Starting HH job in a little over a week... I've got questions/worries

[NurseCard, ADN]

So as the subject says, I'm starting a HH job in a little over a week. I'm SUPER excited but also I've got many questions and concerns...

The insurance stuff... private insurance, medicare, Medicaid... all of that worries me and always has. Will I be able to learn it quickly. I'm apparently not going to be a case manager, just a field nurse, FYI.

My IV/phlebotomy skills... they aren't great. Wound care, tube feedings, giving injections, foley cathethers, various dressing changes, disease management, diabetes management, COPD, CHF... drawing from ports, PICCS, central lines.. changing the dressings... SURE! NO PROBLEM. Sticking people's veins... yep, I'm worried. I looked online for phlebotomy classes in my area, but they seem to require much time in a classroom, followed by clinical hours. I just want to take a couple of refresher classes, or three, or four.... any advice??

Oh, one other big concern... my ex sister in law said that HH nursing is a bad area as far as patients and families trying to file malpractice suits, trying to sue you, saying untruths about what you did or didn't do while in the home... yadda yadda. Any advice there?

Thanks!!! Again I am really excited!!!! Can't wait to start!!!

Again, I'm super excited and willing to learn all that I can.

[MyUserName,RN]

I'm interested in the answers to your questions too. I also am worried about the phlebotomy skills....we'll see how it goes!

[anh06005, MSN, APRN, NP]

Your agency should give you time to learn everything regarding insurance stuff. I mostly get Medicare and I try to apply their rules to everybody lol. Many of the other insurance companies deal in 60 days "certification periods" like Medicare thankfully. Private insurance you may need to get visits preapproved (eval nurse will go see pt, do start of care paperwork, call or fax insurance company asking for how many visits they think they need). If when you use up those visits you need more you just call the insurance company and request more. It's just a matter of keeping count! Medicare you can go out basically as much as you NEED to. If there is no need then they may not pay. If there is a NEED they will (such as daily dressing change but no family around).

As for phlebotomy stuff....if your office is associated with a hospital at all they might can send you around with a phlebotomist for a day. I know one of my coworkers went around with a phlebotomist one morning because he wasn't sure in his skills. I wasn't confident in IV skills so my boss set it up for me to go to outpatient surgery and start their IVs for that morning. Might not hurt to ask.....

And as in any area of nursing you will have the "problem children" who try to nit pick. I haven't had any issues with patients and in home health they actually seem to be more appreciative of your work because they are back where they are comfortable! Just make sure if there seems to be any sign of potential trouble with a patient or family you let your boss know and you DOCUMENT. If one of us has trouble with a patient sometimes we change who the primary nurse is just to see if they have better luck. There will ALWAYS be personality clashes!! We also have a place for the patient or caregiver to sign on our documentation showing we were there....REMEMBER TO DO THAT so if the patient ever came back saying you weren't there you have proof (apparently it came up one day in our office...but the patient didn't have the greatest memory).

Home health is a whole different ball game from anything else! You are on the PATIENT'S turf and will see a whole new world and experience a ton of new things! As I said patient's seem more appreciative that you are coming to them in their home. As a field nurse you develop relationships with these patients and they learn to trust YOU and YOU alone in some cases. When you first catch a problem (like CHF weight gain or a recent pneumonia with a SpO2 reading down 3% points) and get early intervention and avoid a hospital visit you feel great and the patient loves it as well.

Good luck!