Welcome back to the Nursing School Week by Week podcast. I’m your host, Melanie, and today I’m gonna go through what a day in the life of a home health nurse looks like. But first, one of today’s sponsors is TrueLearn. TrueLearn is an NCLEX prep resource that perfectly ties into Picmonic, and uses funny pictures and stories to help you study for that oh so important test that we all have to take after nursing school. TrueLearn uses performance analytics to perfectly map out a study blueprint for you so you know exactly what to study when. There are a ton of NCLEX prep resources now yall, but I love this one because it implements the picmonics. And obviously, if you aren’t using Picmonic yet to study for your classes, you need to go check them out like yesterday. But I’ll put a link to both TrueLearn and Picmonic in the show notes for a discount.
So if you guys have been following along you’ll know that I graduated from nursing school and I worked in Med Surg for a year, then I worked in the Emergency room, which I haven’t really talked about yet. That will be sometime soon, but that one’s coming. But now I’m working as a Home Health nurse and let me just tell you, the difference between working in a hospital and working home health is night and day. And I’m gonna be talking about my experience as a home health nurse, what a day in the life looks like. I’m gonna touch on some myths about home health nurses, kind of the reputation that they have and if I think that that’s warranted or not. And how it compares to working in the hospital. And these are just things to kind of tuck in your back pocket if you’re going through nursing school right now, or if you’re about to go through nursing school. And if you’re anything like me, I had no idea what kind of nursing I wanted to do after I graduated. Some of my friends knew exactly what they wanted to do and I always envied that. But that was not me, and I think in some ways, I’m still looking. You know, but I don’t think there’s any shame in that. I think it’s good to be curious, and I hope I’m forever curious and forever learning. And that’s what I’m doing right now. I’m learning about different specialties within nursing, and that is the beauty of nursing. Oh my gosh, I mean what other field can claim so many specialties? It’s like, if you don’t like what you’re doing in nursing, you don’t have to completely throw in the towel and give up the degree that you worked so hard to get. You can just try a different specialty.
Alright, so what does a typical day of a Home Health nurse look like? Usually you will get your assignment the night before, so you’ll kind of know what your next day is gonna look like before you even go to bed the night before. So you have your own ipad, and you log on, and you can see the patients and the types of visits you’re gonna have the next day. Andy typically a home health nurse will see 5-6 patients a day. And I know when I was working in the hospital, what I would have given to know what I was getting myself into. You know, I used to have so much pre-shift anxiety driving to the hospital in the morning partly because I had no idea what awaited me. I had no idea if it was going to be a stroke patient, an ortho patient, someone having a diabetic episode, I had no idea. But it’s a lot less stressful going into your day kinda knowing what to expect.
Alright, so you log onto your ipad the night before, and you can kind of see, ok, yeah yeah, I’ve seen this patient before, I’ve seen this patient before, this patient is new, ok. Let me look up real quick where they live. And you can go through and plan out your route for how you want to get from house to house. Like which house do you want to start at, because I know for the company that I work at, you get paid mileage, but only from patient to patient. So I would get paid mileage going from my house to my first patient’s house. But I would get paid mileage going from patient to patient to patient’s house. Does that make sense? So you want to plan out your route in such a way that you’re not driving more than you have to, and just wasting time. And then you also want to check your bag. You’re gonna have a bag full of all the supplies you need, so just kinda check your bag and match it to the patient’s that you’re seeing. If all of your patients have wounds that are gonna need to be dressed the next day, then make sure you pack some extra dressing supplies in your bag.
And then you typically want to give each patient a call the night before to check in with them and make sure that they know you’re coming to see them. Because that’s the last thing that you want to happen, is that you drive 20-30 minutes to get out to your patient’s house, and they’ve gone to the grocery store or they’re not there because you didn’t check in with them and they forgot that you were coming, so you want to call them the night before and give them like a 2 hour window of when you’ll be there. So, I’ll say, “Hi Mrs. Smith, this is Melanie, I’m a Nurse with bla bla company. I’m gonna come out and see you tomorrow morning, I wanna make sure you’re gonna be there at home between 9am and 11am.” And don’t say, “What time would be best for you?” Because you have 4 or 5 other patients that you have to see in the day, so you give them the time frame and if they do say, “Oh no, I’m not gonna be here”, then try to work around it if you can. But as much as possible, you want to stick to your own schedule that you have for yourself. Just like if you were in the hospital. I remember, as a new baby nurse doing clinicals, you know, I’d go into a patient’s room and if they were sleeping, I’d be like, “OK, I’ll come back later.” You know, but you learn to just wake em up, do what you’ve gotta do, because you have a million other things that need to get done. You can’t try to get them done around your patient’s sleep schedule. That just won’t work.
Alright, so, it’s the morning of your work day. You called all your patient’s the night before, they all confirmed. You’ve mapped out your route for driving, and you get to your first patient’s house. You are going to go in and greet your patient, and make sure that you have the right patient. Make sure you properly identify your patient. So that you know you’re definitely treating the right person. Then, depending on what type of visit it is, that will dictate what you’re going to do for your patient. So most of the visits will be routine visits, meaning this patient has been seen by home health before, and you are following up, with continuing care, like doing another routine dressing change or another IV antibiotic administration, something that’s been done before. Or, it could be a start of care visit. With a start of care visit, you’re the first home health nurse to see that patient, and get them set up with home health care. So that’s gonna be a lot more administrative duties like getting their signatures and consent forms signed, making a list of all their current medications they’re taking, as well as doing a really thorough physical assessment to get their baseline health status.
Alright, but let’s just assume this is a routine visit for a patient that needs a dressing change. And typically most of the patients that I have seen, have needed dressing changes, or have had picc lines or mid lines and they needed an IV medication, like a bag of antibiotics, or an IV push medication, as well as training on how to keep the lines clean. Or they might need a picc line dressing change, or they might need their Foley catheter checked to make sure there’s no blockage. So for a routine visit, we’ll typically go in, greet the patient, ask them how they’re doing, how they’re feeling. If they have any specific concerns. Then you’re gonna want to get a full set of vitals at every visit. So that’s blood pressure, temperature, oxygen saturation, pulse, and respirations. And with the blood pressure, we do it the way you learn in nursing school, so with the actual blood pressure cuff, not how they do it in the hospital with the machine and all that, so the way that you learn to take a manual blood pressure reading in nursing school, you really do need to know that. That’s definitely handy if you're gonna be working in home health. It's also handy working in the hospital. I had several times when the patient’s blood pressure was just too low for the machines that you usually use to detect it. So I had to go in and manually take their blood pressure. So definitely practice on everyone you can. Anyone who will allow you to strap that on their arm, cause the more you practice, the easier it is to hear the little tick tick ticks when you’re listening for a blood pressure. But yeah, full set of vitals, and with the heart rate, you want to actually put your finger on their wrist to find their radial pulse. And you want to get their oxygen saturation level, so you’ll put that little clip on their finger, and you also want to get their temperature every time. And then depending on what their primary diagnosis is, you may need to get a weight with every visit as well. And then if they have a wound, you want to take the dressing off, look at the wound, and you want to measure that wound. The wound has to be measured at least once a week. And when we measure a wound, we measure length, width, and depth of the wound. And remember, you measure the depth by taking that long q-tip and gently sticking it into the wound, then you see how far the q-tip went into the wound, and that’s your measurement for depth. And if it’s a routine visit, you want to clean the wound typically, and then put a new dressing on, according to the doctor’s order.
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So, back to a home health visit. A routine visit usually takes about 30 minutes. If it’s a start of care visit, that first home health care visit the patient has had, that takes about an hour. So, if you think about that, if you see 5 patients in a day, and you’re with the patient for about 30 minutes, and some will take longer. That’s only 2 and a half hours that you’re actually with patients. The rest of your time you are driving and charting, and we try to get as much charted in the patient’s house as you can, and if you do think you want to go into home health, I highly suggest that during training you force yourself to take the time, I know it’s super awkward when you’re first learning to be trying to chart right in front of the patient and it’s very tempting to just, you know write everything down on a piece of paper real quick and then transfer it all over when you get home, but I recommend taking the time to just get into that habit of charting, just like when you’re in the hospital, as much as you can, you want to chart at the bedside. It’s the same thing in the patient’s house. You want to chart in their living room or in their bedroom, wherever you are in their house. Cause that’s gonna save you a lot of time, and it’s going to make your life much much easier, as far as your work-life balance. Cause a lot of home health nurses can get into the habit of bringing their work home, meaning bringing all their charting home. So they may still spend 30 minutes in each patient’s house, but then when they get home, they’re not done for the day. They still have 2, 3 hours of charting to do.
So most of the home health nurses that I’ve seen, you’re gonna love this; they start their day at about 8, 8:30 in the morning, and they’re usually done by 1pm. That’s right, you heard me right. They’re usually done by 1pm. Which means this is a great choice for Moms! Cause you can drop your kids off at school in the morning, then go work, then you’re done in time to pick them up in the afternoon. And they pay yall. Now this is obviously gonna depend on where you live, but where I live, the pay is the same as working a 12 hour shift in the hospital. Now I will say home health nursing is usually 5 days a week, if you’re a full-time employee, but I’m pretty sure most Mom’s out there would take 5 days a week of 8am to 1pm over working 12-14 hour shifts in a hospital and struggling to find suitable child-care. So, I don’t know, I mean it kinda depends on what stage you’re in in life. If you’re going through nursing school and you’re young, just out of high school, and you don’t have any kids yet, then that may be a moot point for you. Trying to find childcare is not gonna be an issue for you. But if you’re a parent of young kids, it’s definitely something to think about.
Alright, so, you might be thinking, “What is the charting like?” I’m not gonna lie, it is a lot. I’d say you’re doing more charting as a home health nurse than in the hospital. Definitely more if you’re doing a start of care visit because you’re charting everything to get the baseline information for that patient. So that all the other home health nurses and home health physical therapists that come after you, they’ll have that information that you took to review.
Alright, so, we’ve already touched on some of the differences between home health nursing and working in the hospital. But I would say the main one is the stress level. The stress level, working in the hospital, at least for me, was ridiculous. Um, and I’m also an introvert, and that can definitely play into it, but having 5-6 patients at a time, there’s just no way around it, that’s super stressful. Trying to keep up with all their vitals, and meds, and everything else they need; their admissions, their discharges, their family members. All the other people on their care team are trying to communicate with you, and it’s just a lot. But as a home health nurse, you’re able to focus on just one patient at a time, which to me, it would be worth it to take a big pay cut just for that alone, but I’m not! It’s the same pay. I feel like it’s one of nursing’s best kept secrets. Like, what? You’re telling me I can get the same amount of pay, and just see one patient at a time, and not have any call lights going off? Not have any doctors or case managers trying to call me and ask me a million questions while I’m talking to my patient? I mean, that’s gold right there.
And also, I think the care that you’re able to give to your patients is a lot more individualized. Like, when you see a patient in the hospital, you don’t know what kind of struggles they have going on at home. When you’re sitting in their living room and you’re talking to them, maybe you’re talking to their family members as well and you can walk through their house, you get a very clear picture of what their living situation is like. And as a home health nurse, you’re also a detective. For example, if the patient says, “Oh yes, I take all my medications on time every day,” but then you go into their bathroom and look in their medicine cabinet and half their pill bottles are empty. Or they’re expired, or the patient just can’t find half of their medication. Then you know that maybe there’s something going on. Maybe they can’t afford their meds or maybe they have no way to get to the pharmacy. And these are issues that you can help the patient with. Also being in the home you can better evaluate what the fall hazards are in the house. Is their floor totally cluttered? Are there boxes everywhere? Are there pets around that they might trip on? What is their true living situation like?
I also think home health nursing gives more back to the nurse. And let me explain what I mean by that. So, most of us went into nursing to help people. But a lot of times, working in the hospital, we don’t get to see the results of our efforts to help these people. So a lot of times, you know, we’re just part of a huge team, right? We come in for 12 hours and we take care of this patient, and then maybe we never see that patient again. But as a home health nurse, you’ll often see the same patient for months, 2-3 times a week for months, and you really get to know that patient. And you really get to see, “OK is this wet to dry dressing, is this really improving this patient’s wound? Or do we need to maybe try something else?”
Another thing that I’m liking about home health nursing is, the patients are just generally happier. You know, nobody’s at their best when they’re in the hospital. That’s usually most people’s worst time in life. You know? They’re at their lowest. But, as a home health nurse, we get these patients after they get out of the hospital. They’re happy to be back home, back in their element. And they’re much easier to deal with. They’re happier, they are grateful that you’ve driven out to their house to see them and help them, and a happy grateful patient makes your job as a nurse much better. Much more pleasant.
Alright, one myth that I want to address that I’ve heard, um, from nurses and from other disciplines is that home health nurses are nurses who couldn’t hack it in the hospital. And I just want to touch on that a little bit, um, I do think as a new nurse it is good, I don’t think it’s completely necessary, but I think it’s good experience to get a year on a med-surg unit or doing something in the hospital, so that you will always have that to compare. But, one of the first things that I heard after I took this home health job, I heard it from another nurse, but she said, “You know, my worst day as a home health nurse was still better than my best day in the hospital.” And so far, I have to agree with that. Totally agree. I mean, will I lose some of the skills that I learned working in the hospital? Yes, definitely. Doing what I’m doing now, I’m probably not going to be as good at starting an IV as I was when I worked in the ER, or inserting an NG tube, things like that. But, I’m learning skills that I didn’t have before working in the hospital. I’m seeing a whole other side of nursing and learning the challenges that the patient faces once they leave that hospital room. Once they get home. You know, we tell them during hospital discharge to do all these things, and then we just kind of send them on their merry way with maybe 15 minutes of education, maybe, and a printout that I would guess 90 percent of them never look at. So I’m losing some skills, but I’m gaining others. And I don’t know if working in home health is going to be a forever thing, but for now, it’s a pretty sweet gig.
Alright, you guys, I hope that gave you a glimpse of a different side of nursing, maybe one that you hadn’t considered before. Like I said, I think it’s one of nursing’s best kept secrets, and an especially good option for those of you with young kids at home who need a more flexible schedule. Alright, you guys have a great week, and I’ll talk to you next time.