Grow your own nurses to address staffing needs

Clinical sites produce grads with HH experience

[Editor’s note: This is the first in a periodic series that addresses recruitment and retention issues with examples of how home health agencies are meeting the challenge of finding and keeping good employees. This month, we look at a partnership with a nursing school that has resulted in new employees for one home health agency. In future months, we will look at career ladders and staff burnout. If you have a success story you’d like to share with Hospital Home Health readers, please contact Sheryl Jackson, Hospital Home Health, Thomson American Health Consultants, P.O. Box 740056, Atlanta, GA 30374. Fax: (404) 262-5447. E-mail:]

Home health agencies typically don’t recruit new nursing school graduates because the new graduates need time to practice their skills and because it’s hard to find out in an interview or two if the new graduate has the personality, self-motivation, and confidence to work in home health.

While this is true for many home health agencies, at Kenosha (WI) Visiting Nurse Association (VNA), there is less hesitation to hire a new graduate because there’s a good chance the nurse rotated through the agency during his or her schooling.

"We’ve hired three new graduates in the past five years and had a great experience with them," says Rochelle Nelson, RN, BSN, clinical education coordinator for the agency. One of the three did leave nursing in the past year to become a full-time mother, but the other two still are working in home care, she says.

"They did require a longer orientation period with longer preceptor support than an experienced nurse, but their quality of care and enthusiasm for the job was terrific," Nelson says.

All three of the nurses hired were part of a program for which Kenosha VNA serves as a clinical training site for the University of Wisconsin Milwaukee School of Nursing. "We have eight students at a time for three days a week for a total of an eight-hour workweek," she explains.

In addition to the new graduates the agency has hired, it also hired several nurses who went on from school to get their acute care experience, then returned to home health because they were familiar with the environment and knew they wanted to work in home health, Nelson points out.

During their time with home health, the students accompany a nurse on regularly scheduled patient visits. "The students stay on the same team during their time with us because we want them to have a chance to see the process from admission to discharge if possible," she says.

During the visits, students take vital signs, perform physical assessments, draw blood, administer enteral feedings, teach, perform Foley catheter care, and participate in wound care, she says.

Students don’t do the initial wound care, and any wound care they provide is done along with the nurse, Nelson points out.

At first, staff members did not want to serve as preceptors because they thought the students would slow them down, but now they welcome the students, she says.

"All of our preceptors are case managers who have more time to spend on visits or with students," Nelson says.

In many ways, students can help cut the amount of time to prepare for the day’s visits because the students gather teaching materials needed, make telephone calls, and research and make referrals to community resources if needed, she explains.

Provide staff preceptors

The program has not always gone smoothly, according to Nelson. A few years ago, the school didn’t have a preceptor program set up; an instructor supervised the students as they visited patients, she says.

"Students didn’t believe they really learned about home care because they didn’t have the contact and supervision of an experienced home health nurse." Now, with the preceptor program, students have a chance to learn during the visit as well as before and after the visit as the student and nurse travel, Nelson says.

While students do complete some charting activities, the nurse completes the Outcome and Assessment Information Set (OASIS) form, Nelson says.

"It would be impossible to teach students how to complete the OASIS tool in a few short weeks, but we do introduce them to it and explain its purpose and its importance," she adds.

Any home health manager that wants his or her agency to serve as a clinical site for a nursing program should keep a few things in mind, Nelson suggests. "Don’t just pick any nursing school with which to partner," she says. "Look for one that has a strong community health nursing program." Not only does the University of Wisconsin-Milwaukee have such a program, but all of the faculty members have a strong background in community health and are very involved with the students," she explains.

Nelson also recommends that a home health agency work only with mid- to higher-level students to make sure they have the basic skills needed to perform assessments and other activities. "We are seeing more senior students who are working on their leadership and case management requirements," she says.

Make sure you get a patient’s permission for a student to accompany the nurse, Nelson recommends. "We call the patient prior to the visit to obtain verbal approval and then have the patients sign a consent form. It is rare to have a patient refuse to allow a student on the visit," she says.

Her agency does have a number of long-term patients who she doesn’t approach for approval because of family dynamics or the patient’s demeanor or condition, she explains. "If the student’s presence is seen as a disruption to routine or care, it’s not a good experience for anyone," she adds.

From the school’s point of view, the agency should be supportive of the program at all levels and be prepared to offer the student a chance to participate in care and contribute to decisions regarding care, says Joan Wilk, RN, PhD, associate professor with the University of Wisconsin-Milwaukee Nursing Program.

"We want agencies that view the relationship between the school, the students, and the agency as a collaboration," she says. "The purpose of the student’s time at the agency is to synthesize classroom knowledge with real-world situations that enable them to make clinical decisions that produce good outcomes."

Reactions from students who have rotated through the home health agency have been positive but the students are usually surprised at what they find, admits Wilk.

"Initially, students always think the home health rotation will be easier than the acute or critical care, but they find that because home health nurses practice independently, they have to be more proficient, more accountable, more responsible, and more qualified than other nurses who have resources and supervision nearby," she explains.

[For more information about nursing student programs within home health agencies, contact:

Rochelle Nelson, RN, BSN, Clinical Education Coordinator, Kenosha Visiting Nurse Association, 600 52nd St., Suite 300, Kenosha, WI 53140. Telephone: (262) 656-8400. Fax: (262) 656-8406. E-mail:

Joan Wilk, RN, PhD, Associate Professor, University of Wisconsin-Milwaukee, Nursing Program, P.O. Box 413, Milwaukee, WI 53201. Telephone: (414) 229-5488. E-mail:]