Published Oct 29, 2004
I started HH 3 weeks ago, had 2 weeks of a very quick and disjointed orientation. This week I was sent out on my own, and have had 2 to 3 patients a day. It may not sound like much to the more experienced, but I have never done home health, I have been in a hospital the last 25 years. The paper work is unbelievable, but what is hardest for me is the way you have to chart..I do not think I will ever get that right ! And let's not even get into the icd-9 codes, v-codes. I was told, Oh..you will pick that up on the way. I can't even figure out how to do the frequency for visits. When I got to the office this afternoon, I was told I would have to do another start of care tomorrow.."because we have 3 new admits and no one else to do them, so you will have to do one." I have literally been in tears on several occasions. Next week I am already up to 4-5 pts. a day. I have been driving about a hundred miles a day just seeing 2 to 3 pts......I guess what is really bothering me is that after 25 years in the hospital, I knew my job inside and out....could handle any situation..now i just feel totally and hopelessly lost. I was so tired of the hospital and its short staffing, thought home care might be better...but what I see happening now is seeing pts. all day and doing paperwork at night at home. The words "I quit" keep running through my head all day. Maybe I should quit. Other home health nurses tell me to stick it out for 3 to 6 months, until I feel comfrotable and have a stronger knowledge base. I just do not know what to do (wiping away a few tears) Well that it is my vent, thanks for anyone reading through this pity party of a story !!!
Well... not sure what the words of encouragement are.... Home health is a great world, but quite different than hospitals for sure. It does take a while to get through the paperwork, and understand the new language. I might suggest that when you get off your route, see if you can go back to the office to have someone teach you things that will help with documentation and paperwork. Ask a supervisor to assist you. If they value their staff (and you ) , someone will teach you one on one, if you can get no assistance, I would suggest finding a new agency who cares about their employees. It would seem to me that if the supervisor has no interest in teaching you this new world of nursing, and spending time with you to learn, then they probably have very little care and concern for the staff in general. Home care is a very rewarding field, and gives great pleasure to make a difference in the lives of others on a personal level, patient and families. Home care is delightful, but the paperwork can be a problem, if you do not understand it. It is not bad after you learn the forms, etc.
Take care and Good luck to you.
Hang in there SRbear. I too just started in HH (on Sept 13) and it is overwhelming for sure. There are lots of changes from hospital nursing. Some days I am loving it. Other days I hate it. Already I am dreaming about some of the pts I have seen. Because of insurance issues etc. It seems just when I think I have it down it all falls apart.
I would definately speak to my supervisor if I were you. I know that some days I have had to speak up and say hold on I don't get it.
hoolahan, ASN, RN
I agree, sounds like you don't have a very good support system.
Besides the paperwork, did you enjoy this kind of nursing? Do you find that you have any flexibility with your schedule? Are there things that you do like about it?
If you really don't enjoy it, then move on, or try another agency that will give you better orientation.
Don't forget, you are not a baby if you call your supervisor for answers. If you aren't sure how to code, by all means, save yourself the aggravation of trying for hours to figure it out, and call the supervisor and have her explain how she would do it.
I strongly suggest you make an appointment with your supervisor and sicuss your concerns. tell her you are thinking about leaving because you don't feel you had a thorough orientation and are spendning hours at home frustrated. They invested time and money in your orientation, I would think they'd like a return on their investment. It would be more beneficial for them top help you get acclimated, instead of placing another ad, orienting another nurse, etc...
Can you spend any time with some of the other nurses? see how they organize themselves. See if this is their norm, or are they able to finish paperwork in a reasonable time frame.
Don't feel bad if you decide to leave it. It isn't everyone's cup of tea, but 3 weeks isn't a very long trial period. Best of luck to you!
barefootlady, ADN, RN
I am exactly where you are, been with HH since August, had 3 weeks of a hap hazard orientation, put out on my own after that, was always told we can fix that later, but YOU have to see this patient today. Now, lots of things are coming back for me to fix and I am finding some of the comments very nasty and uncalled for. When I have defended what I wrote or told them " hey, NO ONE showed me how to do this or write this, so when I asked and was told "do the best you can, we will fix it later. I thought you meant to take the time to teach me how to do it correctly". I am tied to this job for a short period, but I will be moving on as soon as possible. I do not feel that the patient is the focus with my agency, only the dollar sign. They want us to do as little as possible, and keep the visits down, but they want every cent of money they can rake in or fake in from Uncle Sam. The sad part is I work for one of the best in the state, much less area. The other thing I am running into, none of the other nurses have much hospital experience, so when it comes to a complicated dressing, lab stick, or indepth teaching I get assigned. So the same mess has followed me, I just want to do my job and go home. Very little overtime, do my patient care, follow orders and leave and have some sort of life. I am sure HH is not for me and I can't wait to quit. One of the nurses I worked with for 5 days, got her check and went into the office and quit, she said the "smart ones get out quickly." I believe that was good advice.
CardioTrans, BSN, RN
I am so sorry that you are having a difficult time. Home care is very different from hospital nursing. I agree with Hoolahan that it sounds like you dont have very much support. In home care every one needs support at one time or the other. Talk with your supervisor and let her know what you are feeling. If you truly love the patient care (paperwork not included), make sure you let the sup know.
Talk to the other nurses and ask how they do things, the cms website has some very good information on OASIS and coding.
Another very good resource is a book called Handbook of Home Health Standards & Documentation Guidelines. Its written by Tina M. Marrelli. You can get it at a Books A Million or at mosby.com. It will help sort out alot of things you maybe having problems with.
I truly hope things get better for you!
renerian, BSN, RN
Bear I am sorry your feeling that way. If it makes you feel better I have been in home health for almost 15 years and I cry sometimes. I know it is hard. It does get better but I think you need a year or so. Are you coding? Your not ready for that.
I am an LPN in HH care. I just go to 1 pts home. I have been going to his home for 4 years now. Right now I only work per-diem. Our paperwork isn't that hard. I havn't done any admits we have an RN supervisor who does that. Do what you think is the best but I really find HH very rewarding. Angelia
I was supposed to start with 2 pts.per day this week, building up to 3 at end of week. Next week starting at 3, building up to 4, then next week, full load (and I have no idea how many that will be). This is what was told to me by the nurse orienting me. Well the nursing supervisor is not sticking to that. This morning she told me I had to do a SOC, along with my 3.....this start of care was about 45 miles from where I would be, and just seeing these 3 today I knew I would log about 100 miles. I told her that was not how things were set up for me, and I got this story about how pts. had to be seen, I could worry about the paper work later. Later when...on my own time....? I told her I had been in nursing way too long to start working for free now, and that I would see my 3 pts. today, but it would be my last day. She called me about an hour later...asking me to think it over on the week-end, and that HH nursing changes a lot, and I must be flexible. I told her I was still in orientation, and if they could not stick to what they said my load would be, then maybe this job was just not right for me. I can be flexible....but I am still learning this job, and I feel they are not as concerned about what kind of job I do, just as long as a pt. gets "seen" Maybe I am being unrealistic. But dang it, I feel like I have been lied to and taken for granted already. This is why I left the hospital...just being treated like a number, being given too many pts. to actually give good nursing care to. But I see now, this seems to be happening in all areas of nursing. I am going to stick it out for a while, but I will be searching for other avenues of employment. You know the old saying "the best time to find a job is when you already have one!" The sad thing is that this HH company was started by a bunch of nurses 2 1/2 yrs ago. How quickly we forget !
And thanks for all the replies, words of encouragement, and just listening to me vent.
I know someone else posted about PDN work/private duty nursing. Maybe that is something you would like to do? One place?
HH is not for everyone. I personally can't stand it. Did it for about four months and just wanted to puke every day when I had to leave home for work.
My sister in law on the other hand, hates facility care and loves HH and doesn't understand why I don't like it.
If you don't like it, aren't comfortable with it, get out there and look for something else!!!!
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