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It's time to make an appointment with your supervisor and tell them what you have told us. If they can't make a plan for you to have the tools you need to do your job, then you'll need to move on. If your conversation does not yield an actionable plan then make sure your supervisor knows they will likely lose you.

I second knowing your state's Nurse Practice Act. It is invaluable. Also, you can always get information from your Board of Nursing. I am in an agency with an OT in charge, under her is the Nursing Clinical Manager. It is more typical to have an RN as the head. I see instances (especially since Covid) where decisions are made that I doubt an RN would make. I feel like our office infection control procedures are lax as a direct result of this. Most experienced nurses know that things run better if RNs are in the management chain. When nurses have to report to Therapy or accountants as their boss, things can go sideways. So your instinct that says this is less than ideal is correct, but that is a different thing than whether it is legal.

Stay at your current company until you are vested, then jump over to HH. If you have the bandwidth to do PRN on top of your ICU job then add that in. We all need to take retirement planning seriously, and no one knows it better than a HH nurse who sees people every day that for whatever reason don't have the resources they need in their old age. HH agencies vary a lot by region/state because the laws affecting them vary. I live in a western state where it is law that HH clinicians are to be paid by the hour- and this is a golden law. If you are paid per patient or per start of care, there is pressure to rush through patients so you can make a living wage and keeps the lights on. The day you have a patient with 15 wounds that all need to measured, photographed, dressed, and charted on will be a day that you work very hard and make less- if you are paid per patient. Point being: try to avoid per patient pay if you can in your area. Also, patient care, continuity of care, and professionalism can be better in a hospital-associated home health agency. I've worked in both, and this has been true in my experience. If you have a choice, be associated with a hospital. Hospital HH tends to be non-profit, which is a plus for patient care. Ask who the manager of the HH agency is, and expect it to be an RN. An RN is going to have the right priorities (I hope!) when making business decisions that affect safety and patient care. You know, little things, like whether they provide fit testing for N95s. Good luck! Home Health is awesome. I spent part of Friday on a mountain top providing nursing care, and I kept thinking "I love my job!!"

I haven’t read all the responses, but your post and some of your replies that I’ve read are very poignant and resonate with your truth. I have a couple things to say: 1. You've received some good career advice, such as outpatient surgery work. Consider moving away from home health which appears to be eating you alive. 2. Make some immediate decisions to bring love and joy into your live. I personally would get a puppy. What’s right for you might look a little different, I don’t know. Hot tub? Regular massage? You need some relief NOW that doesn’t depend on your husband or your job. Make it a priority to bring some joy and love into your life ASAP- because you are in an emotional emergency imo. 3. Consider helping a baby out. You may not be ready for this, but ultimately it might bring you some peace. Volunteer to hold drug addicted babies at a hospital. Or become a respite foster care provider, and care for a baby one weekend a month. Volunteer/work at a respite nursery once or twice a month in order to help a family in crisis. If you are open to it, it can be healing and centering to hold a baby. It begins with you helping them, but in the end there are two people being held in the rocking chair. Namaste, KalypsoRed

Hello, I took a different Fazzi online course ~$300. It did not include a certification, but the online course is available to you for a year. I took it over a long weekend (takes 8+ hours of computer time) and printed off the certificates of completion given after each "chapter" test and gave them to my manager. I have since decided to take the computer-based COS-C certification test this August and I'm reviewing my Fazzi materials and retaking their tests as prep. I have the OASIS Answers book to bring with me to the COS-C test. Good luck to us! I hope this helps. By the way, my hospital's nursing education department that my Home Health department is associated with pays for all this including my mileage on test day. You may want to check with your manager re reimbursement.

This patient has behavior and safety needs. In Oregon he would be able to have a behavioral analysis by a psychologist who would work with the county developmental disability social workers to create a behavior plan for him that would address his safety needs. This plan would include specifics about how everyone on his care team (and that includes you) can stay safe while with him. I won't list all the likely components of a good behavior plan because it has to be based on his individual assessment, needs, and triggers. This is a team problem that needs a team solution in order to best meet the patient's needs and provide for safety. Providing individualized supports to people with developmental disabilities is the backbone of successful services that create the greatest amount of self determination and life satisfaction for the patient. You can't keep this to yourself because it is not in the best interest of the patient (or your own safety). This difficult event is an opportunity for your patient to receive better care through a more realistic behavioral support plan. I agree with those who have said that you will see this behavior again. It may be possible to resolve it (over time and with team effort), but right now this behavior is the current reality. You need to speak with your manager. Is it possible for you to involve his developmental disability caseworker? Peace.

I struggled with all of these things you worry about. I worked very hard for good grades on my pre-reqs, got in to nursing school and just kept working very hard. There have been times I wanted to quit because I was so discouraged, but I made up my mind that the only way I was leaving was if I was thrown out. I have shown up to clinicals completely scared. I give myself pep talks in the car before I get out: you can do this, you prepared for this by studying and simulation work, courage takes practice and that practice starts right now, and: you only have to get through the next five minutes (repeat for 12 hours). I am three months away from graduating with my BSN. I am still giving myself pep talks in the car, but I have grown in confidence. I know other student nurses who get scared and anxious too, but they don't let that be a reason to stop. There are moments when everything comes together: nursing skill, knowledge, and therapeutic relationships. And other moments when I'm clunky or awkward or inexperienced. The more I do it, the more skillful I become. I might be an introvert by nature, but I really like my patients and the nurses I work with. I might find small talk a challenge, but I am really good at therapeutic listening. I've noticed that some patients connect well with the fun, outgoing nurses, but other patients really appreciate a quieter approach. There is room in nursing for both kinds of people. When I am giving myself a pep talk in the car, I am alone with both my fear and my determination. When I hold the hand of a frightened patient, they have me. Remembering that helps me get out of my car the next day. I wish you the best, whatever your journey.