Thoughts on switching to HH nursing

Tiffie1210 · May 19, 2015

I'm in the same dilemma except I have 2 years med surg experience in a hospital. I have a 3 year old I'm putting in preschool in the fall and would like to drop him off and have more time with him in the evening. I also have a 3 months old. I work 3 12s a week every other weekend and holiday. I recently applied and was offered an job in HH for the major hospital I work at I accepted the job and figure it can't be any worse than now. Even with 4 days off I'm exhausted! I start June 1st so I'll keep u posted!!

Libby1987 · May 19, 2015

I've worked in HH most of my career and I love it, it's my passion and I live and breathe it as much as anyone does their passions.

But I also took a number of years off to stay at home with my kids and then went back to a different home health (post Medicare reform) as a single parent which was rough. As well as have trained umpteen nurses new to home health, some stayed with it, some left a few weeks in.

So with that experience I can say that it is worth it and doable but it doesn't come until at least a year into it, really a couple of years. You have to give it a chance and go into it not because it will be a better schedule or not as bad as anything that inpatient can dish out. It is a speciality that requires just as much dedication and energy to learn as any other speciality. I have seen ICU and ER nurses come to us not because they dreamed of home health but as an escape of their burn out in their inpatient unit and of course we weren't what they looking for. It is not an ease of pace, the paperwork/charting is none like you've ever seen and you can plan on having to roll with a changing schedule.

What it is however is an entry to autonomy and quality time practicing your trade. And depending on your employer and your own flexibility and tolerance, you can set up your schedule to meet your family and personal needs.

It kicks everybody's butt at first, actually more so after a few months when you're expected to be productive. If you can stick it out, and you like the core work, it can turn into a good career.

ICU experience will bring skills that need to be adapted to the home setting, some nurses are uncomfortable with the different setting. Our patients have different problems that we deal within our scope. Some heart and kidney stuff, a lot of pain and GI symptom mgmt, advanced wound care, skin care, diet, chronic disease mgmt, medication mgmt.. all things you see in ICU but a different perspective and scope. We don't administer, as much as we teach patients to manage their own. All stuff that is learnable but it has to be done while jumping thru paperwork hoops and learning highly regulated HH guidelines (thank you Medicare abusers).

If you do go with it, there are posters here who are great at describing tips to manage and develop organization geared to HH.

NurseB2014 · May 19, 2015

Thanks for the input. I'm going to apply and see if an offer comes my way. It's a lot to think about.

adreamdeferred, MSN, RN, APRN, NP · May 21, 2015

First, I too am a new grad coming up on completing my first year working. I knew right from the beginning I wanted to do home health after I did my rotation in school. Home health does offer some flexibility and that was one of the draws for me having school aged children. With that being said you have to have a very flexible personality because your day can change in an instant due to changes in the patient's schedule, getting assigned a SOC, or arriving to find a patient in distress of some kind that extends your visit and throws off your schedule. Also the environment is not controlled like it is on a unit, you are a visitor in their home so in addition to not having access to needed equipment or supplies you have to deal with cigarette smoke, pets, uncleanliness, and other interruptions while you're trying to complete your visit so you can, again, stay on schedule. The learning curve to learn the rules and how to complete OASIS type documentation can be brutal and the time to complete paperwork can a lot of times run into personal time which can take away from family time. If you hang in there it will get better. I can tell you that even though I curse the paperwork daily I wouldn't change what I do for a living because I love my patients and the ability to meet with them on a one on one basis. I work for a good company and my supervisors have been great. All home health companies are not created equal. I have heard good and bad from both hospital and privately owned agencies. Look for a good orientation program and find out their expectations for productivity. If that is not reasonable, run. Mine is only 27 pts and all Oasis visits count as 2 pts. Some companies count SOC visits at 2.5 or more though. You also want to know that if you need help there is some available and you can feel comfortable asking. My first company I worked for on a PRN basis did not have a good mentoring program so when I did need help I felt like I was interrupting or annoying my colleagues. Ask some of the nurses who work in the HH dept about their day and how they like it to get a general idea of how things are there and take it with a grain of salt unless you keep hearing the same answers over and over. Home health is not ICU but it is certainly not easy. It is a specialty within itself with an increasing acuity due to health care reform. I get to perform various skills including running IV's, feeding pumps, blood draws, foley catheters, wound care/wound vac, lots of education, we also are trained to disconnect chemo pumps, we have had LVAD patients, trachs, you name it. You shouldn't be worried about losing skills is my point. Switching companies slowed my learning curve because the software was different and not very efficient but I am slowly getting over the change. After a while your schedule should become fairly predictable when you are out on your own. Your organization skills will be vital because there is a lot of autonomy meaning you can figure out how to complete your job but you must do it within medicare/CMS and company guidelines. There are visit frequencies that need to be met and time constraints or windows for SOC, recerts, transfers, supervisory visits, documentation etc to be completed. That's basically home care in a nutshell, besides the pay. My first job was pay per visit, now I am salaried with bonuses if I take call or work over, plus mileage. We have full time on call nurses so that is rare. I actually make more than I would make in a hospital doing straight time. If you decide to do it commit at least 6 months to a year to get the hang of it. Best wishes.

NurseB2014 · May 21, 2015

So I just woke up (I work tonight) and I have a voice mail to call back to set up an interview! I really don't know any of the HH nurses, only a couple of the hospice nurses (same company different office). I'm so afraid that I won't like it or that I'm not independent enough for HH. But at the same time, I want to find my "thing" in nursing and I know that ICU is not it.

tokidokifantasy · May 27, 2015

I have been working as a HH nurse for the last few months. I am doing Hospice + HH for two different agencies. It is the flexibility and the autonomy that really attracted me. The fact that I don't need to rush with patients calms my nerve, and you have ample of time with your patients. It is not easy job, because we have higher acuity patients than expected, so you have to think quick and know what to do. Charting is crazy, yes , you will come home and sit in front of PC and type away for few hours. It is definitely not like ICU, I don't know if you will really like it, but why not try out as per diem and go from there?

It's so great you have ICU experience, your opportunities are limitless. Good luck!

NurseB2014 · May 28, 2015

So I interviewed that. I think it went fairly well. I never have a clue after interviews lol. I know the manager pretty well, she was actually a childhood friend of my sister's. We chatted for quite a while after the interview (at her request) about how my sister is doing etc. I'm still so torn about what I'll even do if I get an offer. It seems like such a HUGE responsibility and it scares me, but I felt that way about ICU too and here I am, I've made it almost a year. I know I would still have a lot to learn skill-wise but I feel like I can handle that portion of it. I'm more afraid of the being on my own aspect and making the right decisions with little backup.

I did get a little more info about the position. If hired, I would be the 6th nurse, so the "rotating weekly call" was explained that I would be on call for a week once every 6 weeks.

It was also explained that the expected productivity is 55 units every 2 weeks. She sais a regular visit is 1 unit and a Medicare admission is 2.5. She didn't go into more detail than that. Of course they said they wouldn't expect that right away.

They said it takes 4-6 weeks to complete all the training.

Each nurse has a smart phone and a laptop for use in the field.

She said holidays were "business as usual" unless you had requested them off. If I get an offer I'm going to have to get more info on that, because it's the same company as my hospital, and we aren't allowed to request off holidays so I'm not sure how that works.

I know the position is salaried but I won't know about the pay unless I get an offer. The manager said it's usually a "lateral move" pay wise. The job listing says they have productivity bonuses.

This is such a hard decision. I'm gonna be totally honest and say that I really don't like my job now so I don't want something that I like less. I want more time with my family in the evenings, on holidays, weekends, and not less. My schedule is opposite theirs now and it is not fun. I really think I would like the opportunity to build relationships with patients. I know (from my previous job) that I would like not being trapped in the same spot for 12 hours.

HHRN81 · May 28, 2015

I worked ICU nights before moving to home health. I've been working in home health for 4 years now and absolutely love it. I'm an admission nurse, so I don't have my own case load. I love the variety and flexibility. I love never knowing what I'm going to be walking into. Every day is an adventure.

The charting is daunting. Our department has a 12 week orientation for nurses who are new to home health. It took me about a year before I was comfortable and felt efficient. I have 2 kids. I am able to take my oldest to school every morning and most days pick him up and finish charting at home. It's an autonomous job and that can be overwhelming for some people. You don't have someone right there to look at something with you. Best of luck!

NurseB2014 · May 28, 2015

I've looked through SEVERAL threads to try to find the answers to these questions without repeating then, but since I can't, here are a few questions for any that feel up to answering:

How many units per week do you work? What's reasonable?

What skills/services do you most commonly provide patients? What would you recommend I brush up on?

What's your holiday schedule like? Is it "business as usual" at your agency? Are literally gone 8 hours on Christmas day if it falls during the week? (prospect of this makes me sad, I'd rather keep my night job and function like I did last year without sleep) I'm more interested in what salaried nurses experience here, since that is what I'd be.

How often are you called when on call? What types of calls do you get?

I'm in a very poor, rural, southern area with a lot of farming. In the ICU we see mostly out of control / noncompliant diabetes, respiratory issues like COPD (lots of smokers), heart issues (a fib and failure the most) and sepsis. Of course I've had lots of ventilator patients, some trachs, some quads, etc etc.

HHRN81 · May 28, 2015

Our productivity expectations are 5 points a day for an 8 hour shift and 6 points a day for a 10 hour shift. This is very realistic. We get a point if our daily mileage is over 60. We see a variety of different patients: wound care, picc maintenance, enteral feed education, foley cath maintenance, chf education, medication management etc. I would assume that each agency different regarding call and holidays. We rarely do routine visits on holidays. Very few people will allow us to come to there home on Christmas. We have hospice in our office too, so holidays are usually hospice patients and home health patients who must have visits. How many calls you get is going to depend on your census and patient population. The majority of calls we get are hospice. The calls that I routinely get for home health are Foley catheter issues or other trouble shooting things. Each day is different, so there's not anyway to predict how many calls you'll get.

Libby1987 · May 28, 2015

I average 30 units per week. I'm PPV so I come out ahead pay wise, about 12K more.

Services are the same as HHRN except add post op CABG's and joints.

Holidays have been light for us, I haven't worked a Christmas or Thanksgiving in 8 years.

I haven't taken call in a few years, I have a PT nurse that gladly takes my share (again not salary and we are paid a flat rate plus our visit rate if we go out, and OT if applicable). It falls every 5 weeks I believe. We only need to go out on catheter problems for retention but opt to see others at our discretion, usually it's telephone advice.

I'm in a rural area, love the open highways. Some are close together in the housing developments.

We're paid 45 cents or so per mile plus hourly for any drives that exceed 30 minutes.

Any ICU can DO home health, it's more a matter of if you'll like it. Everyone loves the patient care aspect, that's always the draw, its 50/50 on the lack of structure, personally I love the autonomy, it's the charting and driving that always the deal breaker. And again, personally I'll take the charting at home to minimize daycare over having to be onsite.

The first year or two is usually rough for everyone.