Starting per diem or take the full time plunge?

[smellyacres, BSN, RN]

Hi All, 

I've been a RN at the bedside 4 years, in the ICU for the last 2. I used to do LTC home health assessments on the side (pre-covid), and loved visiting patients in their homes. I also have years of live-in caregiver experience from before I was a RN. Basically I've known home health is something I've wanted to do from the beginning, but didn't want to jump into it without first having a strong clinical foundation. I like my ICU job but I don't feel like it's my "calling" or anything. I do miss visiting patients in their homes. 

Based on your experience, would you recommend taking a full time home health position or starting per diem and working up to full time? Keep in mind I could always go back to my ICU job if I left for a while (they like me and are known to re-hire & re-orient nurses after leaving the bedside for extended periods of time). My thought process is that going into home health case management full time would really give me the opportunity to learn the ins and outs of the job, so I'd get better/more comfortable with it faster - and I could always go back to the bedside if I wanted.  On the flip side, starting off in HH per diem might be nice so I could keep my current job incase I decided it wasn't for me or didn't like the company, but it seems like it'd also take a lot more time to learn the ropes and actually get good/efficient at the job. Also, with my experience I already know I like the home setting and am fine with the charting aspect. I recently found out I have a connective tissue disorder and I'm basically a L&I claim waiting to happen, so that's another reason for considering leaving the bedside all together. 

I'm feeling an itch to do something different with my life, and hopefully find my niche, just undecided on how to go about doing it. I need to stay with my current company (large healthcare conglomerate) a total of 5 years to be vested in my retirement and have just under a year left, so my options are

1) full time home health job at same company

2) decrease current FTE and go per diem at a different home health company 

 

What would you do if you were in my shoes and/or had to do it all over again? 

 

Thanks ?

 

 

 

[qrnh, BSN, RN]

Stay at your current company until you are vested, then jump over to HH. If you have the bandwidth to do PRN on top of your ICU job then add that in. We all need to take retirement planning seriously, and no one knows it better than a HH nurse who sees people every day that for whatever reason don't have the resources they need in their old age.

HH agencies vary a lot by region/state because the laws affecting them vary. I live in a western state where it is law that HH clinicians are to be paid by the hour- and this is a golden law. If you are paid per patient or per start of care, there is pressure to rush through patients so you can make a living wage and keeps the lights on. The day you have a patient with 15 wounds that all need to measured, photographed, dressed, and charted on will be a day that you work very hard and make less- if you are paid per patient. Point being: try to avoid per patient pay if you can in your area. 

Also, patient care, continuity of care, and professionalism can be better in a hospital-associated home health agency. I've worked in both, and this has been true in my experience. If you have a choice, be associated with a hospital. Hospital HH tends to be non-profit, which is a plus for patient care.

Ask who the manager of the HH agency is, and expect it to be an RN. An RN  is going to have the right priorities (I hope!) when making business decisions that affect safety and patient care. You know, little things, like whether they provide fit testing for N95s.

Good luck! Home Health is awesome. I spent part of Friday on a mountain top providing nursing care, and I kept thinking "I love my job!!"

[smellyacres, BSN, RN]

6 hours ago, qrnh said:

Stay at your current company until you are vested, then jump over to HH. If you have the bandwidth to do PRN on top of your ICU job then add that in. We all need to take retirement planning seriously, and no one knows it better than a HH nurse who sees people every day that for whatever reason don't have the resources they need in their old age.

HH agencies vary a lot by region/state because the laws affecting them vary. I live in a western state where it is law that HH clinicians are to be paid by the hour- and this is a golden law. If you are paid per patient or per start of care, there is pressure to rush through patients so you can make a living wage and keeps the lights on. The day you have a patient with 15 wounds that all need to measured, photographed, dressed, and charted on will be a day that you work very hard and make less- if you are paid per patient. Point being: try to avoid per patient pay if you can in your area. 

Also, patient care, continuity of care, and professionalism can be better in a hospital-associated home health agency. I've worked in both, and this has been true in my experience. If you have a choice, be associated with a hospital. Hospital HH tends to be non-profit, which is a plus for patient care.

Ask who the manager of the HH agency is, and expect it to be an RN. An RN  is going to have the right priorities (I hope!) when making business decisions that affect safety and patient care. You know, little things, like whether they provide fit testing for N95s.

Good luck! Home Health is awesome. I spent part of Friday on a mountain top providing nursing care, and I kept thinking "I love my job!!"

Thanks for the tips!! Yeah I'm not leaving before I'm vested regardless - I might have the option to do HH full time now, within my current company, because they are associated with the hospital I work at now.  I'll definitely ask if they pay hourly, good advice. I also wonder how flexible the position is, like, can I schedule my own hours as long as I meet 40/week. And how they are supporting their employees through covid. 

I have an application out to a different HH company, per diem through a different hospital organization too, so I might start there. I know many patients and healthcare workers who think highly of them. Wasn't sure what the learning curve will be so I was more asking if its better to go full time right off the bat, or do per diem first (because with either option I can stay at my current company). 

Do you work full time? What are your typical hours and days like? How much charting do you do at home versus at the patients home?