this and that

tl;dr: I got a new job, Im helping out another nurse so Ive been working long hours, I like my new job, sorry I havent posted much/hung out with you, friend.
Listen here are the facts:

1. I started a new job in December. This means that ive been extra busy the last few months learning stuff, taking classes, etc. In fact, when I first started, I had to do forty hours of online training. This is because my new job is as a nurse case manager and they have to make sure I know what I am doing. Unlike in a hospital, when I am out at a patient’s home doing something, I dont have another nurse there for backup. Ive had to completely relearn how to think, since nursing school gears you for working in a hospital, not on your own in home health.

2. Even though I am now no longer on “orientation” and have been working completely on my own since late January, I work A LOT. More than I’d like. It will get better though. The problem is that I have been helping out another nurse. Her sister had been dying of cancer (it is so sad…she was only like 36 and had cancer like all over her body), and she passed away last Monday. So Ive been having to drive to like Ellijay and Jasper and Ball Ground and places like 1.5 hours away from me over east like in the mountains. Thats like a 3 hour round trip where Im in my car and doing nothing, which makes my day a lot longer. Many days I start working at 7:30 AM and I dont finish my paperwork at home until 10-11pm. Once I am not filling in for her so much though, my days will be shorter and I will be able to update more, hang out with my real life friends more, etc.

3. I like my new job! They told us in nursing school that everyone just has to find the nursing position/area that is right for them, their “niche” or whatever. I pretty much knew after my first year of nursing that Hospital nursing wasnt going to be for me. I knew however, I needed several years experience before I could do anything else so I was kinda stuck miserable for a while. Then when I saw that a home health company in the area had an opening for Catoosa (the county I live in) and Murray county, I jumped on it. At first I was a little unsure about the position. It was hard at first to learn to think differently and not in a hospital mindset. Also, I had to learn all the medicare stuff and of course all the paperwork. As with any government program, it is way complicated and super annoying. It took me a really long time to get it figured out, and I still learn new things every day. However, the moral of the story is that I dont dread going to work every day. I did before, and I was pretty much set on leaving nursing because of it. I didnt think I could ever not be miserable working as a nurse, but I am not with my new job. Sure, it is hard and there are really long hours some days and working more closely with doctors is really frustrating, but its like I dont mind it as much, if that makes sense. Even though it sounds cheesey, its kinda like a “labor of love”. I really like all my patients, and you do kinda start to get attatched and build a friendship with them when you visit them in their homes several times a week. Its neat though because I can see that I am making a difference more. In the hospital, you are in such a rush and sometimes only see that pt for a 12 hour shift and never see them again. With my job now, I can actually sit down with them in a comfortable environment, actually talk to them about what problems they are having, and I actually have the time to fix them like they need to be fixed. In the hospital, you pass on whatever you cant fix on your shift and just hope someone else can figure it out.

4. I like my new job also because I pretty much only depend on me and I like the independence. In a hospital, if other nurses/CNAs/etc didnt pull their weight, you had to pick up the slack. If the nurse before you didnt get all her stuff done, you are expected to get all of it done and your stuff too. If the CNA isnt doing their job, or if the hospital doesnt have one assigned to your floor that night, you have to do the CNA work and your own work too. It just doesnt work, and your unit is constantly behind. Plus, hospitals are so short staffed, you are just honestly constantly running around like a chicken with its head cut off trying to help everyone. I couldnt stand it.

Now though, they fax me my assignment (which people are due to be seen that day). I pretty much make my own assignment, tell the scheduler, and she puts it together (as in Mrs. A has to be seen 3x a week, mwf is best, mr. B needs to be seen once a week, whenever he fits in the schedule is fine, Mr. C has to be seen 2x a week, space it out). Then I call my manager in the morning and tell her who I am seeing, just to check in. They will also then tell me if anything has changed (i.e. if a doctor has called in any new labs on a patient, if a catheter change is due, or if they need me to pick up a new patient or something). Then I go drive to their houses and see them. I have to stay at least 30 minutes. Most of my visits though are between 45 and 60 minutes, but sometimes up to an hour and a half if its complicated. I get paid per visit, and Im paid more if its like a new patient and I have to fill out all their new paperwork, or if its a discharge, or recertification). At 4:30 or so before my manager leaves the office, I call again and check out and tell her if there are any major problems, incidents (like a fall, ER visit, or hospitalization).

Since I am a case manager, I technically dont have to depend on anything else and I like it. If a lab needs to be drawn for a patient, I go and draw the blood and personally take it to the nearest hospital. When I worked in a hospital, if a lab needs to be drawn, I have to wait around for the lab department to come and do it…if they dont forget, lose the order, or take 3 hours because they are too busy. If a patient needs supplies, I call the supply company and order them. I dont have to wait around for Central Supply to get around to bringing it to our unit at a hospital. If a patient has a wound and I know that it is not healing well and have a better idea, all I have to do is call the doctor and ask if we can do it differently, and then do it. In a hospital, you’d have to wait for the next time the doctor makes rounds, try to catch him when he is there to ask him about changing the wound orders, then he’ll say “I dunno, lets have the wound nurse take a look”, then you have to wait for the wound nurse to come look at it (if she is working that day and who knows when she can fit that patient in), and then possibly get changed orders. The doctors trust us to make suggestions because we see the wound more than them in their home and we have to take like 20 hours of wound training for the position, so they let us do a lot of stuff nurses usually wouldnt get to do in home health.

And the list goes on. I can make so many more decisions for myself in this field, and if something does need to be changed but I am not sure of how, they have all sorts of people I can talk to for advice. Its awesome.
5.  I get to do so much cool stuff I didnt get to do in the hospital. I get to see and treat really cool wounds unlike in the hospital. The wound nurses deal with the really bad wounds there. I get to do them now, and even though some of them are super gross, you have to understand as a nurse some of them are really fascinating. Especially wound vacs. I had never done them before this home health position. In a hospital, the wound nurse does them and the floor nurses just make sure they stay connected and the dressing doesnt come off. Now I get to iniate them, decide how I want them done, and change them myself 3 times a week. Its so cool, wounds are almost like a puzzle. You have to assess them, and figure out what will work best. Call me a dork…but its fun. I get to take out sutures and staples all the time. I get to access implanted ports that I never got to do before. I get to do stuff with suprapubic catheters, which I never really saw in the hospital. Plus, I get to decide when a patient is discharged, which is cool.

It is neat not dreading to go to work every day. While Im working way harder than Ive had to work before, I dont mind it. Im pretty sure I found my niche or whatever, and I’d like to do this longterm. Plus, I make pretty good money (much better than in the hospital) and in between patients I get to hang out in my car and listen to music and eat snacks or whatever I want. And I make my own hours, and can work pretty much whenever during the week as long as I get my work done. Unlike at the hospital, I can also wear whatever color cute scrubs I want. yay. I pretty much have an office in my car though, since I spend all day in it. Also, my trunk is full of plastic bins with medical supplies in it from enemas to catheters to IV kits to gauze and dressing supplies. I dont mind though, its all worth it when your little old elderly patient hugs you and asks if you are an angel *cheeeeeeeeeeesseeeyyyy*

This entry was posted on Sunday, March 29th, 2009 at 1:26 pm and is filed under General. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.