going to be you in the home - there is no back up if you can't place a foley or draw a lab. There's a ton of charting, different charting systems make a huge difference. Simple ones, like Kinnser or Axxess are a breeze. HCHB can be frustrating, but if you do as much as you can in the home it won't be so bad. Home health can be extremely flexible if you set boundaries with your company and with your patients. Make sure that your territory is a reasonable area, there is nothing worse than having dead time because you're driving 20-30 minutes between visits and having to complete 6-8 visits a day. You really have to be able to handle constant change because days hardly go as planned, patient schedules don't always line up with your planned route, and there is always calls from the scheduler begging you to pick up "just one more easy visit" that turns into a 3 hour wound VAC. Pros - can be flexible, usually pays much more than hospital, frequently have same patients for months at a time so you build relationships, become strong with clinical assessments and skills because there is no back up Cons - can have the same patients for months (can be very frustrating, emotionally taxing), charting is 110% worse than hospital, patients call after hours, driving (car always loaded down with supplies), charting, charting, charting, always charting. I worked one year in transplant and then moved into home health for the last 8-9 years. While I appreciate the flexibility home health gave me as a single mother, I eventually had to move into a different field because I got so tired of the charting. Everything else I loved.

It really depends on what your home life is like and how often you would have to take call with the m-f. I would have preferred to have the weekend call with terrible hours over the m-f 8-5 with call because after working all week doing regular visits you get to have a weekend with terrible hours or nights during the week where you get no sleep and then end up working all day again. How big the company is makes a huge difference too. How big is the coverage area? Do you have to triage calls and make visits or do you work in an RN/LVN team? If it's a bigger company, is there back up on call in case you get two crisis calls at the same time? I would ask a lot of questions about what their typical weekend calls looks like and also what the weekday visit load is.