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...

 

[mmiller1887]

Thank you so much for that glimpse in to your day. I am a second year nursing student and I am trying to determine my best fit for preceptorship. I am torn between med-surg, just for the fast-paced experience, or home health because I really think I would enjoy it.

[Blackheartednurse]

:lol2:That happend last friday.

1.So I see my first patient.She lives in a senior building and anyone who wants to get into the building needs a visitor pass.So the lady at the front desk ask for my photo ID,I reach into my walet for my Driver license and it turn out I lost my driver license.I literally beg her to let me in since I was here before and she knows me.She finally agrees and let me in just this once.The visit goes uneventful except that I discover a fungal infection in my patient foot and my patient barely understand English and the caregiver who speak English and usually is present when I'm there is off for a doctor appointment!

2.I go to see one of my patient.He is outside of his building waiting for me with his neighboor.That is unsual of him.He states that he didnt pay for his phone so now it is disconnected (it is a secured building so I have to call him in order to get in).

So we are headed to his building ,his neighboor opens us the door and then takes off somewhere.We walk up the stairs and reach my patient apartment and he is trying to look for his keys to open the door.He cant find it and claims that probably his neighboor took his keys by mistake but left somewhere but will be back soon.:idea:So we sat down on the stairs waiting for this other guy to come back.In the meantime my patient states he feels very weak and puts his head down. I rush to my bag and take out blood pressure machine and blood sugar machine.Have you ever took someones else BP,sugar in extreme condition as if on the very narrow stairs? If you didnt join a home health care,aboundant opportunities arise! Well his BP is within normal limits, and blood sugar is elevated but nothing drastic,well anyway the neighboor with the keys doesnt come back so my client decides to go one floor down and get help from another neighboor.I'm staying put sipping on my Donkey Doughnuts tea.So after literally what it seems like FOREVER my patient comes back with his downstairs neighboor,an older lady that does not speak English at all and her son.The lady speaks to me in a foreign language and even though I let her know I dont understand at all what she is saying she stills attempt to communicate with.Her son holds a screwdriver and decides to "open" the door. So me and my patient thank me and step into an appartment.Having an intuition I go into a patient's bedroom and guess what I find?! The keys!! I show it to my patient and he looks very surprised LOL.Next I set up a meal for my patient (a chicken soup) and motivate him to eat it,check the medication box (to see if the patient took his meds) only to find that of course he skipped some of the days cause according to him the med box is too confusing and he sometimes forget what day is it in the week.So I instruct him to comes back to taking the meds from the bottle (as he did before).Uff than I work on the rest of my assesment.Finally I'm ready to leave.As I attempt to open a front door I discover that the downstair neighboor's son broke the knob.So now the front door dont want to open.The patients reaction was "oh well I'l just use the back door to get out:rolleyes: I asked him for the phone number of his landlord,of course he couldnt locate it so he goes again to his downstair neighboor to ask for one.He comes back after some times with the number.So I call the landlord and the landlord promises to send someone TODAY:) Then the downstairs neighboor comes with a big watermelon and she inform my patient in a different language that the half is for me.

I must me crazy for doing HH:)))

[RyanSofie]

hi,

i was wondering because 5-7 clients are seen per day at their homes and it seems to be maybe 1 an hour. is there enough time to drive to different houses and provide them the care they need in your day? or is it just in, out, quickly, next house? cause i dont know if you can give them adequate care in just less than 1 hour like 30 min? cause then it takes time to drive to the next house. is it under pressure and stress?

if it were a perfect world a hh nurse could work an eight hour shift and see one patient every hour. unfortunatley that is never the situation..a start of care oasis..requires an hour just in paperwork ( at the home) in addition to the reams of additional documentation ( poc, clinical pathway overview. variance tracking. medication list with all meds numbered for reference for the patient , physician notification with orders, contacting any other disciplines you access are indicated, hha poc, writing out your visit calendar and noting dates for recert window etc etc etc etc...multiply this x 5-7 visits a day. not only paper work but crisis ( i recently had an entire family flipped out because mom was "boiling towels on the stove" which physical therapist informed the family was due to possible "appendicitis" because mom had flank pain. i was called and went immediately as ordered to do prn on patient and methodically unraveled the situation , calmed the family and patient. the diagnosis? uti. i obtained a simple urine specimen , calmed the family and patient and went about my business for another 10 hours . time invested: 2.5 hours ! my quota required by my company 5-6 patients a day...if crisis occurs and you miss appointment...continue the day until you reach quota or add to the next day to make quota. . needless to say the treadmill was too fast for me...i had to go contigent i simply could not work 14 hours or more everyday . in the end earning less than i would at mcdonalds flippin burgers. driving? try 86 miles for one patient...then another 100 plus that day to see the remaining..an hour drive to that one:eek: patient and an hour drive back to see the remaining ...:eek::eek:

[xEdgexRNx]

Do visiting Home Health RNs have on-call hours? What are the typical shift hours (start to finish)? Do you work past your shift often?

[RyanSofie]

The company I work with rotates call between clinicians. One week on usually a month which includes a weekend ( Friday to Friday). We have no "shifts". If you work in the field you work until you finish your required "quota" of 5-6 visits. You set the appointment times with your patients and that determines your work hours. Typically I say "I have an opening in the morning between 8am and 12 noon or afternoon between 1p.m and 6pm. I have learned not to set precise times for appts because of the variables that can occur ( traffic, previous patient in crisis ,etc). I can see typically 4 routine visits between 8am and 12noon if all goes smoothly which is rarely the situation. If I have SOC's ,RC's or ROC's they consume at minimum an hour and a half excluding travel time because of assessments,wound measurements, report to physician ,etc etc. Of course the other factor is mountains of paperwork and that is many times hours in addition to my day. Home care is not an easy task by any means. My team and I have calculated our true rate of pay based on hours invested and we would earn more at McDonalds. On call is another thing, typically you can triage on the phone and if the patient is having a critical situation the advice is 911 EMS to hospital. If the call is in regard to cath coming out or something a nurse can address you get in your car and hit the highway to that patient. We are paid 50.00 /week for on call and per visit for visits. Weekends or evenings may also include late referrals or hospital d/c's that require immediate SOC or ROC. I have had to drive 160 miles round trip to see "1" patient and make that daily quota of 5-6. We are given points for visits...routine (1 point) SOC (2 points) ROC (1.5), D/C (1.5 ). If clinician must drive 10 miles or 200 miles to see a patient the points are the same. A nurse must make "productivity" that is "30-32" points per week. We are expected to work Mon thru Sat every single week. So? What do you think? Beneath all this...frail elderly many living alone in financially and support lacking circumstances. patients with numerous chronic disease procesess in addition to the acute problem that results in home care eligibility. Good luck nurse...hold onto your hat its a heck of a ride...

[Nursecathy123ca]

I understand what you are saying. The 'extra' hours spent on paperwork are ridiculous. We have lost some good nurses due to the ever-increasing paperwork burden. And I refuse to work 50 hours for 30 hours' worth of pay. So I looked for another job with a reasonable salary. When I found it and told my current employer, they suddenly decided that they could meet the offer of the other company.

So don't sell yourself short. If you have experience and good references, look around at what's out there. There are employers who value good nurses!

[RyanSofie]

I understand what you are saying. The 'extra' hours spent on paperwork are ridiculous. We have lost some good nurses due to the ever-increasing paperwork burden. And I refuse to work 50 hours for 30 hours' worth of pay. So I looked for another job with a reasonable salary. When I found it and told my current employer, they suddenly decided that they could meet the offer of the other company.

So don't sell yourself short. If you have experience and good references, look around at what's out there. There are employers who value good nurses!

:nurse::nurse::nurse: We are advocates for our patients. We will use our critical thinking skills at solve issues with intelligent, experience based knowledge that we have diligently worked to aquire in our professional settings. Why then do we as NURSES simply "HOPE' things will improve ? We as nurses must begin to recognize our VALUE to healthcare. We fail to use our voices where they count in the legislative halls of the government. We are millions strong across this nation and we can make the changes that need to be made through our united efforts. Physicians are heard ,pharmecuetical companies, insurance companies etc. We are an integral part of healthcare and I say NURSES stand up...be counted and recognize your place in healthcare is VITAL.:nurse::nurse::nurse::yeah::yeah::yeah:

[septvirgo03]

RyanSofie,

thank you for your honesty re: HH. i've been in HH for less than a year and am utterly shocked at how "it never ends". To me, it's equivalent to working in the hospital, arriving on your unit every single day, taking care of 10-12 patients, on your feet for your entire 8 or 12 hours, no break; you're taking a bite of your food in between room-to-room (seeing patients)....go home (with your laptop in hand to document on all 10-12patients), and start all over the next day. No "light days".

i didn't have a clue. I was told in my interview that my hours would be mon to fri, 8-430, one weekend a month...sweet, right?!!! when i was on orientation, i remember the day when my preceptor said, "Good job! now, go home and finish your documentation, synch, and let me know when u finish it, so that i can look over it" (via laptop). Cool, no problem! after all, it wasn't 430 yet, i was still on the clock; i did what he told me to do, 430pm, done....so i thought. He texted me (via my cell phone) around 9pm, "hey! i checked ur documenting. good job; here's a few changes i need u to make. let me know when you're finished"....Huh????? maybe i misread the text; maybe he meant "TOMORROW, make the changes....". Nope. He meant that night!......that was my first inkling in that most nurses are STILL working/documenting during the evening/night..Why? because 8 hours isn't enough to finish all the "required work" for 5-6patients. Per day. Every day.

Where i work, majority of nurses have voiced the same concerns to managers, etc...but wonder if the concerns are falling on deaf ears. One of the issues that concerns me is 'what is considered productive?'...To the managers, clinical supervisors and HH directors, 'daily quota/productivity' is defined as seeing 5-6+ patients daily...anything less, or any non-patient time, is not a productive day.....So taking the time to call doctors, explaining to doctors what is going on in the home, taking time to order supplies, taking time to research answers for questions patients/families have, taking time for find some good teaching materials to give to the patients, taking time to fax info to the doctors and mobile lab company, the time it takes to drive between each patient, NEEDING an administrative/office day to do all of this "non-client work", is THAT NOT PART OF THE QUOTA/PRODUCTIVITY????? well if it's not work, then what is it? Play time?

sorry for venting.....just a lil discouraged....thanks for reading.

[RyanSofie]

Sept/Virgo: HH is a 24/7 commitment without the compensation to reflect the amount of time consumed from your life. The companies know the time required and the managers,adminstration are appropriately compensated for putting the whip at the field staffs backs to complete the reams of documentation needed for billing purposes. I went to per diem status because I was literally overwhelmed at the 'productivity! requirements of seeing 5-6 patients daily or more if pts cancelled or refused that particular day. In addition to completing documentation which required hours more of (work @ at home). We do not get "administrative office day". We had a turnover of administration as a matter of fact and the "office was rearranged "to make it exceedling difficult for clinicians to work there at all. Charts are under lock n key...there is no desk space for clinicians...no pc to utilize etc. To staple papers together one must ask to get stapler from office manager. my home has therefore become free office space for the company. Complain away because I sincerely understand your frustration. May I add one positive to this? I enjoy my patients and their families. I feel I can make a positive impact in health care management for the patient through teaching. I enjoy getting in my car and traveling away from my city into the countryside here. Those families who so lovingingly care for their loved ones at home face so many challenges in the day to day of life. I know what we do is time consuming and poorly compensated financially for us but my compensation is when a family member takes the time from her busy day to bake me a loaf of homemade bread which she wraps warm from the oven to send with me. To see the parents of two very ill adult children sitting on their front porch waiting for me, lifts me from my fatigue in a way that is incomparable to any day in a hospital. I believe as nurses we give of ourselves beyond what most do in any profession but our rewards are also beyond what most recieve as well.

[septvirgo03]

RyanSofie, re: the rewards are greater than financial compensation, you are so very right. I had that experience today: woke up early to get started early, went to visit my first patient. He asked me who can he speak to regarding his home health care experience. I told him he would be receiving a survey to answer and write comments on his homecare/rate us nurses, and other disciplines, etc...He told me he can't wait to write a review for me because out of all the care he's received (pre-admission, pre-op, post-op and while in the hospital), no one has ever taken the time to explain things to him, like I have...it humbled me and gave me strength, and placed a smile on my face.....so now, let me get off of the Internet because it's 9pm and i have a slew of documenting to do....:)

[ConflictedRN]

Hi,

You all sound very dedicated and I appreciate that. I have a dilema, I am currently working in a hospital for 10 years now in and work 3 12.5 no holidays no weekends no call. shift is 9:30 -10p takes 1.75 hours to commute in am 45 min at night. There is no shift after mine and sometimes have to wait for a pt to be placed appropriately in step down or critical care bed.

Recently interviewed for a home care position. It is a full time salaried position. I have a second interview next week. I believe I was told I will be seeing 6 pts daily and every week to 10 days have an office day. There are a total of 6 full time RNs and then perdiem. I am not sure of pay yet but I will not even consider it if it is not close to what I am currently making. If it is a reasonable amount then I really not sure if I should make this jump. I definately want something closer to my home and I am told I would be working independently. What questions should I ask at this interview are there certain things that are deal breakers if so what are they. Thanks for all of your input. I read many of your days and have a better understanding of what hh nursing consists of

[RyanSofie]

Hi,

You all sound very dedicated and I appreciate that. I have a dilema, I am currently working in a hospital for 10 years now in and work 3 12.5 no holidays no weekends no call. shift is 9:30 -10p takes 1.75 hours to commute in am 45 min at night. There is no shift after mine and sometimes have to wait for a pt to be placed appropriately in step down or critical care bed.

Recently interviewed for a home care position. It is a full time salaried position. I have a second interview next week. I believe I was told I will be seeing 6 pts daily and every week to 10 days have an office day. There are a total of 6 full time RNs and then perdiem. I am not sure of pay yet but I will not even consider it if it is not close to what I am currently making. If it is a reasonable amount then I really not sure if I should make this jump. I definately want something closer to my home and I am told I would be working independently. What questions should I ask at this interview are there certain things that are deal breakers if so what are they. Thanks for all of your input. I read many of your days and have a better understanding of what hh nursing consists of

Ask if clinicians are allowed contact with physicians if orders are needed. Do physicians see patients if change of status occurs? Commuting/road warrior is the norm for home health. Expect alot of travel time and reams of paperwork unless company has computerized system. Are clinical supervisors involved in field visits ( or are they just administrative and hands off? How often are clinicians required to take on call rotation? How many patients are you expected to carry and does clinician also do case management with assigned patients.