tinderbox

When I got interviewed, I met with a 3 person panel with set pre-planned questions. Questions such as: What draws you to Public Health? Tell me a time when you were able to persuade someone reluctant to change (a co-worker, patient, MD, etc) to see things a certain way. Tell me of a time when you had to display leadership skills. And of course, the perennial favorite of interview questions: Tell me of a a difficult situation with a patient, co-worker, MD, etc. and how you were able to come to a resolution. There were a couple other ones that I can't remember, but those stand out. I was very nervous and didn't think I'd get called back, but I must've done something right because I got the job!

Thank you for your replies! That does clear things up for me, especially regarding travel time. It seems to me that public health nurses seem more satisfied with their jobs than HH nurses do. There is a lot to love in HH, but I constantly hear and read comments from HH nurses expressing burnout with the hordes of paperwork, unpaid overtime, charting well into the night at home, and wear and tear on our cars. It's all true, and I've had the same issues! LOL! Whereas in public health, it seems the common complaint is lower pay. I think I would enjoy public health, though, as I do enjoy promoting wellness and preventative care. I went back to full-time in HH, and we still have to work a weekend a month and some holidays (depending on who wants what off, according to seniority). The hours and the work of public health sound very appealing to me!

I currently work in home health and am thinking of making a change. I had considered wound care and even going back to acute care (temporary bout of insanity on my part!), but neither really hold an appeal to me now, especially not acute care. I really like educating my patients and the one-on-one interaction I get to have with them, but I'm getting really tired of doing hours of paperwork at home, after having seen my patients and also getting wary of constantly having to drive into bad neighborhoods alone. I also hate the amount of paperwork involved in home health. I mean, it is really ridiculous! Other than that, I actually do enjoy the work, and I thought public health nursing might be a good option. From what I understand, it seems to entail a lot of patient education and preventative care, both of which pique my interest, but not as much crazy paperwork and charting on your own time? Am I right? But it also sounds like some phn's go to people's homes, and that is where I get confused. I do see the major differences between home health and phn, but are there any phn's out there who can elaborate, especially on the home visits? Do you have to spend hours charting after seeing your patients? How much travel time exactly is there in ph nursing? I'd like to kind of steer away from traveling so much as well...

I also carry mace. I see patients in very bad neighborhoods. I work in a city that is consistently in the top 5-10 on the most dangerous cities list.

Sorry, but in a case where a call to 911 is necessary, unless it's in the case of a patient medical emergency, I am out the door. I do not stick around 10-20 minutes, if for example, I hear gunshots or if I feel in any way threatened. I'll leave my equipment if I have to, but I will not stick around. That is exactly what our supervisors tell us to do, too-- just leave and call the office after you're in your car (and in a safer location).

I know one of the greatest concerns of new HH nurses is safety. But how much riskier do you really think HH is compared to the hospital? I was listening to some friends who work in the hospital setting, and some of the stories were scarier than what I've experienced in HH, i.e., getting kicked in the head by a confused patient getting restrained, a manager getting beaten up by a very large agro patient, being threatened by gang members in the ED...also I remember myself getting swatted at, screamed at, spit at, and, yes, kicked by patients when I used to work in the hospital. Add to that with all the other hazards of hospitals (dangerous chemicals, machinery, small rooms, isolation patients, etc), how much riskier really, in total, is HH compared to in-patient acute/critical care, in terms of safety hazards to the nurse?The discussion just had me thinking of this issue in a different way..

Any case managers here who previously worked in home health? I realize that case managing exists in home health as well, but from I've heard, the two types are quite different. How would you compare your job satisfaction, hours, and work-life balance? Thanks in advance!

Just say no. And don't feel guilty about it. Guilt is a wasted emotion. Let some of the other nurses step up to the plate.

Good grief, well that is .. creative, I guess. Shoot, we were looking at luxury models. Sigh. I mean, not BMWs or anything like that. But maybe an Audi or Infiniti. We only have one car so we kinda wanted to spoil ourselves. We don't actually drive that much otherwise plus we live in the city.

Caliotter, You do extended care, right? Do you think it's because your car is parked in a spot for a longer period of time, it gave the perps more time? Shoot, sorry to hear that it happened anyway.

I only work part-time, though, and the number of miles I put in is nowhere near 38000. More like less than 10000. I think I drive less in Home health than some people commute daily to their jobs! I'm more concerned with anything happening to the car while parked when I'm inside a patient's home. I go to some pretty rough neighborhoods every once in a while. Am I being paranoid? I think it's my husband's influence.

I only work part-time, though, and the number of miles I put in is nowhere near 38000. More like less than 10000. I think I drive less in Home health than some people commute daily to their jobs! I'm more concerned with anything happening to the car while parked when I'm inside a patient's home. I go to some pretty rough neighborhoods every once in a while. Am I being paranoid? I think it's my husband's influence.

Any of you hesitate to buy a new nice car because you work in home health? And have any nurses who drive newer nice cars had any problems when going into the rougher neighborhoods?

Anyone out there with a history of migraines and works noc shift? I will be going back to acute care and will be on noc shift, but I started suffering from migraines this year. Yes, I know noc shift and migraines sound like a recipe for disaster, but the thought of waking up at 0530 am and doing crazy dayshift makes my head hurt, too. Plus all that noise, bright lights, constant streams of people, and chaos...aghh, I get anxious just thinking about it! I worked nights before and did pretty well. My last time in acute care was on dayshift, and I hated it.Anyway, I'd like to hear from those migraine sufferers who work noc's and how you deal with it.

Thank you all for your advice! I think I may need to review my resume. In the meantime, I will keep trying.

That is what I am afraid of. That is true, foreseeing patients' needs is a true asset. I wish more hospitals would realize that.

I actually do not want to do case management at all. I hate being on the phone all day! Thanks for your above tips, though. It is true. We in home health do do a lot of prioritization, problem solving, etc etc that you mentioned! :)

I'm just wondering if anyone has had this experience or knew of someone who actually wanted to go back to hospital nursing and had difficulty getting even an interview because of his/her time away from the hospital? I know most hh nurses would find me crazy, but I miss the hospital and want to get back into it. I have been sending out applications left and right but have received no calls. I do live in an area that pays well and where there doesn't seem to be a nursing shortage. I'm not sure if this was the appropriate forum to post this, but I thought I'd try anyway. Do you think or have you heard that hospitals are hesitant to hire those RNs who have been away for a while? I have been doing home health for over a year and a half. Thanks!

I'm wrapping up the last portion of the wocn program and am about to head there for the required on-site training ( I did the distance learning). They're pretty responsive. I almost always got a response to a question or issue that day, if not that HOUR. It's very good. I'd recommend it.

Isabelle49, That's what I figured, but I'm still learning the vague (and not so vague) differences between hospital nursing and home health. This one, though, just seemed like something too invasive to be doing just on nurses' "best judgment"!

Would you generally say that in home health, as in most other settings, you'd need to get an order from the MD before digitally disimpacting a patient? It seems to qualify under invasive procedure to me, but I know one nurse who does it without getting an order first. She just uses her "best judgment". Order before disimpacting or no?

I worked as a cardiac/stepdown/tele nurse for several years, tried the traveling thing, and worked at some top-notch hospitals. I got out because I was severely BURNED OUT and knew it was time to move off the floor. So I got into home health about a year ago, and, at first, I LOVED it. Until reality hit. And then I started hating it. Not the patient care but the paperwork, the ridiculous amount of regulation that you need to be aware of, having to drive into bad neighborhoods all the time, AWOL patients etc etc etc... So anyway here is where I am now: I don't "hate" home health anymore now (especially since I stopped case managing and went part-time- much more manageable! Instead I find many things about it "irritating", if that makes sense). I started the program to become a Wound/Ostomy/Continence nurse (WOCN) because the one thing that I find continually interesting about home health is wound care, plus I love how really "hands-on" this aspect of nursing is. I am pretty disillusioned with many other aspects of home health, which I won't get into heavily in this post. My concern is this: What if I finish the WOCN program, graduate, get certified, get a job as a wound specialist, and find--- Hey, I don't much like this job either?? I'm really worried because it is an expensive program, and I'm paying for it myself. I just can't seem to really feel satisfied or super passionate about my career. I also feel guilty because there's a part of me that feels like, Hey grow up! No one really LOVES their job. They call it work for a reason.

So I have recently received the first module to start the Emory WOCN program. The trouble I'm having is finding a preceptor. The place where I work currently only has 1 WCC, and she is pretty new and stressed out to begin with, which is why I hesitate to approach her. I've emailed some potential preceptors, going from the WOCN list given to me by the school, but no one except 1 emailed me back (to tell me that their facility would be unable to fit me in due to their already full load precepting their own nurses). I really think I will start calling people, though, instead of emailing them again. Anyway so I am just a teeeeeny bit worried and anxious about this. Do a lot of WOCNs dread or dislike precepting new students, especially if they don't know them? Has anyone else run into this problem, and what happened? About to hit the phone now and go down my list....

I loved reading the posts on the Day in the life of HH nurse, but they seemed to have digressed away from the daily routines aspect of HH. I was wondering what everyone else's daily routine is. For example, 1. What time do you usually schedule your first patient? 2. What time do you usually get up in the morning to start your day? 3. How much time frame do you give your patient, of when you will arrive? My agency says 2 hours, but is that what nurses realistically do? I usually give 1 hr time frames. 4. How much time during the day do you spend on straight case managing, minus the actual visits?

What are some interventions/teaching you could do for a patient with long-term COPD, on continuous oxygen? He already knows oxygen precautions and to rinse his mouth out after using inhalers.