Thinking about switching to HH nursing....Q's

XYRNMN · Apr 7, 2007

Oh, and if I have a choice, is hourly pay or pay per visit generally better.

I've got a mortgage, two cars, and am living right up to the limit of my means, so I couldn't afford to have inconsistent paychecks.

Thanks, -K

floridanurse65 · Apr 7, 2007

Hourly or is better....more stable paycheck anyway. Unfortunately, the trend is towards per visits for a lot of companies. I just left my 2nd home care position due to per patient pay. I love HH. I just can't afford it anymore. I'll be switching positions with you. I'm starting 12 hour shifts on a med-surg floor on Monday (day shift). I originally turned to home care because I was a burnt-out, exhausted Dialysis Nurse. HH really did make me enjoy nursing again. There is a tremendous amount of paperwork, so prepare yourself. I don't have much negative to say. If I could have budgeted my money, I would have stayed in the field. Per patient is awesome when you are busy. You can make a lot of money, but you sound like me in needing to know what your pay is from week to week. If you can find a company still paying per hour then go for it. I'd probably even stay away from salary at this point. Good luck with your decision.

CapeCodMermaid, RN · Apr 7, 2007

I was in management for years and was passed being burned out...I was crispy! I moved to HH about 8 weeks ago. I don't want to sound like Pollyanna, but....I was having a hard time adjusting from the rules filled world of LTC to the it's the patient's home and they are in charge world of HH. I was getting ready to quit.

My first patient on my own case load....87..husband lives in a nursing home. She's diabetic with a stage 3 on her heel. So in I go to do her wound care and her med box prefill and teaching. I was getting ready to leave and she said to me, "Dear, I hope you're my nurse every day, but even if I never see you again, you have already made a difference in my life."

That's why most people do HH nursing. You CAN make a difference in the lives of your patients. My friend who has been in HH for years told me when I was thinking of going to HH said: here is the patient------------ ------------here is the hospital or nursing home. YOU are the one standing between them and the hospital. You make a difference every day.

As an aside, you said "As I am a male, my friends said.........." What the heck difference does your gender make when you are a nurse?

XYRNMN · Apr 7, 2007

Thanks for the replies thus far!

Either people are logging on before going into the ol' salt mines, or they just got off and are heading to bed (like me).

Those "thank you dear, you're wonderful" moments ARE what I love about nursing!

Really warms my heart inside.

To think that I could see the same pt.s over and over and REALLY help them in the long road of recovery or living with illness, that is what seems to attract me to HH right now.

Sure, every week or so I get one of those moments in my current hospital job, but interspersed between those 'highs' are tons of staff-infighting, pettiness, having to sign of on yet another made up competency (that the hospital invented, not anything 'real' like JCAHO or the State requires, although there is that of course as well).

To make matters worse, the hospital has fired/displaced ALL night IV nurses, and ALL night orderly/escort staff; meaning I have to try and fail a stick x2, then the charge RN has two attempts, then we are supposed to call anesthesia, who of course are delighted to be called at 0'dark30 to slip in a butterfly on a renal pt.

And we RN's have to do all the transport to and from OR/ER, which happens alot on our unit at nights, even though the suits think we just dim the lights and babysit while reading novels and surfing the web! :angryfire

Mgmt says this is all about cost-cutting.

Fine, they have a bottom line, that's real life.

However, in the same pay period all these staffing changes took place, the hospital outfitted EVERY unit with an $8000 refrigerator that has a little thermometer and radio in it, and if it goes too warm it dials up some nerve-center in California, and a light beeps on some guys screen, he pushes a button and adjusts the temp remotely.

Fancy huh?!

Of course, all the fairly new fridges we had were checked every morning by an NA, who would document the current temp and adjust it with two fingers if necessary.

So, the hospital claims it's bleeding money and it trying to stop the leak, but instead is hemmorhaging more money than you can shake your stethoscope at.

See why I'm burnt?

Whether I go to HH or something else, the winds they seem a changin'.

-K

CardioTrans, BSN, RN · Apr 7, 2007

I have been doing home health off and on for almost 17 yrs. If I get burnt out in home care, I go back to critical care.....then back to home care...... Its all I have ever done.

Home care can be the most rewarding nursing that anyone can do, when I say home care I am also including hospice with that. At the same time, home care can be the most aggravating.

Some of the aggravations of course can be the rules that you will have to learn about Medicare. Some of the aggravations are the families of the patients that you are trying so hard to take care of. You will have families that no matter how hard you try, they just wont do their part in taking care of the patient. They wont have the patients meds filled, they wont do the wound care, they wont take the patient to the MD, etc. Then you have the families that cant do enough for the patient and will be all in your business.

The paperwork, as said previously is horrendous. Just when you learn the rules Medicare goes and changes them again. You will learn a totally new side of patient care. You will have to case manage the patients, you will know everything about them, their finances, their families, they will become like a family member to you and you to them. You will be the one that they come to trust. Sometimes they will call you for advice instead of calling the doctor. You can teach them things about their medications, their disease process that they never knew before. You will teach them things that only once used to be done in the hospital. You can teach them how to do IVs in the home, how to do wound care, how to give injections, etc. You will help them maintain their independence in their own home as long as possible.

Some of the non-clinical benefits of home care......... cards from the patient or family on your birthday or Christmas, little goodies that they make, fresh veggies from their garden, etc. In home care you are not supposed to take gifts etc from patients. You would be surprised how sneaky these patients or families can be. You will turn your back or leave the room to wash your hands, then when you leave and open your bag at the next patients house, the previous pt will have put something in it for you.... they send things to your office for you....

Over the years I have had patients send me little gifts to the office, one was a ceramic dreamsicle angel in a wagon.... with bandages on a teddy bear.... from a pediatric patient, I have had roses sent to me from a patient when I was in the hospital, had a patient give me a Santa ornament for my Christmas tree because he knew that I collected Santas, had a patient give me a handmade afghan that his mother had made, he had packaged it up, and mailed it to my office because he knew that I wouldnt take it. Have had letters mailed to my supervisors about their appreciations of things that I had done to help them..... they have mailed letters to their docs........ the list goes on and on........ I am sure that I am not the only home care nurse that have had these done......... this is just an example of how home care nurses touch the patients lives and we are just doing our jobs by taking care of them the way they are supposed to be taken care of..... the whole patient, not just a system or diagnosis.

There will be days when you wonder what the heck you have gotten into, there will be days that make you completely crazy, days that you will be mad at the world, at the healthcare system, and that make you question your career choice. There will be days that you cry with the patient, that you laugh with them, that you will go home at the end of the day knowing that you made a difference, no matter how small, in someones life.

There is a HUGE learning curve in home care. The paperwork is totally different than anything you do in the hospital, the Medicare rules and guidelines are different, you have to be an organized person, you have to have superior assessment skills, clinical skills etc. You are the only one in the patients home. You are the eyes of the physician, you will come to know your patients so well, that you can walk into the patients home, without saying a word, and KNOW something isnt right. You have to be up for change. You may start your day out at 8am thinking you have X amount of things to do, only to have it completely change by 10am, then again at 1pm. Flexibility and organization are two very key things in home care.

Salary vs per visit........ sometimes per visit is the best........but if you dont have a lot of visits, your pay check will suffer. With salary, you have your set pay, but at times you will work more than 40 hrs a week, sometimes less. Its a toss up. Both good and bad with each. I have done both, loved and hated both.

Please dont think that I wrote any of this to discourage you from home care. I wanted to place light on some of the things that people dont think about when it comes to home care. Some people who work in the hospital (nurse and physicians) think that home care nurses only do home care because they dont have what it takes to work in the hospital. That is total BS. I have seen many hospital nurses come to home care and quickly run back to the hospital because they dont have what it takes. They come into home care thinking it will be a cake walk, its not real nursing, that its a job where they can relax and have tons of free time. That is not the case at all. Yes there are days that you do have free time. There are days that your schedule will allow you to go to the doctors appt that you have, or run by your childs school to watch their program, etc..........then there are days that you wish you could just have 5 min to breathe.

If you are unsure that home care is what you want to do, I encourage you to call a home care company and ask the director if it would be ok for you to ride along with a nurse for one day to see if you might be interested in moving to home care. I have allowed nurses who were thinking about it to ride with one of the nurses, some come back and say they want no part of it, others have come back and asked when they could start.

I wish you the best in whatever you decide to do!!