The good, the bad, and the ugly about home health

imintrouble, BSN, RN · Dec 14, 2011

I am thinking about HH too. Have been mulling it over for months. Safety, as the OP mentioned, is a concern.

Would really like to hear the facts from the experts too.

prettymica, ASN, BSN, MSN, LPN, RN, APRN, NP · Dec 14, 2011

I work home health 3 days to be considered full time. Sat- mon. I like the majority. One thing i don't have control is scheduling. One day I may have to get started at 4:30am to go give insulin the next I may have evening insulins.. Lately I has lots of free time sitting in an office alone waiting my certain times to see certain patients. Also having them sign my pc to say I was there and fill out a chart in the patients home to say I was there. I also work hospice and I see the patients whenever I please, no signature or in home chart

schooldistrictnurse · Dec 14, 2011

I worked home health many years ago and the independence was both a plus and a minus. You don't appreciate how much you bounce ideas off of your fellow nurses, plus the social interaction at lunch and break time. But doing your own problem solving and planning can be a great joy.

As for safety, part of the area I covered was so-so--I used to place a call to my next patient from the current patient's house (yes, before cell phones!) so they could watch for me. One family used to have me wait in the car until they came out to walk me in. As long as you stay aware of your surroundings and act business-like as you're out in the street, you should be ok. The agency I worked for had escorts for pm calls. (by that I mean a man who rode along with you, not the other kind of escort!)

bigdinks · Dec 14, 2011

The reality is you cant really have a day off. Today is suppose to be my day off but I have had numerous calls from the office, request to admit a new pt,

paperwork to finish. And if you have a pt/inr to draw, its when the md orders it

and may be on your day off. We do alot of pt/inr, and sometimes docs dont call you back till the evening or next day. Then you must contact pt or family to make sure they know the coumadin dose. This wk has been rough with a pt

drunk and crazy at 9am and a druggy in a bad neighborhood. You really never know the full history of the patient or the family dynamic till you walk in that door. Thats the bad, the good is your mostly work with nice people that appreciate your help. They get to be like family. Just didnt want you to think

you could only work 2 days a wk cause usually it doesnt work out. Also I'd

love to not hear " you cant come till after 11am" That seems to be when the

older people are finally up, dressed and fed brfst. hope this helps

StrwbryblndRN · Dec 14, 2011

I currently work med-surg overnight. I have 2 kids and have been working nights for over 4 years.

I did HH for 6 weeks. I hated it. Five days a week with work to take home.

Someone told me that it would take a year to acclimate. Well I did not want to wait a year for my kids to be able to see me again. Plus I cried everyday, all day except when I was with my patients. I loved them.

I quit and went back to my med-surg job. I was happy again.

Many people I work with did not like HH but there are some who left and loved it.

merlee · Dec 15, 2011

I loved Home Health, every minute! Depending on where you are, and what your territory is, safety may be a consideration. When I worked in New Orleans, in one neighborhood a woman sent her kids out to mind my car. In Indianapolis, I had to tell a patient that I wouldn't see her unless she got rid of her gun!

But overall, in 7-8 years, I made hundreds of visits, and only felt nervous on a few occassions. And I am certain I made a difference to many, many families.

Every position is different, every agency works a bit differently.

Best wishes!

Bklyn_RN · Dec 15, 2011

The bad:

1) Very high staff turnover.

2) As the newbie you will get the pts that no one else wants.

3) Parking issues and parking tickets, if in urban area.

4) Pt's who do answer the door or phone. Then you drive away and they call to ask why you didn't show.

5) Pt's with too friendly or unfriendly pets.

6) Pt home hygiene issues. Carrying bugs etc with you to your car, or home. Inadvertently of course.

7) Inability to cook when you get home or help your kids with homework because you have unfinished paperwork that have to be handed in the next day.

8) Pts living in elevator buildings with broken elevators.

9) Oppressive amounts of paperwork including OASIS.

10) Recerts of pts due when you are covering someone else's pt.

11) Sexual advances by male pts.

12) Shoulder pain from carrying a heavy bag.

13) Pts who insist that you take off your shoes. When its obvious their floors have not been cleaned since the inquisition.

14) Pts wife's who think you dress too provocatively when you don't.

15) Supervisors who call pts behind your back to confirm that you visited them.

16) Supervisors who call you constantly to make sure you are not out shopping (but sometimes you are :)

17) Pts who pretend they lack the manual dexterity to administer their own insulin, even with the insulin pen. But you see them open a can of tuna during a visit.

18) Pts relatives who act like you are their nurse. And want your advice on all manner of physical ailments.

18) Pt who insist on smoking during the visit.

19) Pts who always want to feed you when you arrive and you feel bad refusing so you stay and eat or take the food item with you. Because you realize that they are really just lonely.

20) Feeling sorry for pts and allowing yourself to go outside your professional obligations to help them with personal matters. Like buying them groceries etc.

The good:

1) Meeting really nice people.

2) Being able to run personal errands while working.

3) Variety in your daily routine.

4) When you finally quit, being able to say that you did it.

HIPAA · Dec 15, 2011

Bklyn_RN's post is awesome, especially if you live in an urban area.

seemerun · Dec 15, 2011

I had a good experience working in home health. I did it for 4 years and just quit 3 months ago to get back into acute care.

I liked the scheduling. We had computerized charting so much of my charting was done at home, after the kids were in bed while watching TV :-) Or sometimes I would chart in a coffee shop and feel like I had the best job in the world.

It's nice to be out and about instead of cooped up in the same building for 8 or 12 hours. I also did not have problems with "working on my days off". I would call MD's and such during my working hours but if they did not call back it I wouldn't sweat it. We have a "team lead" nurse (sort of like a charge I guess?) who worked strictly in the office as well as case managers who could follow up on things that did not get resolved on my work day.

That potential for threatening circumstances are always there so you have always be aware but in 4 years I never had a situation where I felt threatened. Grossed out by disgusting homes? YES! And some safety concerns related to driving to rural locations in inclement weather. But never threatened from a patient or family member

Ultimately I quit though because a home health nurse was just not where I wanted to spend the rest of my career. So I am back in the hospital and hoping to progress to a specialty in the next couple of years. ICU, L&D or PACU are my top picks right now. :-)

bigdinks · Dec 15, 2011

more cons:

If your ppv and the pt isnt home/doesnt answer, no pay.

you spend time the night before, not paid, setting up your appts.

My tire had a blow out 300.00, not paid.

If census is low, there goes your paycheck.

Sorry for being a negative nancy, it was a bad week!!

nursearoo · Dec 31, 2011

Hello to all home health nurses!
I moved this from the specialty forum since there were no replies. I don't think as many people check the specialty areas as much lol. Anyway...
I am a newer nurse and work in the ICU now. Home health has always interested me ever since the few clinicals I had experienced in home health as a student. I really love my job in the ICU now since I am learning a ton, and get to provide the kind of care I want to provide for my patients with the lower ratios. I am interested in home health not in the immediate future for that reason (since I do intend to stay where I am now, but possibly down the road when I have a family/school-age children). How are the hours? I think having years of experience in acute care would help me; I know some people do it, but I personally wouldn't be as comfortable being a brand new nurse working in home care since you have to be completely independent. I don't know, though, I really like the ICU, so I may want to try to do both somehow in the future (maybe doing one just PRN and the other part-time to keep my experience varied).
Also, anybody work 2 different nursing jobs, have a family, and find that your schedule works out? I think it would be kind of nice to have a varied nursing experience from week to week, help prevent burn-out in one area. Today, for instance, I go to work, and I got to teach my new diabetic management of their disease. Tomorrow, I may just have a terminal wean or someone go to the OR emergently, etc.
Are the hours conducive to family life? Anybody just work home health just 2 days a week? I really enjoy educating patients, so I feel like there would be more opportunity to do this here. I really think I would enjoy the autonomy home care provides (that is why I love the ICU, more standing orders, etc). Also..safety issues. Do you feel safe on a day to day basis going to patients' homes? Safety probably is my biggest concern; I don't want to feel threatened going to work every day.
Hope you all have a good shift, and thanks for your wisdom!

Ugggh! I have been doing home health for quite a few years and it has it's many positives, but also negatives......families not telling you of any new MD orders or changes, and finding out AFTER the fact.....also having teenagers trying to tell you how to perform your nursing duties......can be really aggravating at times....I actually had a teenage girl of 14 who is my patients aunt talk as if I wasn't even there......patient kept passing gas, and would make comments to the grandparent.." is xxxx sitting in a poopy diaper?" and when I was checking vs, the aunt would say something like " does xxx have a temp?" ...one time a while back the patient had a temp & as I was writing on the MARS to give some Tylenol..the teenage aunt runs to the parent to tell the patiet had a temp...and made me quite ****** because I hadn't even got up yet to go let the parent know...this was literally all within 1 minute...so I hear "can you come here for a second?" by the parent.....kind of made me feel like the aunt was trying to make me look like I was not doing my job......I was very mad....I wanted to say "look here you little xxxxxx, let me do my job & you just be the kid"..of course I bit my tongue....but stuff like this can really make you dislike your job at times......now I do mmy job very, very well...I have a couple of patients I have been with since they were 1st home...and the families actually request me to work there full time because I take such good care of their kids......You have to just sometimes let things not try to aggravate you but there will always be something or someone to make you dislike your job at one time or another.........