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...

 

[catjmoses RN]

Sue, Here's my 2 cents for what it's worth. I was a hospital nurse and traveler for 10 years and switched to home care this past fall. I'm not liking it too much. I give credit to all the gals in my office--they do this day after day. It truely has it's perks. However, I'm not a winter person and this winter I feel like the mailman! --through snow,slush, wind, rain and treacherous ice! --not for me. And the paperwork/computer work is a lot (as it is anywhere but more than I've seen in a long while (and I'm good with a computer). I'm also not fond of the 25-50% surprises in the home--(many)pets--which I love, just not the fleas, dirty places, obnoxious family..... and I think my decision maker to give my notice is that I make $10 less than the hospital girls (in the same company) and have to take work home at least 50% of the time--AFTER hours to work for free!--I don't think so (as well as be on call one night a week and one weekend a month). It's very rewarding at times, just think it over carefully--I wish I hadn't taken this job--only because now I have to give my notice and I know how much they strugle with keeping staff. cat

[Silverblitzen]

Hi CCMermaid and Cat,

I think the thing that made me want to look into HH is mostly my legs. The poor things just can't take standing on the concrete floors all the time. Our building has no carpeting and even though I wear "Anywears", plenty of rubber between my feet and the floor, I wake up at night in agony from the pain in my legs. Here, too, I'll be taking a cut in pay but I'm hoping the trade off will result in my legs being happier. Doing paper work at home after I've done the home visits is OK. I'll be home in the evenings - well, most of them.

I'll keep you all informed on my progress. I know I"ll have more questions!

Sue

[flrl0706]

Great Thread. I was just hired as a HHN with a pediatric agency. I have never worked HH only long term care. any tips for me? I will have only one client, a one yr old little girl.

[NurseRoRo]

I made the switch to HH after spending almost 10 years in the hospital. I started out in General Peds and then went to a free standing inpatient Peds Rehab facility. I then went to the Operating Room and stayed there for about 3.5 years. I found that I work well in a team but not as a supervisor of a team. In the OR the team has to be work in synch and I had to poke or prod those that were not working up to speed with the rest of what was going on.

As a case manager, I work in a team but am independent in my field. I work with other disciplines and maintain great communication with them but for the most part I am responsible for my part of the care and I facilitate more than supervise.

I love the independence. I love the lack of noise pollution so I can think in the car between visits. Long gone are the days of simultaneous phone ringing, people standing around talking while you're running around like a crazy person without them asking if they could do anything to help you, the call light going off, the unit rep telling you that family is on the other phone, and a resident following you around to ask you a question about how to arrange for discharge. I have crazy busy days, but I create my own chaos. I like to call it controlled chaos.

A typical day for me is: 5 patients, or maybe 3 or 4 regular visits and an admission. My patient load consists of PICC line/CADD pump patients, COPD/CHF patients, cancer patients still seeking last ditch effort treatment before deciding on hospice. I tell my patients I am great at playing Devil's advocate, I ask difficult questions to see where they are emotionally with their disease process and poor prognosis.

Sometimes I chart in the home. Sometimes I save it all up for home. I am never on the computer for more than 2 hours at home. And I start my day as late or early as I want to depending on what I have going on. One of my patients works and gets home at 5pm. Those days I start later...

[imanedrn]

I made the switch to HH after spending almost 10 years in the hospital. I started out in General Peds and then went to a free standing inpatient Peds Rehab facility. I then went to the Operating Room and stayed there for about 3.5 years. I found that I work well in a team but not as a supervisor of a team. In the OR the team has to be work in synch and I had to poke or prod those that were not working up to speed with the rest of what was going on.

As a case manager, I work in a team but am independent in my field. I work with other disciplines and maintain great communication with them but for the most part I am responsible for my part of the care and I facilitate more than supervise.

I love the independence. I love the lack of noise pollution so I can think in the car between visits. Long gone are the days of simultaneous phone ringing, people standing around talking while you're running around like a crazy person without them asking if they could do anything to help you, the call light going off, the unit rep telling you that family is on the other phone, and a resident following you around to ask you a question about how to arrange for discharge. I have crazy busy days, but I create my own chaos. I like to call it controlled chaos.

A typical day for me is: 5 patients, or maybe 3 or 4 regular visits and an admission. My patient load consists of PICC line/CADD pump patients, COPD/CHF patients, cancer patients still seeking last ditch effort treatment before deciding on hospice. I tell my patients I am great at playing Devil's advocate, I ask difficult questions to see where they are emotionally with their disease process and poor prognosis.

Sometimes I chart in the home. Sometimes I save it all up for home. I am never on the computer for more than 2 hours at home. And I start my day as late or early as I want to depending on what I have going on. One of my patients works and gets home at 5pm. Those days I start later...

I'm so thankful to read this...

I'm a NG -- just over 2 months on my own (just over 4 total) on a med/tele floor. I have a per diem HH job lined up. Haven't started yet because the DON is trying to work around MY hospital schedule to pair me with a nurse mentor to teach me SOCs first. (Hopefully, one will fall on one or more of my days off this week.)

While I love the experience I'm getting in the hospital, I look forward to all of what you described! I actually look at doing HH per diem (a few visits a week) as a respite from the chaos of the hospital! Your days sound ideal to me, and I can't wait!

[shirlz]

I am an RN who is working Home Health for the first time and I hate it. It has only been 2 months and it keeps getting worse. I am the only RN and one LPN. I run around till 5 pm and then do charting until 11 pm every night. I am on call every other week (14 days a month). On my week end on call I always have a couple of admissions. Maybe I picked the wrong agency, but now I am afraid to try another one.

[Silverblitzen]

I am an RN who is working Home Health for the first time and I hate it. It has only been 2 months and it keeps getting worse. I am the only RN and one LPN. I run around till 5 pm and then do charting until 11 pm every night. I am on call every other week (14 days a month). On my week end on call I always have a couple of admissions. Maybe I picked the wrong agency, but now I am afraid to try another one.

Wow! I think I'd try another agency! They're not all like that; I mean, if you read through some of the postings in here, you'll see a big variety. Do you live in or near a bigger city that may have more to choose from?

Best of luck,

Sue

[proserose]

Hi everyone,

Just joined the forum. I'm a home health nurse for the past 12 years or so. I took a few years off when my last child was born but have been back for a couple years now. Anyway, I'm so tired from my typical day in home health nursing that I can't bring myself to describe it. It was a long exhausting day - - lots of driving and things didn't go smoothly. I had four admissions and a visit. At the end of the day we all had a VM message from our boss listing all the things we have failed to do in order to please Joint Commission. Trying to get it all right is like beating your head against the wall. Sheesh. It 's very discouraging somedays

[annaedRN, RN]

I had four admissions and a visit

Yeeessshhh! I would quit or be calling in sick the next day if my agency asked me to do that! I personally think that is expecting to much of any one nurse. It does not enable you to perform your assessment thoroughly and is not fair to the patient. For us a full day is 6 or the equivalent of ( admissions being 2) but never more than 2 admissions a day. Occasionally 2 admits and 3 visits, but that is a rare day.

[proserose]

Hi,

I am an admissions nurse. I enjoy doing soc visits and I work 2- 12 hour days per week and am paid for 30 hours because I have a lot of paperwork. The problem is they don't take into account what's involved in each admit, or how much time I spend driving. I feel 3 admissions - - in order to do a good job - - is a good 12 hour day. I usually push more towards 14 hours by the time I'm done. I'm salaried so I get a certain number of units for everything. 'They' say the average admit only takes 45 minutes to an hour so we only get 2.5 units for an admission. That means in 12 hours it looks like we should be able to do 4. But all that is required at soc takes me longer than 45 mins or an hour unless it's just a 50 year old total knee with only a couple meds, and no complications. Trouble is most admissions are not like that. Someone upstairs just looks at numbers and forgets it's all about people - - at least that's how it feels somedays.

[annaedRN, RN]

I am an admissions nurse

Well that makes a little more sense to me now! I work 8 hr days too, instead of 12. It's funny how nice the units add up on paper for the office staff...just doesn't work that way in the real world. If all my admits were therapy only...aahhh, I can only dream:)

[Silverblitzen]

Hi all,

I've been in HH for 4 months, started full time and am now part time. Even at only 3 days a week it's burning me out more than anything else ever has and the kicker is that I love this kind of nursing! I took an $11 an hour pay cut to do this, but my main complaint is that it takes over my life! The day off before I work, I'm doing admission paperwork, schedule adjustments, faxes, phone calls to schedule appointments and the list goes on. We have no benefits, no paid days off, no paid vacation time and we're all afraid to call in sick because our team members would have to pick up the slack. All my team members are physically sick and I don't know how much longer they'll last, but I can only change MY situation, right?

What to do? Hospitals are crazy. :hdvwl:LTC, unless you get into a supervisory position are extended med passes and kill my legs. I have an ADN degree (AAS nursing) and I'm 58. I wish I could retire, but that's not an option. Any suggestions out there?

Sorry this is such a whine, but it's good to vent now and then. I hope with all the accumulated wisdom out there, someone may have an idea of where else I could turn.....

Many thanks,

Sue