Typical Day For A Home Health Nurse | Life of a Nurse

[hoolahan]

Not a bad day today... started back per diem today.

6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like I usually try to do.

8:00 am:6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that.

First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec steroids), reviewed her meds, VS stable, edema but no change. Off I go.

Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is back ordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re please give pt RX for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go.

Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now)

Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go

Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently, she was on spironolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back Thursday for labs. off I go

Next, funniest LOL, she answers the door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook and was taking her meds correctly. Then she pulls out five RX dated 1-21-03, two are new meds, but PRN types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason, she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relieved, she gives me a big hug. Off I go

Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad.

2:15 pm. Back to my township, drop wee wee at quest labs, drop off RX at the pharm, get to my house. Reheat leftover Chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much.

Worked on paperwork until 4:45, finished time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow.

Pretty routine kind of day today.

Anyone else want to share??

A Day in the Life of a Public Health Nurse...

 

[CapeCodMermaid, RN]

hello all,

thank you for your interesting posts. I will be graduating soon with my BSN in nursing and would like to get into home health. How long would would I have to be orientated before being on my own? Are you all making your own schedules, how does that go??

Any input would be greatly appreciated.

Bembcar

None of the agencies around here would hire a new grad. You really should have at least a year of med-surg to work for a HH agency.

[steelcityrn, RN]

Sounds like there are some private duty nurses and home health nurses here. Thats cool, just to let you know as a home health nurse, I have done very little lifting. Most patients that need asst. with transfers will have a family member or caregiver to help with that. As far as hourly wages, most nurses I know make around 25 per hour plus mileage. If your getting paid per visit, its around 40 for a visit, maybe as high as 70 for a admission, or other oasis paperwork.

[Catfish RN]

Wow, sounds familiar. With the going "Live", Kaiser any chance? I work at Kaiser San Diego. PACU cirrently.

[Catfish RN]

I think that if you told your client and her lazy husband that you were going to ask to be taken off of this case, ie: quit.. they would straighten up. You are being taken advantage of people because you are allowing them to do it. Since you have already paid for the cleaning supplies... buy a litter box and bring it with you. ( don't forget the scooper) Tell them that you will no longer clean the cat crap, you will not clean the litter box and you will no longer be doing chores that are not in your job description. If they do not like it... you will quit this assignment. Honey, there is always another job out there for CNA's.

[momof4ndocswife]

Hoolahan,

I just researched "home health" and came upon this thread you started. THANKS! I'm an "Old" new grad at 52 who longs to spend time with patients and came into nursing b/c I enjoy patient education, etc. I'm discouraged working on a hectic surgical floor for 12 hour shifts (runs in to 13 hours) where I race from room to room and rarely even have time to go to the bathroom. Working nights is tough on my body, but the only shift available for newbies, and I know I couldn't handle dayshift on this floor after seeing how demanding the care is for these patients.

I keep thinking "home health" might truly be where I'd like to head. My college roommate from my 1st degree (30 years ago) is a HH physical therapist and tells me she thinks I should go into HH. I know I need hospital experience first. Most jobs I've seen in the classifies desire 2 years of experience. I hope I can last that long on my present job! I'm learning a lot as I manage chest tubes, NGTs, wound vacs, drips/drains, PCAs, and do TONS of dressing changes... some quite complicated. We get a lot of "frequent flyers" with infected wounds, apparently.

I'm enjoying reading through this thread. I'd been thinking about asking for a transfer to an easier floor, but it sounds like I might be on the right floor to learn the skills I need for HH. I guess I need to tough it out! My daughter suggested I view this as my "boot camp" experience.

[catjmoses RN]

well here is my 10cents worth.... last year i was looking at this site and thinking the same thing (i'm a med-surg-tele nurse of 10 yrs and was atraveler as well). i was getting tired of the rat race as the rats were winning! i wanted to stay home from traveling but knew i didn't want to go back to the local hospital. after a summer of thinking and talking i took a job at a local vna. a very nice small place. everyone knows everyone and i even knew a few from when i graduated, so that was a good start. they have a pretty good training/orientation time so i felt good about that--being a traveler you have to learn quick ( and you need to know the computer)! i have been there now 4 months and it is a different ballgame!! half of what you learn at the hospital will not apply or will be retaught a different way. wound care--forget it! it is completely different! the hours well, i'm a true night owl and now i work 5 days a week from 8am to 4:30 with rarely a lunch and then sometimes i take my computer home to finish charting. and i (will) have 1-2 weekend rotations and a few night calls during the month (starting next month) i soooooo miss working 3-12 hr shifts!! you come home and that is it! and i took a $10 an hour cut in pay! our charting is on a computer--thank god!--and is nothing like what you've ever done. don't let the whole "oasis" thing scare you--it's just the regular charting that kills me. you can't just chart--you have to make every note stand on it's own. so you are charting much more. on the good side---it is nice to spend time with each patient in the home, but you have to be looking at your clock as you know you have more to do (along with the charting that goes with it). and keep in mind in the hospital you are in a controled environment, out in the field you never know where you are going or who you are going to see. or if the home has animals or is clean or what. it has it's good points. me i'm glad for the experience and i will give it one year but then i'm leaving. and....i live in the northeast and i'm out in the freezing cold many times in the day!! through the snow, rain, what have you---not for me! i hope i can make it intil a year. think it over well and go with someone for a few days before you accept a job---better yet transfer to another dept in the hospital! good luck cat

[annaedRN, RN]

Cat - I am sorry that HH is not working for you. I understand/agree with many of the things you say. But, I feel if you truly love HH you look at the same things in a different light. For example, my schedule is M-F 8-430 but my day often ends much earlier..and where else during those hours can you keep dr appts., swing by the bank or pharmacy, let the dog out to pee, etc and not need to use any PTO?I only have on-call every 5-6 weekends...much less than in a hospital. Or yes, I do finish up my charting at home sometimes...but I get to do so on my couch in my sweats..not stay over an extra hour after a crazy 12 hr shift. I feel that I do get to practice quite a few of the skills and yes they are often adapted for the home. IMO, hospital nursing is not always "real world nursing" b/c these patients (except for the very acute stuff) are going to be managing their needs at home and not in the fashion that it was done in the hospital. To me that is what makes HH so rewarding...along with the challenges posed in the home. I love that each new patient is a totally new challenge in a totally new environment. I love that I get to help this patient stay in their home!But, thank goodness everyone has their own "fit" for where they want to be in nursing - we need all the parts to make the whole! Good luck in wherever you go!

[jnette, ASN, EMT-I]

Cat - I am sorry that HH is not working for you. I understand/agree with many of the things you say. But, I feel if you truly love HH you look at the same things in a different light. For example, my schedule is M-F 8-430 but my day often ends much earlier..and where else during those hours can you keep dr appts., swing by the bank or pharmacy, let the dog out to pee, etc and not need to use any PTO?I only have on-call every 5-6 weekends...much less than in a hospital. Or yes, I do finish up my charting at home sometimes...but I get to do so on my couch in my sweats..not stay over an extra hour after a crazy 12 hr shift. I feel that I do get to practice quite a few of the skills and yes they are often adapted for the home. IMO, hospital nursing is not always "real world nursing" b/c these patients (except for the very acute stuff) are going to be managing their needs at home and not in the fashion that it was done in the hospital. To me that is what makes HH so rewarding...along with the challenges posed in the home. I love that each new patient is a totally new challenge in a totally new environment. I love that I get to help this patient stay in their home!But, thank goodness everyone has their own "fit" for where they want to be in nursing - we need all the parts to make the whole! Good luck in wherever you go!

Couldn't have said it any better.. thank you ! :)

[catjmoses RN]

i do agree there are a few good perks to the job. i only live a few minutes away from the office and being intown i can run home quick if i forgot something or what have you. i guess i am just crabbing because i hate the cold. and i listen to too much estrogen in the office. i know i need to give it time. i need to reduce to only 4 days and i think it will be better. it just seems that all i do is work and by the time i get home it's still dark and cold and it seems like the day is over (at 5pm)--ugh. (did i say i am not a morning person--big time) oh well, we'll see. cath

[steelcityrn, RN]

It of course is not for everyone. I too don't miss the 12 hour shifts, but then again the days off were nice. Many HH offices are looking for per diem. Thats a very good way to get your feet wet. The paper work is what it is. Its negative charting. You can control the amount if you only focus on the negative and your skill. The new oasis is taking away credit for some negatives, but giving more visits for others now. I swear they change their formats just to trip up the home care company and keep them on their toes. Oh and of course save money.

[Silverblitzen]

I'd really like to thank you all for letting us see what your days consist of. I've been an RN for 20 years or so, doing everything from OR, ICU, rehab, psych, tele, and LTC. I just interviewed for a home care position and I'm hoping it's what I need. I'm finding my underpinnings aren't too happy lately from standing on concrete floors for 8 hour shifts. I also think that being in LTC has contributed to the feeling I'm losing my skills. I look forward to putting in IV's or catheters!

Anyway, thanks again. I'll be reading with interest!

Sue

[CapeCodMermaid, RN]

You must be working in the wrong LTC! Last week we started 5 IV's...we have 4 midlines, 2 PICC lines and now a wound vac. I have very few catheters in my building, but guess what, we are great at inserting those as well. I've done both and thought I was losing skills doing home care. Good thing there are so many types of places to practice our profession.