What nursing skills will I never learn if I start my RN career in home health?

Sour Lemon · Jul 27, 2018

I suppose that would depend on the type(s) of patients you have or don't have.

caliotter3 · Jul 27, 2018

All people who work in any nursing specialty are going to have experiences that differ and will become proficient in some skills versus other skills at any given point in time during their nursing career. When one moves to a new specialty, one learns the required new skills on the job, just as they did with their very first nursing job. Becoming a home health nurse does not prevent one from learning skills any more than becoming an ED nurse prevents one from learning skills.

conroenurse · Jul 27, 2018

Geesh, sure it's just me, but I think that 1 yr on the Largest hosp u can get to (worse), on Med-Surg floor, in a teaching hospital, is best for any nurse LVN or RN. You learn basic nursing and other things and you will never forget. : )

Nurse on the Go · Jul 28, 2018

Home health is really not an appropriate setting for a new grad and you'll find that reputable agencies won't consider nurses without at least 1-2 years of experience. There is good reason for this: the assessment skills, critical thinking, ability to direct a care plan, and autonomy necessary to succeed in home health are gained with real-world experience, not learned in nursing school.

As the above poster mentioned, I would recommend you get some basic foundational experience and set yourself up for success. Home Health will still be there once you're experienced, and you'll be a far more effective clinician for it.

Oh, and the multitasking piece is certainly not unique to the hospital. Home Health is incredibly busy as well and you'll find that effective time management is very much required.

Lemon Bars · Jul 28, 2018

Home health is really not an appropriate setting for a new grad and you'll find that reputable agencies won't consider nurses without at least 1-2 years of experience. There is good reason for this: the assessment skills, critical thinking, ability to direct a care plan, and autonomy necessary to succeed in home health are gained with real-world experience, not learned in nursing school.
As the above poster mentioned, I would recommend you get some basic foundational experience and set yourself up for success. Home Health will still be there once you're experienced, and you'll be a far more effective clinician for it.
Oh, and the multitasking piece is certainly not unique to the hospital. Home Health is incredibly busy as well and you'll find that effective time management is very much required.

Can you elaborate on what you are saying, Nurse On The Go? I performed many assessments on hospital patients during nursing school, and they always felt rushed because I had other patients to get to. It seems to me that in home health, with just a single patient in front of me, I could do a more thorough assessment. Same situation with developing a care plan. If I can find a home health agency that has a training program...

I have work experience in jobs which required multi-tasking and also in jobs that require a lot of hustle, but little multi-tasking. For me there is a difference between working quickly and efficiently and being in an environment that constantly distracts me and pulls me in different directions. I can hustle, but I do not multi-task well.

I am listening to what you are saying, and I know that you are giving traditional advice, but I'm just not clear on why this advice is typically given. Thanks for any help!

Libby1987 · Jul 28, 2018

Can you elaborate on what you are saying, Nurse On The Go? I performed many assessments on hospital patients during nursing school, and they always felt rushed because I had other patients to get to. It seems to me that in home health, with just a single patient in front of me, I could do a more thorough assessment. Same situation with developing a care plan. If I can find a home health agency that has a training program...
I have work experience in jobs which required multi-tasking and also in jobs that require a lot of hustle, but little multi-tasking. For me there is a difference between working quickly and efficiently and being in an environment that constantly distracts me and pulls me in different directions. I can hustle, but I do not multi-task well.
I am listening to what you are saying, and I know that you are giving traditional advice, but I'm just not clear on why this advice is typically given. Thanks for any help!

Not Nurse on the Go but I'll agree with everything she says.

Assessments and decision making are the big ones. You won't have listened to hundreds of sets of lungs, heard the team (MDs, RNs, RTs etc think out loud or explain things). You haven't made a hundred calls to MDs for changes in condition and heard their feedback.

You haven't functioned as a basic nurse yet let alone practice independently while learning a tremendous amount of non intuitive reimbursement, regulatory and compliance information that you cannot imagine until you've worked in home health.

I've precepted acute care nurses, ICU nurses are particularly blown away at everything home health nurse hasn't to know. Not learn, but know. At least an ICU nurse can recognize early symptomology of sepsis and CHF from the door and have established skills but they haven't practiced in disease management and wound care.

For you to go take responsibility for the management of the high acuity patients out there would be reckless.

Get a year or two of acute care (or sub acute/skilled end of SNF), preferably a variety of Med Surg as you will see everything in home health.

Nurse on the Go · Jul 28, 2018

Not Nurse on the Go but I'll agree with everything she says.
Assessments and decision making are the big ones. You won't have listened to hundreds of sets of lungs, heard the team (MDs, RNs, RTs etc think out loud or explain things). You haven't made a hundred calls to MDs for changes in condition and heard their feedback.
You haven't functioned as a basic nurse yet let alone practice independently while learning a tremendous amount of non intuitive reimbursement, regulatory and compliance information that you cannot imagine until you've worked in home health.
I've precepted acute care nurses, ICU nurses are particularly blown away at everything home health nurse hasn't to know. Not learn, but know. At least an ICU nurse can recognize early symptomology of sepsis and CHF from the door and have established skills but they haven't practiced in disease management and wound care.
For you to go take responsibility for the management of the high acuity patients out there would be reckless.
Get a year or two of acute care (or sub acute/skilled end of SNF), preferably a variety of Med Surg as you will see everything in home health.

^^^ This!

I'll also add that the orientation program for even the best home health agencies won't focus on teaching you how to function as a nurse. Home health orientation teaches you the basics of how to organize your day, the mountain of regulatory requirements you will need to know and follow, and the basics of case management (if you're lucky), but it is designed with the expectation that you have already mastered the basics of nursing. Clinical competence is typically validated, but is not the focus of the training program.

Home health is an amazing field and a great goal to work towards. Focus on getting some solid med-surg experience (and any wound care experience you can get will be a huge plus) and you'll be in a good position to make the leap in a year or two.

allnurses Guide · Jul 28, 2018

I just got my RN license on Tuesday of this week. I did not like the multi-tasking environment of the hospital during my nursing school program and I'm interested in trying home health. Although a nurse is a nurse wherever she or he works, what important/traditional nursing skills will I never develop if I start my RN career in home health instead of in a hospital setting?
Thanks for any advice!

Aside from the issue of whether or not a new grad should start in home health, I think that question would only be pertinent if you plan to stay in home health for your entire career. Maybe I am misunderstanding the question, but the requirement to learn and ability to learn new nursing skills doesn't have an expiration of some time before you lose the ability to learn them forever.

The drawbacks you might encounter would be on the employer side of things. They may assume your years of experience in another area translate into them offering you less thorough or shorter orientation vs a new grad.

The other point I would make is that hospitals seem to place a premium on recent acute care experience. So in that case, putting your time in acute care for a few years followed by many years of another specialty isn't necessarily going to give a great advantage of one over the other. Best wishes!

Lemon Bars · Jul 30, 2018

You make several good points, Nurse/56. Thank you.

turtlesRcool · Jul 30, 2018

For me, the biggest advantage to starting in a hospital setting is that you have other people RIGHT THERE. No one knows everything, and as a new nurse, there are MANY things you don't know. You probably don't even know what you don't know yet.

When you're in a hospital, and you have trouble with a skill, or an order doesn't make sense, or you just feel like something is "off" about a patient, there is another nurse there to ask. There are doctors, respiratory therapists, physical therapists, etc. all there to lean on.

If I'm in the hospital, and I notice a patient is coughing while/after eating or taking pills, I can mention it to the doctor and try to get a speech language pathologist in to evaluate the patient's swallow and put him/her on a modified diet, if necessary. In home health, you're on your own. Is the cough nothing? Or is the patient aspirating? What do you do?

KalipsoRed21, BSN, RN · Jul 30, 2018

I think the biggest disadvantage to starting as a new grad in home health would be that one had not had the opportunity to sharpen their assessment skills relative to the amount of autonomy in home health. It will be a terrible disadvantage to you that you won't have someone with more experience right down the hall to grab and come look at your patient with you when you have a concern. One learns a great deal in nursing school, but it took me 2-3 years of telemetry and med surg before I was confident in my assessment and could come up with a complete course of action for the patient on my own. Like knowing what I could implement before I called a doctor and having a good idea on what the doctor was going to tell me to do. During the time it took me to understand what to do, there were more experienced nurses throwing it in my face what I was missing. It wasn't fun, and I thought no could be done in a kinder way, but it was necessary.

Having an idea of what you want the doctor to write orders for is kinda a big deal in home health. Mostly because they are relying almost completely on you for what needs to be done.

I get not wanting to work the floor. I was miserable on the floor and slightly less so in the ER, but I would be truly stressed in home health had I not had that experience.

Now I work with a nurse who started as a new grad in a doctor's office and has been able to transition to home health pretty successfully. So maybe that might be an option for you as well?

I'm sorry but I truly feel that home health as a new grad would be seriously bad for the patient and for you. You really don't yet have the assessment skills for it yet. And while I agree with nursel56 statement that there isn't an expiration date on learning a nurse skill, the lack of support for you to learn those skills due to the requirements of the home health position make it a position detrimental for a new grad. If a nurse with 5 years or more of experience was to drive around with you for every visit you have for a year...then maybe home health wouldn't be such a bad place to start your nursing career. But that is not the kind of orientation you will get.

Unfortunately you don't understand what you don't know about nursing yet and why what you don't know will probably lead to a poor outcome trying to start your career in home health. It isn't something that can be explained to you by any nurse on this website...it is only something you will get after you have been employed for a year as a nurse.