Should I leave the ICU for VNA?

Libby1987 · Jul 13, 2015

HH has been my career and I've seen many hospital nurses over the years try to make the transition.

First, it is not a relaxed pace. It may seem relaxed when you're trying to compare it to ICU but no HH nurse would describe it as that.

It is very stressful for the first year and another year or so before you're knowing all of your resources, fully understanding the documentation requirements and Medicare reimbursement and regulations inside out. Until then you'll likely be spending more time charting and organizing than your experienced coworkers. Many don't give it a chance and quit in the first few months. Especially when they're coming into HH burnt versus intentionally as a career goal.

What you will like is the one on one patient interaction. The teaching, assessing and treating without interruption is what everyone loves. And most patients love that too which makes them happier customers.

It's been a great great career for me, the nurses I work with love the patient relationships. The paperwork and driving can be the pits but gets easier if you stick with it.

I recommend it to anyone with strong nursing skills and a willingness to devote a tough year to learning it.

Not all HH companies run the same and there is some hopping around finding an organized office that assigns territories and minimizes the driving as much as possible. Once you have a couple of years experience you will be marketable and know what to look for in a well run organization.

tachynut · Jul 13, 2015

Thank you for the reply! I want to make an informed decision. I did shadow with a home health nurse in nursing school and absolutely loved it. Then somewhere after graduation I just got eager to get a job-- any job!- and got into the hospital environment.

I believe there are many aspects of home health nursing that I would enjoy- the patients as you mentioned, being away from the hospital environment, having some degree of flexibility in my schedule, getting to actually eat lunch!!!, and believe it or not I actually really enjoy driving :woot: ! But I have heard about the paperwork, and how it can consume your whole life- especially if you work full time as I intend to do.

How manageable do you find the paperwork to be after getting some experience with it? How much time per day would you say you spend on it? Does electronic charting make it easier (I applied at a company that is now electronic).

Thank you!

Libby1987 · Jul 13, 2015

I work 8-9 hrs a day including completing my paperwork and have made 104K the last several years.

I'm admittedly a nerd and as long as I have the time I don't mind the paperwork. I'd say I spend about 2-3 hrs charting/responding to communications in total per day much of that though is incorporated into the visits.

We had a rough EMR launch and are in the process of getting new software. It was very time consuming, much more than paper, but it was also rejected for how time consuming and problematic it was. So I can't really tell you how time consuming it will be but I know it will be better than it was and even with that I was getting the hang of it.

caliotter3 · Jul 13, 2015

If you want a career rest from ICU, suggest you consider extended care home health before intermittent visit home health. One stable patient for a shift from four to 12 or 16 hours, usually eight, and one nurses' note for the shift. If you really want a rest, look for a night shift assignment where you may do little more than sit in a rocker monitoring a patient throughout the night while the family sleeps. Some assignments can be described as 'boring' by some, but it all adds up to what you want. Once you have rested up, you may find that you want the challenge of doing visit work, along with its unique challenges and paperwork. Some agencies offer both types of home health nursing, and you can choose what you want to do. Later on, you might want to take a case manager or clinical supervisor role. Or, move out of home health altogether.

tachynut · Jul 19, 2015

Wow I had no idea HH nurses had that type of earning potential!! I see that you do case management in HH. How does that differ from the regular visiting nurse? I see some positions posted for each, and would assume I should probably only apply for the visiting nurse positions since I do not have any experience in HH yet. Any recommendations?

Thanks! I am eager to get started on a new career path

Libby1987 · Jul 19, 2015

My hourly was equivalent to hospital day shift straight time, in order to be competitive, however I am PPV and have a higher pay for increased productivity. (Patient care isn't supposed to be affected, just improved time mgmt.)

I've taken on different responsibilities and now my hourly exceeds local Hosp hourly (days/straight time).

Case mgmt in HH simply means you are in charge of your patients' care. It can vary from office in how they structure their nursing care but in ours, either a case mgr or a Per diem/part time nurse admits to patient to services and then either can make the revisits with the case mgr making the assessment visits that occur when patient had a Hosp admission and is resumed back to care, is recertified for another plan of care (every 60 days) or is discharged. The visits in between would consist of their planned teaching/treatments and tend to be more task oriented however everyone's eyes should be open for change in condition and/or change in needs.

In my situation, which is almost as good as it gets* I live in my out lying territory so I usually admit my own patients and make all of most of their revisits while some admits are done by the weekend nurses or a per diem helping me on a busy day. Revisits on your own patients that you know well and can anticipate and plan for their needs are the easiest kinds of visits, esp if they're a simple protime/cath change type of visit.

*the most perfect world is living in your own territory which is close to the office, meaning minimal driving. I can keep my driving down by upping my organization and planning and only driving into the office 1-2 x week, but that comes with experience.

gibsongirl · Jul 23, 2015

Honestly, homecare is stressful. It is not 8 hours a day. It is all day seeing patients and documenting in the evening. The only 8 hour jobs I have seen in years of looking are in nonclinical jobs such as documentation specialists, disease management, navigators and physician offices. Everything out there is stressful but not taking work home is what helps keep the work/life balance. Homecare is not that. I think you would be an asset in the nonclinical jobs because they look for someone with recent acute care experience. Also, you might be a good fit for an INR clinic or office nurse in a cardiology office. The cath lab and postanesthesia care units have 8 hours shifts but you also have call which home health also requires. Do some soul searching. Do you have kids? Look into school nursing. Occupational health or woundcare (in a center) nursing are other avenues but they require some expensive certifications. Good luck. I hope you find your dream job.

gibsongirl · Jul 23, 2015

Can I pm you here or do we have to be "friends?" Honestly, I want some advice and to pick your brain. I have been a per diem in homecare. I could not pull off fulltime even after 3 years of doing 4-6 points a day. I am expected to do everything fulltime staff do but of course, I don't get benefits. I do not case manage. I feel very stuck because I have been unsuccessful finding another fulltime job while there are many fulltime homecare jobs out there.

Libby1987 · Jul 24, 2015

I saw 5 revisits today in 6 hrs and done. It came out to $54/hr plus mileage and benefits. Never even went to the office.

I have rec'd wage increases and promotions.

I make a good living and work an 8-9 hr day (that includes my commute) but I have been at it awhile. It wasn't like that my first couple of years but I'm driven and always trying to improve my quality and efficiency and it has panned out for me.

It will be rough initially, especially after the honeymoon period. I cried after work most nights the first 6 months I returned back to work but I now know it inside out, I contribute to our protocols and structure and I've made a great career out of it.

On top of that, of the 3 aspects of HH, patient care, collaboration and documentation I love 2/3rds of my job. I love 2/3rds of my day everyday. And I don't even hate the documentation, it's just exhausting sometimes.

It's an investment of time and energy to make it into something you want to keep.

Kcattanp · Jul 24, 2015

I have been doing home care for 7 years. I transferred from a step down unit. Both positions have stress, just different types. Sadly, there is no such thing as an 8 hour day. And that is due to the amount of paperwork that is required. When I get home, the last thing I want to do is bring my work home, but I must. Then there is the traffic, parking, being out in the elements, the wear and tear on your vehicle. And not to mention, if you saw one of my posts, once you get in to home care, it's difficult to get out. Recruiters do not view what you do for the patients as skilled nursing care. I actually had one recruiter ask if I do any "hands on care" in the home. Patients for the most part can be wonderful, but you do have some unsafe, bug infested areas that you may need to go to. I guess I'm just as burned out as you are right now. But these are the facts. Think before you leap.

thenightnurse456 · Jul 24, 2015

I agree, home health isn't relaxed at all.