Universal Pediatrics Home Health Care

doodlebuttRN · Dec 24, 2014

Hi Shelby! I work in Peds home health (I don't do home care visits, I work a full shift in a home with one patient- private duty) and I really enjoy it. I actually never ever intended to work with children, but I have found myself learning a ton of new things about nursing, pediatrics, and about myself. On the positive side, usually you get to work with the same patients for extended periods of time, as opposed to the turnover seen in facilities (for me this is a positive) Helping these little ones stay at home with their families is amazing. Being able to go to school with your patients, working nights so that mom and dad get some rest, or go out to dinner for the first time in three years, or be able to go to work. Being able to enjoy therapeutic play and work very closely with OT, PT, speech, and developmental therapists, as well as homebound teachers, etc. You really have the opportunity to become a part of the patients and family's lives, in a different way than you can in a hospital or LTC/ skilled care facility environment.

Having worked in both hospital/LTC and in the home, there are some HUGE differences that may or may not be positive, depending on your own preferences, skills, comfort, etc. When you are in the home, the workplace is, of course, an actual family's home. Establishing boundaries is critical. Imagine having strangers in your home for 18 to 24 hours a day (or however many nursing hours are allotted to the patient), trying to live your life and raise your other children while not only dealing with the struggles of having a chronically ill child but with all these different people and personalities in your home. As all nurses see, people and families deal with the loss of control that comes with illness in different ways. Some are frightened, frustrated, eager to blame, scared to death. I have met families who I felt totally uncomfortable with and chose not to return to a toxic (for the nurses who must work in that home) situation. I have met some of the most amazing, brave, loving, thoughtful families as well.

Also, as the nurse, you are often alone. I see other nurses only when giving report at the start/ end of the shift, and often I get report from the parents or trained caregiver. If I have questions or problems, I must call the agency to get them resolved. While the parent(s) are usually trained caregivers, often you are home by yourself with the child, or at school, and must be prepared to handle any and every crisis that occurs, without help. There is no code blue button to press that will bring help to you. You must be thoughtful, prepared, thorough, and a careful critical thinker, as is true for every specialty of nursing. You must be comfortable improvising with the supplies at hand. I don't recommend home health for a new nurse; the experiences I had in the hospital and NH shaped me into the nurse that I am today, and I am comfortable dealing with situations like this: at school, or on the school bus, having to perform an emergency trach change or circuit change; the ventilator malfunctions, so you must ambu-bag the child until help comes or until you get back home where the primary ventilator is, while suctioning the trach, monitoring vitals, etc, as long as you have to. I try to plan ahead as much as possible to prevent problems from occurring, but often this is not possible. It is sort of scary, but as you practice as a home nurse you can learn how to deal with these situations. And agencies are all different. If you are in a position to do so, I recommend 'shopping around' and making sure you will have the support you need.

I really hope this was helpful; I am sure there are a million things I didn't mention, but hopefully you get some sort of idea. I love home care, and I love working in facility setting. Ideally I would like to do both, to keep working with my patient I have had for the last 3 years while working in a hospital also.

Best of luck,

emmylue

caliotter3 · Dec 24, 2014

There are two forum sections where you can find threads about peds home health, the home health forum and the 'private duty' forum.