The reality is home health care is where the jobs are.

[paradiseboundRN]

This is the new reality. Medicare wants patients out of the hospital as soon as possible and does not want them readmitted (at least within 30 days). So one of the specialties with the most jobs for the near future is home health care. Home Health keeps patients out of the hospital. I want to bring this to the board members attention because I see a lot of posts from new grads about starting in home care. No, home health it not a good place to start your nursing career because you need the experience of the hospital. However, the problem is that many cannot find a job in a hospital to gain that experience. I get it! You want to work! You want to be a nurse! You want to make money and use the knowledge that you worked so hard for! Ideally, after about 2-3 years working in the hospital you would be ready for a job as a home health nurse. But unfortunately times have changed and they are not adding hospital nursing jobs. So unless some of the hospital nurses retire or leave there are no jobs there. So how do we solve this problem? The only answer I can think of is to lower our expectations of experience to 1 year of hospital or long term care nursing. Also to have new grads work with an experienced preceptor for the first 3 months or more when starting in home health. What do you think? How do we solve the problem of --How do new grads to get their experience to be home health nurses?

[paradiseboundRN]

I agree, but the question is...How do new grads get experience if there are no hospital jobs??

[LadyFree28, BSN, LPN, RN]

I started out as a new grad in HH. It allowed me to learn to advocate, hone my assessment skills, make decisions that will benefit a pt, be comfortable in interventions regarding sending pt's out, HCP collaboration, educate and. collaborate with families, and acquire a multitude of skills; ie trach vent certification. The current agency i worked with was very supportive, you shadowed with a HC nurse, even if you have experience. It really depends on the agency, as well as the person. A lot of HH position gives you opportunities to do complex wound care, and infusion therapy. If anything the more complex the pt , the opportunities to move into acute care can happen. My HH experience allowed me to be hired in CC, as a new RN...so there is a plus in being in HH, you have to be receptive of it. And most facilities are aware if how many complex pts are going home and receive HH services...HH can be as highly skilled as acute care, just with one pt. With the RIGHT type of agency, you are never alone.

[grneyes8]

I agree wholeheartedly with QueenNasus! There are some things that you can only learn from experience and I don't feel home care is the place to learn. You need to be able to walk in, look at that pt and know if something isn't right! There is no back up in the home, you're it and one bad move could cost a pt their life!

[paradiseboundRN]

I agree wholeheartedly with QueenNasus! There are some things that you can only learn from experience and I don't feel home care is the place to learn. You need to be able to walk in, look at that pt and know if something isn't right! There is no back up in the home, you're it and one bad move could cost a pt their life!

I agree. But how are new grads going to get their experience if the hospitals are not hiring? We all agree what's best. But what about reality?

[grneyes8]

I know that the hospitals aren't hiring new grads but a new nurse in home care could lose her license pretty quickly if she doesn't know what she's doing. Ideally they would offer extra training to new nurses but we know that probably isn't going to happen in most cases. They're going to want them out there making money. Not sure what the answer is.

[LadyFree28, BSN, LPN, RN]

I started out as a new grad LPN in HH. The companies I have worked for in the Northeast have at least 20 hours of preceptorship for a new grad, as well as the Clinical managers who make weekly visits, as well as classroom time before you are out on the field-experienced nurse get 8hrs class room and 12-16hrs preceptorship ...these are the requirements set by Medicare and insurance companies to make sure they are compliant-as well as Joint Commission standards. It does depend on the company you work for, if its Joint-Commission based, expect that process. You also don't get a complex case in the beginning, regardless of your experience. The purpose is to make sure you are comfortable in handling basic nursing care..give you opportunities to build on complex skills by going through educational courses, making sure you can handle a complex case, i.e. TPN/infusion, trach/vent cases, wound care visits, etc. The educational/competency evaluation is more if a liability issue, so if you don't think you are getting enough education and support, you can always report them...they want to be accountable to provide safe care so they won't be dinged by the government, as well as lose a case-they will be hit double time if they did not have education on risk management, ethics, documentation, safety, all the things that are required to be aware of as a nurse.

I found that most of my co-workers were able to get hospital jobs, especially in critical care, because they were trach-vent nurses...there are ALWAYS a shortage of trach/vent nurses in home care, especially in pediatric HH. I am grateful of the support that they were willing to be always available to support me, as well as the critical thinking, and advocacy skills I was able to develop in HH. I am a better teacher to pts and families because of HH...I think there is a MYTH that HH nurses can't cut it the hospital, but that's the opposite...it seems like hospitals are taking in HH nurses (like myself) and HH is welcoming hospital nurses with open arms, for the invaluable skills that both arenas possess.

[nekozuki, LPN]

Certain home health jobs are ridiculously easy to get into in my city. Within 1 week of taking the nclex, I walked into two pediatric HH agencies and was immediately offered employment. One wants to start me on patients with g-tubes only, the other wants me to start trach care right away. I was blown away by how one can get a job by simply showing up. The pay is comparable to LTC's in my area, and it's an easy way to get your year of experience. In fact, the recruiters use that as a way to get LPN's to sign up, advertising that you can work for them and receive no benefits/per diem work, but they will grant you what is so difficult to get: new grad training.

It's a scary world out there sometimes.

[camping_RN]

Hi JMichelle59, I tried to figure out a way to direct message you so that I didn't have to comment on this thread about something unrelated but I am a new grad who just got a job in HH and after reading all of these comments on here about what a bad idea it is, I am terrified. What was your experience like as a new grad in HH? Thank you for any advice you can give me! :)

[MissRigg]

I think this thread has a really interesting point for myself. I'm a fairly new grad, ive been a nurse for 2 years now. When I graduated I couldnt get into a hospital, which is where i thought I belonged, and worked for about 6 months in a neurologist office, while part-time doing home health. My DON was always available to me, and because I was new i asked her regularly to talk with me post visit to make sure I was on the right track with my careplan, but low and behold, with a little less than a year nursing experience my DON retired and I was promoted to clinical manager. I totally get the experience required aspect of home health as a manager, when looking a potential hires, but also when i hire a nurse, i am really looking for someone who is active and interested. My motto is something like when I was in nursing school, I tell all my nurses this: you don't have to know everything, but you absolutely must know when there is a problem, and know to call me in the patients home if you note it. That way I can help the nurse to make the right interventions. I will say, I took to homehealth REALLY well. This is a dream come true job for me, before being a nurse i was a home aide, so I'm familiar with care in the home, and the MAIN reason i wanted to work in a hospital was because I wanted to teach patients health management, which I always felt was lacking- i feel like the areas I was interested in in school, play very well with the things I do as a home nurse.... I think the ultimate issue is this; if a new grad is hired, the agency needs to plan for inexperience in judgement, and plan to offset this by regular and diligent follow up. My DON only made one joint visit with me, and then I had several here and there joint visits to learn specific skills with other nurses, but she was 110% available to talk to me about my concerns and the issues i noticed during a visit, and in turn she helped me learn how to solve them

[HelloWish, ADN, BSN]

New grad residencies in home health like they have available in hospitals would make new grads starting out in home health gain needed experience or just and old fashioned internship.

[HDHRN]

I have been a nurse for a long time. I started my nursing career in 2009 as an LPN. I could not find anything full time and decided to pick up PRN at a few places and finally got a job at a LTC facility. However my friend worked at this home health company and I loved how she set her own hours and made great money. I finally got hired there and they had so much for me to do, it made me go PRN with my other job and eventually I quit altogether. I worked for them all through school to get my RN. And I already had a job when I got my license in 2016. I have been case managing since. I love it and don't plan to leave home health anytime soon. My son is autistic and I don't trust him with anyone except family and few close friends. So the flexibility is very nice.