What did I get myself into??!! I'm scared!!!

AnnemRN · Dec 6, 2012

So I recently got hired at a HH agency as a Case Manager RN. Yesterday I went and took a pre employment test and I met a nurse that has been working there since 2008. I introduced myself and she was extremely friendly. She asked if I had ever done HH before and I said no and she made a face and said whatever you do don't completely quit your current job and stay per diem! :/ She asked if I had kids and I said yes, she asked the ages and I proceeded to tell her that one is 4 months old and right away she cut me off and said, "just don't totally quit your other job" :/ I asked why she was saying that and she said that HH is very overwhelming and extremely hard and the advice she can give me is just to start real slow and again STAY PER DIEM!!! She went on to say that she has just learned to embrace HH and learned to love after 4 years! aaaahhhhhh WHAT AM I GETTING MYSELF INTO?!?! I'm terrified!!! I hope I'm not being unrealistic to think that this job is going to give my family life more structure and really it's just going to be work, work and more work!

I think it's best not to have any preconceived notions about home health such as having more time for your family that way you won't be disappointed. A lot will depend on your agency - the quality of your orientation, expectations and caseload. I have seen more than a few nurses who were overwhelmed with the demands of home health. They didn't realize that it can eat into your "off time" hours, by that I mean charting into the evening,many of them went back to the hospital.

I wonder if the nurse you spoke with has seen a lot of turnover at your agency. I think she's warning you that there are problems there.

suanniam4 · Dec 7, 2012

I agree with everything she said. The paperwork is overwhelming and cuts deeply into your home life.

I've been charting nightly till 7-8pm and I'm part time. HH is a whole different animal, usually you love

it or hate it.

paradiseboundRN · Dec 7, 2012

Remain calm. Try not to worry about something that hasn't happened yet. I did this once, and ending up quitting a job before I gave it a chance . Hopefully, the agency will start you out slowly. I use to do a lot of documenting in the evening but I didn't see my first patient until 10:00 am, and I often stopped for errands. Believe it or not, it takes time to get used to the flexibility. Remember, if you're full time you still need to give them 8 hrs a day, so that can extend into the evening depending on what time you start and the amount of breaks you take. Try to do as much documenting in the patients home so you don't have to bring it home!

RN_Mommy_2_3 · Dec 7, 2012

I think it's best not to have any preconceived notions about home health such as having more time for your family that way you won't be disappointed. A lot will depend on your agency - the quality of your orientation, expectations and caseload. I have seen more than a few nurses who were overwhelmed with the demands of home health. They didn't realize that it can eat into your "off time" hours, by that I mean charting into the evening,many of them went back to the hospital.
I wonder if the nurse you spoke with has seen a lot of turnover at your agency. I think she's warning you that there are problems there.

Thanks for your reply and you are so right about not having any preconceived notions! I know transitioning is going to be challenging, period, so I think I'm already expecting the worst!

RN_Mommy_2_3 · Dec 7, 2012

Remain calm. Try not to worry about something that hasn't happened yet. I did this once, and ending up quitting a job before I gave it a chance . Hopefully, the agency will start you out slowly. I use to do a lot of documenting in the evening but I didn't see my first patient until 10:00 am, and I often stopped for errands. Believe it or not, it takes time to get used to the flexibility. Remember, if you're full time you still need to give them 8 hrs a day, so that can extend into the evening depending on what time you start and the amount of breaks you take. Try to do as much documenting in the patients home so you don't have to bring it home!

Thank you so much for your reply! I'm very guilty of worrying about everything before anything even happens! I plan to start out slowly so I don't get too overwhelmed and burnt out quick...I hope to start my days as early as possible so I can be home early for my children but again I don't know how realistic that is. Documenting at the pts home is one thing I hear a lot and will definitely do! Thanks again!

bubblesbanks · Dec 12, 2012

Mommy_2_2,

The HHC nurse you spoke with was only trying to warn you, but she did you a dis-service by not filling you in with the complete story. I am not a new nurse, but am a year into HHC nursing. It is a whole different ballgame! I came from a big hospice company who paid me salary, and I had great benefits. I went to HHC because I thought it would be the most similar to hospice in the flexibility of hours.

You do get flexibility, but most times you feel to stressed to take it. I recently went PRN with HHC, and am now looking for a better job. Things I do not like about HHC: you get paid per visit, which means your pay is based on how much you get out there, and do. It's like a dog eat, dog world. You are not compensated for all the time you do spend doing the paperwork side of it, and there is a lot of it.

Now, the positive side to it maybe you will work for a bigger company then I do, and get better pay, or more benefits. I work for a small company, have no benefits, and only get paid for 1 hr. of office time per day to do what the boss calls "case management". Mind you, this is not to do my notes, but to do "case management". I am paid the 1 hr. to see my pt., and do my note.

It is a rough field to work in is what I have concluded, but I wish you the best. You might find you love it. For me, I have developed a different opinion. Just keep you eye and ears open. You never know what you will find. Good luck!

jhanes · Dec 12, 2012

Maybe the nurse she ran into is a troublemeker or has an axe to grind with the agency. On the other hand, it sounds like the company is putting a lot of pressure on the full time RNs. Not unusual. When agencies hire full time RNs, they often assign unrealistic work loads then make you a salaried "supervisor" with the expectation that you will see far too many clients, drive way too far, do your paperwork at home after working 10+ hours and in general, grin & bear it because you want FT, need benefits, etc. Want to make money in home care? 1. Do all of your paperwork on each patient in the patient home. 2. Stay per diem and work for several companies so if one gets slow, you can pick up work elsewhere. 3. Get a car with good gas mileage and a comfortable price. Buy, do not lease. Keep it in good repair. 4. Plan your days, don't let the day control you. 5. Get a GPS; even a $99 Tom Tom is soooo much better than an envelope full of maps. 6. Turn your paperwork in right away. 7. Avoid eating in restaurants. Bring a nutritious lunch each day. 8. Work for licensed agencies-avoid so-called registries that pay employees as independent contractors. 8. If your employer is late with paychecks, find another job right away.

WhatNext? · Dec 12, 2012

...it sounds like the company is putting a lot of pressure on the full time RNs. Not unusual. When agencies hire full time RNs, they often assign unrealistic work loads then make you a salaried "supervisor" with the expectation that you will see far too many clients, drive way too far, do your paperwork at home after working 10+ hours and in general, grin & bear it because you want FT, need benefits, etc. Want to make money in home care? 1. Do all of your paperwork on each patient in the patient home. 2. Stay per diem and work for several companies so if one gets slow, you can pick up work elsewhere. 3. Get a car with good gas mileage and a comfortable price. Buy, do not lease. Keep it in good repair. 4. Plan your days, don't let the day control you. 5. Get a GPS; even a $99 Tom Tom is soooo much better than an envelope full of maps. 6. Turn your paperwork in right away. 7. Avoid eating in restaurants. Bring a nutritious lunch each day. 8. Work for licensed agencies-avoid so-called registries that pay employees as independent contractors. 8. If your employer is late with paychecks, find another job right away.

I agree with the advice here. I also agree with the nurse at the agency to stay on at your current employer on a per diem basis. The agency I work for only pays for visits made. I have never had a guaranteed work load in the 2 years I've worked there. When I was the "office nurse" I was scheduled for 2-3 hours of office time per week but not to do case management for my clients.

Advice I would add to the quote above: keep records of your time slips and compare them to your paychecks. And find out the backgrounds of the owners of the agency, particularly their experience in health care education and delivery.

I do like HHC. I like the independence and the case coordination that I do with the doctors, social workers and other agencies that are involved with my patients. I like the connections that I can make with the patients and their families. It can be very rewarding. Good luck to you.

frodo-dog · Dec 12, 2012

I graduated from school and went straight to home visits. This is different from home health: home visits you visit for 1 hour with a client for a specific reason, and usually fill out OASIS paperwork. Home health is usually paid for by the DDD and you sit with a client all day.

I was paid only for the 1 hour visit. I received no benefits: no medical, no PTO, no holidays. I was never short of work. I really liked the 1 hour visits: I like the independence and the case coordination with the doctors, social workers and other agencies that are involved with my patients. I like the connections that I can make with the patients and their families. It was very rewarding.

On the negative side, the paperwork, case co-ordination and case management would take up to 8 hours per week, especially on “start of care”. I would end up averaging $5/hour for my work. I never had any peace: I would be called in the movies, late at night; basically any time was open season for calls from the office or members of the care team.

Being a new graduate was not an issue. I had the case notes, followed the orders, and reported any issues to the appropriate care team member. It was a lot less stressful than the acute care setting I am now in and far more rewarding than simply handing out meds all day. I just can’t afford to do home visits and these agencies usually don’t pay benefits.

Absolutely must get a GPS, makes life so simple and is tax deductible.

RN_Mommy_2_3 · Dec 12, 2012

Thank you all for the helpful replies! :) I actually took a Full-time position that pays per visit with great benefits. Although at first while I'm on orientation I get paid per hour then I go to part-time (22-25 Units/week)then gradually work myself up to full time (30+ Units/week). I hope to take it real slow to not get overwhelmed.

Sterlink · Dec 13, 2012

Chart in home, or immediately afterwards in your car. Call MDs immediately! Don't put off anything you don't have to. You will be busy....that's for sure. If you think it's slower than hospital, you'll be on the wrong track. Be super organized. Be in control. Know what you're asking the MDs for. Think SBAR: give the Situation/Background/Assessment /then Recommendations. Be like an ICU nurse. Only way to survive.