What do you love/hate about home health nursing?

DavidDudley · Dec 6, 2013

I've been a per-diem home health nurse for a little bit over two years, and here are my pros and cons.

Pros:

1. I generally work alone for the most part and don't have to deal with drama or stress from co-workers.

2. Dealing with one patient at one time in the comfort of their home is easy and very low-stress. It gives you enough quality time to teach and educate.

3. Not being strapped down to a facility for 12 hours gives you a lot of flexibility in your schedule to be able to incorporate the normal activities that you would do on your days off into the days you see patients. (This is a great benefit because I was able to make it to a family lunch gathering and was able to schedule my patients after lunch)

4. Patients seem more appreciative of your work as opposed to narcotic-hungry hospital patients.

CONS

1. I always feel like I'm drowning in the paperwork. I might not be strapped down to a facility, but I'm strapped down to always having to chart, and because I have ADD issues, it takes me even longer to get it done.

2. I HATE mixing work and play together. When I'm off, I like to be off; when I'm at work, I like to be at work. I don't like being at home, enjoying my bed, watching tv, and now all of a sudden, I have to get up and drive 60 miles to see several patients. In that circumstance, my brain isn't ready for it. I would rather wake up at 5 am and just work a regular hospital shift.

The positives might seem to outweigh the negatives, theoretically. But I have found that constantly being drowned in paperwork after you see the patient will start to suck the life out of you. It makes me anxious, agitated, angry, and frustrated every time. I can do home health one day a week max; anything more than that, then I feel like quitting.

tktjRN · Dec 9, 2013

Oh yes.

tktjRN · Dec 9, 2013

DavidDudley was very well said and 100% accurate.

rnrg · Dec 9, 2013

I'm currently a PEDS trach/vent RN. Here it goes:

Pros

Autonomy during your shifts. 1:1 pt care.

More laid-back environment

The majority of shifts are 8 hours which I enjoy because I have three children and a husband.

More downtime depends on patient care.

In the state of NJ, we have private duty nursing that can range from 4-24h care—no going from house to house, etc.

Cons

Inconsistent work schedules. When pts are hospitalized, my paycheck is non-existent.

No benefits or PTO

Agencies are not willing to pay for additional certifications such as PALS or IV certs.

Stagnant feeling due to providing the same bedside care repeatedly.

Btw my rate is pretty good, 30 $ an hour. Not too bad. Right? Good luck!

maryen · Dec 9, 2013

Ditto on when patients go into the hospital, no paycheck!

HHN2472 · Dec 10, 2013

The loves: I work on a per-hour basis, so I really like that. I love my patients, and I love the autonomy, the ability to run an errand if need be, and the way that our office closes for bad weather because they care about us (where at the hospital, you are SOL because you *have* to be there). I love I can run to my son's school if need be or sleep late occasionally and leave home to see my patients. I love the sights I see driving in the country every day. I love the extra mileage I get for driving when I have an old car that is paid for; that makes me money. I love the laid-back atmosphere at work and the way it is laid back. I do have stressful days when I have paperwork, but I don't know if it is just my office or what, but I can get my paperwork done in no time because I don't chitter chatter all the time. I never let it pile up, and I get done. I RARELY take stuff home with me because I am always nonstop when on the clock. I love the way my patients feel like family. I love the 8-4 hours. I love having major Holidays off with the option of seeing my patients later in the week to have the day before a Holiday or after a Holiday off. I love seeing the difference I make. I love knowing that I can use my critical thinking skills to make things work when I am all alone in a home, like figuring out a sterile atmosphere to change a catheter or a central line dressing.

The Cons: Sometimes I get the feeling other nurses I am in contact with at the bedside think my job is sub-par because I am not chasing the excitement of bedside. I hate that sometimes families are CRAY-CRAY, and there is NO helping them, and it is scary to see. I hate that sometimes patients get on my nerves, and we have them for months on end sometimes, and the thought of seeing some of them makes me cringe. Sometimes the roaches or the disgusting homes with filthy dogs and smokers, I hate that. I hate that sometimes no matter how hard you try, you know you can't fix some patients who have broken family lives. It's a very emotional job as you are forced to be a part of a patient's daily life. I don't like phone call follow-up calls either because I am not a phone person, and the patients will keep me on the phone FOREVER. Well, that's about all my pros and cons, LOL.

Loodlow · Dec 10, 2013

I love home health! I have been doing it for about 15 years. First pediatric visits, then adult visits, then managing pediatric private duty. The biggest con to me is the insane government regulations, cuts, and inconsistencies. As a field RN, most of that won't affect you. My favorite part of field nursing was the flexibility and independence. Sometimes, you make all the difference in the world to a patient and their family. Sometimes, nothing you can do makes any difference at all. The nurses I have seen through the years that did not belong in home health could not deal with the lack of control. In the hospital, the nurse is in control (even though it might not feel like it.) Patients in hospitals get the medicine ordered when it's ordered, which is not always true at home. Hospital patients get three meals a day, not always at home. Hospital patients are warm in the Winter and cool in the Summer; their rooms are somewhat clean. Not much illegal drug use in the hospital. Hospital patients are seen by their doctor when they are supposed to. Like the hospital, the patient is rarely the difficult part; it's the family.

Good luck! You will feel like a real nurse again!

rn_nxt_dr · Dec 23, 2013

Look for a company that pays hourly and not per diem if you want steady pay, I had experienced being exploited because I needed the nursing experience, and I got the break I needed, but not without the price to pay.

I eventually found an FT position as an HH case manager, then went into Traveling positions which I believe pays very well if you want adventure and flexibility. I'm in CA, and it pays the best rate, as far as I know.

Understand the basic principles of HH by asking your supervisor, Director of Client Services, read CMS guidelines for homebound patients, and follow doctors' orders. However, you have to be clear with your supervisor when you get an order, not all primary care physicians listed are the actual PCP when you talk with patients. Therefore, the orders on the d/c instructions may negate your actions. Meaning there could be an "order," but then you have to have the authorization before the next visit and whether the PCP will sign off on the Plan of Care in the meantime. What do you do with the discharge orders??? be very clear with your supervisor because I have seen that agency will follow a d/c order from the hospitalist and then subsequent orders from PCP, and if they decline, then what happens?

You will learn all this in time but be receptive and ask a lot. Good luck.

Janinern84 · Jan 10, 2014

Pros: Going into the Family's home

Cons: Going into the family's home

haha, if you are experienced, you know what I mean.

SDALPN · Jan 11, 2014

Quote

I'm currently a PEDS trach/vent RN. Here it goes:
Pros

Autonomy during your shifts. 1:1 pt care.

More laid-back environment

The majority of shifts are 8 hours which I enjoy because I have three children and a husband.

More downtime depends on patient care.

In the state of NJ, we have private duty nursing that can range from 4-24h care—no going from house to house, etc.

Cons

Inconsistent work schedules. When pts are hospitalized, my paycheck is non-existent.

No benefits or PTO

Agencies are not willing to pay for additional certifications such as PALS or IV certs.

Stagnant feeling due to providing the same bedside care repeatedly.

Btw my rate is pretty good, 30 $ an hour. Not too bad. Right? Good luck!

That's private duty, not home health.

RNBell · Jan 11, 2014

I work at an agency where we have all RN case managers and no staff RNs otherwise. So whoever we are assigned for clients, we see them on a regular basis. The best thing about home health is the goal of it all - to keep seniors and persons with medical needs in their homes, out of skilled nursing facilities. For myself, otherwise, I like the day shift, the freedom to make my own schedule, usually just seeing my patients and minding my own business. I like the flexibility - at our agency, if we are having a slow day, it's OK to take off early. We are paid on an hourly basis but typically work a set amount of hours per week (typically 32). The most difficult part of the job is the especially busy times - such as having numerous Oasis due, admissions, plus your usual visits - it can get to be a lot at times. The oasis and admits are more time-consuming. I don't mind the charting, but I like it better when I don't feel overwhelmed with a heavy caseload and charting that needs to be done yet.

When starting out, It's important to know when to ask questions. I've been doing HH for ten years, and it's rewarding - but it can burn you out too. I do remind myself of the purpose often, and I feel better - it's such a great service to have available for people in need. It's nice to have knowledgeable co-workers --esp ones with hospital nursing experience. It takes a while to find a routine that works well for you and to understand all of the aspects of charting requirements - but all and all, it's a good gig.