Snf Or Hh?

Genista, BSN, RN · May 2, 2006

I work acute care, but wanted to share my experience with investigating a HH job opportunity. I job shadowed a HH nurse as a student, and it seemed like a very interesting job with a great deal of autonomy.I still think it would be a neat job if the conditions were right.However, I have a caveat for you...

About 2 years ago when I was feeling burned out from floor nursing, I interviewed for a HH position. I had 6 years acute care experience at the time. I set up an interview with the nurse manager of the HH agency.The position offered 1 week of orientation (sounded more like a 4-5 day orientation which seems crazy to me). One week of orientation before you fly solo in a new specialty? This involves learning OASIS and their computer system, etc.I have heard it is challenging to learn the paperwork. Where's the compromise or willingness to see what an individual needs as far as support? I am fairly confident with clinical skills, but would have liked to know that I could have more orientation if needed. This was red flag #1.They offered 1-2 weeks, but as the interview progressed, it sounded more like "well, you'll get about a week's worth...a work week of 4-5 day that is."

I was told I would have to be on call some days, and they paid $12/day on call (if I didn't take call that is...just for stand by pay). That part really bugged me. I don't take call at the hospital. The idea of not being able to make any personal plans while on call and being paid $12/day was insane. Red flag #2.

Also, the nurse manager was telling me aboout the paperwork, and how it could be done in 40 min. or less, and that you are paid per visit, not allowed luxury of time with patients (hmm sounds a lot like hospital work). She said many of her team charts on their own time after work (unpaid OT) but that SHE KNOWS it can be done on the job, at patient's home. These were all HUGE red flags for me.

I left the interview feeling like she was grilling me to see how much of a team player I would be, and I couldn't believe they were asking for so much from me with so little perks to offer! My hospital job is 1,000 better in perks (pay, no on call, benefits, nice staff, flexible shifts, etc.) I at least feel appreciated and valued at my present job! Holy cow, I've NEVER been treated so shabbily and felt so devalued as a nurse as I did when leaving that interview.I am used to being wanted and respected, so, I have had a sour taste in my mouth about HH ever since.This was from one of the big name agencies, by the way. I imagine some HH agencies are better, though. Maybe smaller ones are more down to earth.

If I were you, I would also try & arrange some job shadows! ;-) I am so glad I didn't leave my present job for that HH agency. It sounded like jumping from a frying pan into the fire. However, I know that you may find a great HH agency. Sounds like a good sign if they are being friendly and willing to work with proper orientation, etc. Just make sure and investigate fully! I wish you luck & hope you find exactly what you are looking for!

nurse100 · May 2, 2006

I haven't done Hh, but plenty of SNF. To be honest, you won't find a whole lot of difference between LTC and SNF except SNF requires more documentation :-) and some of the patients eventually get to go home. It depends on the SNF you're working at but at mine there's really nothing much happening in the area of using skills except F/C's, G-tubes, wound care, and sometimes IV's.

Noryn · May 5, 2006

I agree about skilled nursing floors and long term care being similar, especially since many long term care centers have skilled sections.

I did home health briefly and being on call sucks bad. We were paid 500 a week plus reimbursed for mileage if we had to go out. That is just about the worst part of the job--everything else was great. I really didnt feel rushed, I could spend time with my patients. Although I did hear horror stories about a competing home health agency. I usually saw 4-5 patients a day, some visits would take literally 15 minutes while others may take an hour.

I also heard horror stories about the paperwork but to be honest it really didnt seem that bad to me. I had basically 1 sheet to fill out after each visit. The recerts took probably 25-30 minutes and new admissions took about an hour. I thought it was much less paperwork than the hospital or nursing home, especially now that in the hospital you are supposed to assess everything that is not really important (a patient having an acute MI and I am supposed to be asking about how they learn the best :uhoh3: ).

If you have worked an acute floor for a year, I think you are probably ready for homehealth--perhaps another year would be better but why dont you take a prn job at a home health agency and see how you like it? There are a lot of advantages to home health nursing.

Renashia · May 14, 2006

I have worked as a CNA on a SNF, a RN in an Acute Care Hospital, a HH RN, and now as DON at an Assisted Living. Hated the hospital 1 RN, 1 CNA to 12 patients on a 12 hour NOC shift, on an overflow Truama unit. CNA at a SNF was frustration and the nurse where always over worked and understaffed. Home health I loved. Though I defianlty agree about the "red Flags" Kona2 brought up. Our HH agency was fairly well run. And if all you had where re-visits (not first time visits) the paperwork was acceptable and the home visit was about 30-45 minutes. Then there is the evil OASIS, which on AVERAGE took me 4 hour to complete (including the other admission details, med review, excetra). My company kept telling me that I should have the OASIS/home visit done in 2 hours. Though in hindsite compairing the OASIS to the MDS, I'd take the OASIS (at least all the questions where pertinate).

If you really want to pursue a HH job, which I would recommend despite my rant above. MAke sure you find an agency that pays hourly, not by visit. Pays hourly for on-call and full salary for calls. Also look to be a case manager, it is much easier seeing the same patients weekly then seeting everyone elses patient (I was the weekend supervisior and 24 call person for the weekend for salary).