It seems when new grads are lamenting the difficulties of finding acute care (hospital) nursing jobs, the suggestion is to try SNFs or home health, that they might be more willing to hire a new grad.
To me, home health seems like a more difficult area of nursing, requiring more experience and strong assessment skills. Thus, wholly inappropriate for a new grad nurse. Am I wrong?
My husband is a manager for a home health hospice company, and he says they would never consider hiring a new grad. Likewise, I've been looking around for jobs outside of the hospital that offer more sane hours, and every home health agency I've applied to has not been interested in me, due to not having home health experience. Yet, they're a viable option for a new grad? Doesn't seem to make sense.
Specializes in Nurse Leader specializing in Labor & Delivery.
Can we hear from some hospital nurses? I'd love to know what the common perception is.
Since my husband works in home health, I have a fair idea of what the job entails, and as I'm sure you were able to glean from my OP, I don't think it's a position for anyone who doesn't have at least 1-2 years of nursing experience. In hospital nursing, you have several other nurses (plus the charge nurse) available to you for questions, or if you want a second opinion on a situation or a patient's status. In home health, you're pretty independent, and don't have a lot of experience to draw from on assessment skills and what's normal (thus, what is abnormal). There is such a huge amount of autonomy in home health.
I would love to work in home health someday. Sadly, the only agency I would have a shot at, as someone with no previous home health experience (because my husband works for them and can vouch for my nursing skills), I could not ever work for (because my husband would be my boss). No other companies seem to be interested in even looking at my resume.
Specializes in thoracic ICU, ortho/neuro, med/surg.
Can we hear from some hospital nurses? I'd love to know what the common perception is.
Well, I can only speak for my perception, but --
I consider home health to be NOT for the beginner nurse/new grad! it seems like one needs to be really "on top of their game" when working in this environment. You have to be ready to handle things on your own, you have to deal with limited resources, it all seems very difficult. As an ICU nurse I rely on my monitors and lab and supply people to help me out, whereas home health nurses do not have those luxuries! I consider home health to be a very challenging area of nursing, worth a lot of respect.
As Caliotter mentioned, I think what you're seeing is a reflection that some HH agencies are not good employers and they have a hard time keeping staff. New grads might be so desperate for a job and so unaware of what they're getting themselves into that they are happy to sign on. Gradually, the light dawns, that they are in over their heads and that the reasons more seasoned nurses left the agency are still in play (crummy hours, inadequate training, inadequate supplies, nit-picking on every expense, refusing to pay for legitimate claims, etc.). Some will stay and learn the ropes in spite of their employer, but many others will jump ship and make way for a new crop.
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That is what happened to me. I after applying everywhere I was finally hired doing pediatric home health 5 months after passing NCLEX. I was given 1 day unpaid orientation of the agencies policies and procedures. Then when I got my first patient assingment I was given 4 hours orientation the next patient assingment I got, I had no orienation to them, I was told by the office staff to go in early and read the nursing notes to see what was done prior and I could just figure it out
Unfourtnaly I need the money and stuck it out until I was hired by a SNF, 5 months later, but I definatley believe with the lack of support and orientation and education that new grads should not be in home health.
Specializes in Nurse Leader specializing in Labor & Delivery.
The one HH agency that seemed interested in me was very much how Love My Bugs described. It was peds, and their pay was $22/hour. To me, that seems like they're really catering to the new grad, because in this area, that's what they're paying new grads. I don't know too many experienced nurses who would be able to handle that kind of pay cut.
And that's another thing, there's really two different kinds of home health care. The first, as described above is what's called "shift work" or sometimes private duty although that is a bit of a misnomer. In those cases, the nurse spends a specified amount of time with a single, stable patient, usually performing the same routine skills (suctioning, vent settings checks, meds and g-tube feeds, etc.).
The other is skilled home health care, aka Medicare home health care, aka intermittent visits. In this area, the nurse generally has a patient load, does not have a pre-set amount of time to spend (you spend as much time as it takes), and sees multiple patients in a day. These patients may be as simple as a patient with need for diabetic education to as complicated as a patient with multiple wounds on a VAC with IV antibiotics and labs. Think back to your nursing history class, this was the beginnings of the public health movement, the Ladies Benevolent Society of Charleston and the Henry Street Settlement in NYC with Lillian Wald. Even back then, it was acknowledged that this kind of care was not appropriate for newly graduated nurses and required a good deal of education beyond the general nursing program. (I'm reading a history of home health care and learning that there really isn't anything new under the sun!)
Keep it coming, I'd really love to hear from hospital nurses who have/had the impression that HH is an "easy job." I know there are some out there!
As I read through the posts I am reminded that "home health" is a very broad term and there are, indeed, very different types of jobs within that catch-all phrase. I originally read the post and assumed (mistakenly I think) that the reference was to a skilled visiting nurse, the job that I had. Obviously, that is not the only job in home health. I'm sure there are many home health jobs that would be appropriate for a new graduate, particularly if there is proper back-up or if it is a one patient shift job. It may also depend on the referral and intake process that would screen out some of the more difficult cases that I had to deal with. I am in NYC, in Manhattan, and the Visiting Nurse Service will send a visiting nurse into a home to do an assessment without any real screening (when necessary and only as a service to the community). There are other referrals that have been pre-screened prior to discharge so there is more information and, of course, there are the better known cases that just need continued skilled nursing.
I cringe whenever I think of a new grad having to face some of the things I faced because it took all my clinical skills, my critical-thinking skills, and emotional strength to do a good job. Here are things I faced that I would not think a new grad could handle easily:
1. An apartment so filled with items collected over the years that there was no real pathway to reach the patient (think Grey Gardens) who was hidden in a back corner of a filthy dirty apartment filled with roaches and goodness knows what else. Hadn't seen a doctor for "many years" and had serious medical issues, including gross skin lesions.
2. An apartment that had an unlocked door with no caregiver present for a bedbound, incontinent patient, no linens on the bed, no food in the cupboards, and three underage (less than 7 years old) underfed children.
3. A patient who needed the nasogastric tube reinserted. In the hospital I assisted with this but it was not the function of the RN so I had never inserted one.
4. A male patient who needed the foley catheter reinserted. Again, in the hospital it was not the function of an RN to insert a foley catheter in a male patient so I had never done one.
5. A patient who had severe CHF, was fluid overloaded and had run out of Lasix and the doctor couldn't be reached.
6. A patient who was in severe respiratory distress who didn't want his doctor called but his wife did.
7. A newly discharged patient (came home the night before) who had a new colostomy she wouldn't look at. She was anxious to the point of shortness of breath and she couldn't stop crying. She had only a couple of supplies that had been given to her at discharge and it was a type of colostomy bag with stoma ring that I had never seen before and it appeared to be missing critical parts. The current bag had come off so feces was all over the patient and her clothes, still she would not look. The primary reason Medicare would allow a skilled home visit was to teach her to do colostomy care.
I had never faced these things before but my background allowed me to address each situation with a clear head and to find a solution to the problem within the space of a normal home visit. I just don't think a new grad would be able to do that.
For career purposes and purposes of continued learning and well-rounded nursing practice, I still don't recommend it for the new nurse. Nevertheless, I do agree that there are jobs in home health that a new grad could handle and with jobs scarce it is just normal that "you gotta do what you gotta do."
i can't imagine that anyone would think that a practice venue that has constant demands for independent assessment and performance skills would be remotely appropriate for a new grad with none of them. the only think i can think of is that the nurse who make that recommendation had no public health rotation in school, has never seen an actual visiting nurse at work, and has some sort of cherry ames sort of vision of what it's about.
for the last time: home health is not "easier," and it is completely inappropriate for a new grad due to lack of skills.
the next patient assingment I got, I had no orienation to them, I was told by the office staff to go in early and read the nursing notes to see what was done prior and I could just figure it out 
klone, MSN, RN
14,857 Posts
Since my husband works in home health, I have a fair idea of what the job entails, and as I'm sure you were able to glean from my OP, I don't think it's a position for anyone who doesn't have at least 1-2 years of nursing experience. In hospital nursing, you have several other nurses (plus the charge nurse) available to you for questions, or if you want a second opinion on a situation or a patient's status. In home health, you're pretty independent, and don't have a lot of experience to draw from on assessment skills and what's normal (thus, what is abnormal). There is such a huge amount of autonomy in home health.
I would love to work in home health someday. Sadly, the only agency I would have a shot at, as someone with no previous home health experience (because my husband works for them and can vouch for my nursing skills), I could not ever work for (because my husband would be my boss). No other companies seem to be interested in even looking at my resume.