I've been an RN with my BSN for almost ten years and have primarily worked in medical-surgical. I also have experience in labor and delivery, adolescent psych, cardiology, urology, and nursing home nursing. I've accepted a full-time home health position and will start at the end of this month/beginning of January. I am excited about this change, as I am burnt out in medical-surgical. Completely. What I'm wondering is, what do you love about home health? What made you get into this field of nursing? What are some of the things that you do not like? And do you have any tips on how to be successful? I've read many posts about never-ending charting, even in your free time, but I've also read that you are able to finish it in a reasonable amount of time. I've read some horror stories, but for the most part, it seems like the majority of people really enjoy this field of nursing. I'm hoping I really enjoy home health...I don't mind driving, and I like the idea of being able to focus on one patient at a time rather than have 7-8 patients pushing the call light at the same time, asking for pain meds. At my job, I feel like a glorified waitress/drug dealer MOST OF THE TIME. I feel like I am just a "servant" to them, and rarely are they appreciative of someone trying to help them. I want to feel like I'm making a difference, even a small one, to people who really want me to be there. Am I looking at this through rose-colored glasses? Perhaps. I don't want to lose faith in humanity, and a lot of the patients I deal with are making me do just that.
Sorry, my post got off on a little bit of a tangent, LOL. Any tips, like what you keep in your bag/car, how to stay organized, knowing when to call docs, etc., would be greatly appreciated. Any tips on how to be successful and on top of it would be awesome. Thanks!
I do pediatric home visits. I love my patients. I love the autonomy. As someone else said, the lack of control is sometimes difficult. When you are taking care of a child in the hospital, you KNOW that he is getting his full G-tube feeds and all of his meds because you are the one giving him. When you are the nurse dropping in to see him at home, you might discover that Mom hasn't fed him or given his meds for days, and you can't get through to her no matter what, and CPS doesn't want to do anything. I also dislike irresponsible parents... no exaggeration, today I walked into a house and found one of my 7-year-old (ONC) patients febrile, covered in a full body rash with an HR 140s-160s and RR 60-100, and Mom left him like that since last night without so much as even calling the MD because she knew I was coming today.
I have been in homecare for 22 yrs. Yes, there is a lot of paperwork! There is also flexibility. If I choose to, I can see a patient and complete the charting at home or in my car afterward (My agency does electronic charting), or I can choose to complete the charting at the end of my day. (I usually wait until the end of the day.) When my kids were little, I could schedule my day around the Holiday Program and not miss it; I could go to conferences, etc. You have to be organized (and believe me, I was not at the beginning!) Seeing one patient at a time gives you a lot of time for teaching. (but don't get too emotionally involved because sometimes, no matter how much you teach or try to change a habit, they do not do it) Sometimes the most stressful part is dealing with Dr' offices and insurance companies. You spend a lot of time on the phone. I would not work for a company that did not give vacation time—sick time etc., just like a hospital (plus mileage for driving). I have worked in all of the different types of pay systems. (Salary, hourly, and pay per visit) Currently, I work for a company that pays per visit. It has its ups and down. I do get PTO, & if I am in the office for a meeting or class, I get an hourly rate. The downside is that if the agency is slow, your paycheck suffers. If it is busy, you can make some extra money. I always tell my orientee that you don't want to live paycheck to paycheck due to this. We work one weekend a month and 1-2 holidays a year. Weekends and holidays are mostly admissions, wound care.and/or IVs. The admissions require a lot of paperwork, and my agency counts them as two visits. I see 5-7 patient's a day, with six as the average. You sometimes have to do a lot of driving. I am very lucky currently; most of my visits are relatively close to home. I have co-workers who travel a lot and others who don't.
Sorry- this was a little ramble y, but I put in as much as I could think of to assist you.
I have been doing HH for almost two years and wouldn't trade it for anything! I take calls, and all of my pts have my phone number to contact me any time.
Pros:
Having one patient at a time to deal with, learning about their lives and helping change bad habits (when possible), being a supportive figure, and feeling like family.
I can arrange my own schedule, and if I need to stop at Walmart or meet a friend for lunch, I can do that.
I'm paid per visit with mileage and hourly pay for meetings.
I work one weekend a month.
I'm usually home by 5 pm, and I take my kids to school every morning.
If there is bad weather, I stay home and call my pts.
I feel I made the best career choice, and I'm not coming home crying after a stressful day.
Stress? I don't have much.
I am not interrupted by phone calls and pts calling me because they need a pain pill or their IV is bad, no lab calls, no new admit coming to the floor, no MD on the phone wanting test results, and I can assess my pt without these interruptions!
Cons:
What is in the pts home is out of your control (cigarettes, pets, roaches, filth, etc.), but you have to deal with it. EVERY TIME.
Some pts you cannot help, no matter what you say or do.
Sometimes your pts do not get better, no matter what you say or do.
Some pts have a family. Some family is only involved because YOU are involved.
No matter what kind of day I've had, it's always a good day, even if I have to take half a Vicodin to convince me. LOL!
Specializes in Med/Surge, Psych, LTC, Home Health.
Well, I've been doing home health now for about four months. I LOVED it at first, but in the past couple of months, I've had a bit of a love-hate relationship with this job. My input:
Pros:
I work without much supervision at all, which I love. I've always had a bit of a problem with bosses/authority and have always liked doing my own thing.
I love having one-on-one time with my patients. I feel like I really get to know them, and I feel like I am able to really assess them well. In the hospital or nursing home, it's so much easier to miss important things about your patient because you are always in such a hurry.
I feel so appreciated. I have patients who let me know all of the time how much of a blessing I have been to them just by coming to see them, checking on them, help them. I love that!
No night shifts! Well, unless I happen to get an emergency call late one night while I'm on call, which has never happened.
I can run little errands any time I want to.
Cons:
I feel like I have no life! I get paid per visit, not per hour, which means that there are days that I am seeing patients until 6, 7, or even 8 pm. Then I go home and working on paperwork until I go to bed most evenings! I have two young children whom I feel like I don't spend enough time with.
I get WORN OUT driving all over the place.
I have been with this company for four months and STILL do not have any benefits yet. I'm supposed to be qualified to receive them soon, but so far, I haven't seen any benefits yet.
I rather dislike seeing patients that are "teaching/education" only. I prefer doing direct care... IV medications, PT/INR, wound care, etc... I DO like to teach, don't get me wrong, but at the same time, I feel like I have patients that are going to keep doing the same things and keep the same habits no matter what I come into their home for 30 minutes every week and tell them.
I feel strange telling people who can barely afford to eat (many of my patients) to watch their diet and eat healthier. Many of them are living on frozen dinners.
I sometimes feel like we hang on for dear life to patients who either don't need us anymore or they do need us, but they don't want us.
It's a daily struggle to decide whether all of the pros outweigh the cons. ? I know one thing I REFUSE to go back to working in any dang nursing home.
I agree with most of the above- I worked in the hospital for about a year, then went into home health about three months ago. It's a lot to learn, and it's not focused- its WHOLE PATIENT CARE. Everything. I work PRN between two agencies which I'm glad I did because the one I originally liked has been constantly calling me lately, and it's gotten to the point where it's almost harassing. The other agency lets me be and lets me know when I can do something better/different, which I appreciate. love the freedom; I like to "front load" my patients during the week- see most on Monday and Tuesday, then taper down so I don't have so much charting on the weekend. I personally take notes in the home and chart at home, but I sometimes wish I had access to the internet to chat a little at home and then do narratives at home (we are electronic at both companies). It was the best decision I ever made. Probably going to weed out the annoying agency, but not until I find another I like. Good luck to you!
Specializes in Cardiac/Telemetry, Hospice, Home Health.
Pros:
Being able to get to know my patients and their families. Not just a 12 hr shift with hospital patients being admitted and discharged daily.
Providing more holistic care. Feeling like I make more of a difference.
Flexibility, being able to set my own schedule. If I need a specific day off, I schedule around it.
Autonomy. Knowing what I am responsible for and having the trust and freedom to do a good job without someone breathing down my neck. LOL.
Opportunity to make more income. I am per-diem, and if I take on a lot of visits, I make A LOT of money.
Cons:
Having patients all over the county. The mileage on the car can get horrendous.
Last-minute scheduling changes. It can turn a productive day into a long, drawn-out one by having to reschedule patients. Any schedule I have carefully arranged to see patients according to the area goes out the window, and it happens a lot.
Lots of pros, most stem from having the time needed to perform tasks and collaborate with your team and patient's providers.
Not too many cons. Well, I wouldn't miss the paperwork. The main con is the same ones everyone runs into in healthcare..reimbursement issues, disparity and lack of patient resources, and ever-increasing acuities.
My tips?
Everyone has my cell number. I don't work in an office; I work remotely from home and my car. I consider my cell phone my work phone, and I'd rather have a voicemail directly from a patient or caregiver than a message to call the office and end up making two calls. If I can't pick up the call, it goes to VM. My patients/patients know they can call me during waking hours; otherwise, they have the on-call nurse. I also text with those who can; nice way to multi-task and have recorded info. No one has ever abused it in 7 years. And the anxiety leaves their face when they realize they have a familiar person to call. Many people are horrified at this practice, but it works to my and my patients' benefit. I would only advise you to get solid in your HH knowledge first and understand your role better. (You may not be a case mgr making this moot).
Develop good working relationships with everyone. Providers' offices, labs, DME's, Infusion, etc. They will remember you, and once trust and credibility are developed, it will pay off in improved communication, which in turn helps everyone.
Become strong in wound healing principles and products.
Communicate with your team. I text with mine frequently. You have to follow HIPAA, but if you notify your team of upcoming MD appts, tricky directions to patients' homes, heads up on anything that will affect their care or day, etc., they will love you and return the courtesy. I've had several contract therapists make a big deal over how uncommon this communication has occurred in their previous experiences and how much they appreciate it. Benefits everyone, including the patients.
I carry a comprehensive and ample car stock. I want to be able to implement any wound care when it's appropriate, and as soon as I have ordered, pull out an incentive spirometer for that pneumonia patient who wasn't sent home with one.
I just started in HH about a month or so ago. I'm currently the DON, but until another RN is hired, I'm doing field nursing 2x week.
Pros:
Flexibility - you can run an errand in the middle of the day, meet a friend for lunch, run home if you're in the area - things like that.
Hours - it's nice working dayshift. I used to do nights mostly. I work between 9-5, so that's nice as opposed to all-nighters.
Patients - I enjoy being able to go in and not just educate or change wound dressings but actually visit and make these people feel good. They appreciate it so much. I work with Medicare ppl only, so it's a lot of lonely old folks who love the company. Sometimes I feel like I get paid to visit with them.
Low-stress cases - the actual stress level of your patient acuity is so low—nothing like the hospital or even urgent care. So chill and relaxed.
Make a difference - it's nice when a patient's wound gets better from your interventions or their dependent edema greatly decreases because they're actually listening to you when you educate them about elevating and wearing compression stockings. It's nice to see positive changes over time that you helped to implement.
CONS
not as many as pros, but big deals nonetheless.
Pay - I was getting paid per visit plus hourly for the actual amount of time I was with the patient. Now I'm salary because I'm DON but still seeing patients. Technically I'm compensated, but I'm not specifically paid for the exact mileage I expend nor the time it takes me to chart.
Schedule getting thrown off - as someone said, your day could be going smooth, and then patients need to reschedule, and it honestly effs up my whole day. I try to see them in order of distance, so I'm not all over the place, and sometimes, like today, when I should've been done charting right now, I'm waiting around taking an extra long lunch until my last two patients are ready for me. It's frustrating when you have to backtrack and waste gas. My pay might compensate, but I have bills to pay and other stuff I'd like to spend it on, I don't want all my pay going to gas to go to work.
Charting - I may finish up at five and sometimes before, but then I'm charting at home. And I don't get paid for the hours it takes to chart. I like finishing up early or mid-afternoon because I have time to chat and be done by 5. But on that same note, if you want a full patient schedule, you very well may not even finish seeing patients til five or later, and then you have to chart on top. And resorts + admits take forever. Even regular visit charting takes me 20-30 min per pt. So you take an average of 6 pts, and that's roughly 3 hours of charting tacked on to my day.
No benefits - I don't have benefits. I don't like that at all.
I love the patient aspect for the most part. Not sure I'll do home health forever, though.
It's great to have the independence but the never ending charting even on the weekends can be stressful
I mean I chart and submit regular visits before my next visit ,however if it's an admission or a resumption of care you don't have time to complete thie before your next visit and sometimes your left on Saturdays or late at night completing these believe me it's NO FUN. The reality is you get no weekends
KelRN215, BSN, RN
1 Article; 7,349 Posts
I do pediatric home visits. I love my patients. I love the autonomy. As someone else said, the lack of control is sometimes difficult. When you are taking care of a child in the hospital, you KNOW that he is getting his full G-tube feeds and all of his meds because you are the one giving him. When you are the nurse dropping in to see him at home, you might discover that Mom hasn't fed him or given his meds for days, and you can't get through to her no matter what, and CPS doesn't want to do anything. I also dislike irresponsible parents... no exaggeration, today I walked into a house and found one of my 7-year-old (ONC) patients febrile, covered in a full body rash with an HR 140s-160s and RR 60-100, and Mom left him like that since last night without so much as even calling the MD because she knew I was coming today.