Prior to becoming a Clinical Case Manager, I worked as a home healthcare nurse for about 15 years, and loved it. Was it hard work? Yes! But the satisfaction I gained from working with patients in their homes was my reward. I enjoyed the informal, relaxed environment of their home, and the countless opportunities to teach my patients ways to improve their health. I enjoyed helping them become more independent in their care. I enjoyed the challenge of finding a clean place on the dining room table to open supplies to change a dressing, and figuring out the best way to get in the patient’s house when a large barking dog greeted me at the door. Home healthcare was not only nursing; it was a nursing adventure!
What is home healthcare nursing?
Home healthcare is intermittent skilled nursing care that you provide in the patient’s place of residence. The patient must be under a physician’s care who orders the service. You will provide care within the limits of the doctor’s orders. Since the visits are done on an intermittent basis, you will see your patient only a few times per week based on their care needs. A typical visit may last about 45 minutes or so, depending on the care need. Most home healthcare nurses work for an accredited home care agency and are not independent practitioners. The agency I worked for had an expected visit average of 5.0 visits per month. I generally made no less than five to six visits a day.
As a home healthcare nurse you will be expected to work with patients of different ages and with different medical conditions. This may include working with post-operative patients, pediatric cases, mothers and newborns, adults with a variety of medical conditions and even terminally ill patients. At times you may also be called upon the help in health screening clinics, flu clinics, blood drives, etc., but basically your work will be in the patient’s home.
What qualifications are needed to be a Home Healthcare nurse?
Licensing – Most home healthcare agencies employ only registered nurses as case managers for home healthcare. You should have at least an Associate’s or Bachelor’s degree in nursing. Some companies do employ licensed practical nurses (LPN) or licensed vocational nurses (LVN) for home healthcare but check with the agency first. Usually, if you are an LPN or LVN, you will work under the supervision of a registered nurse. As a general rule, you need to have the equivalent of at least one year of hospital-based medical/surgical nursing experience before you can become a home healthcare nurse. Some agencies require additional certification in geriatric care or other specialty care. Proper licensure isn’t the only necessity. Below are a list of other assets that would be beneficial for anyone wanting to become a home healthcare nurse.
Clinical skills – Due to a need for cost containment, hospitals are discharging patients home much earlier. These patients still have acute care needs. Their needs will require knowledgeable, skilled nursing care. As a home healthcare nurse you will need more than just a compassionate, friendly disposition. You will need strong clinical skills and good problem solving abilities. You must also have an excellent ability for ongoing assessment and evaluation of your patient and be able to devise and work within a care plan that is tailored to your patient’s needs. Home healthcare nursing requires you to be independent and confident in many technical areas of nursing skill, including drawing blood work, starting and maintaining IVs, providing wound assessment and dressing changes, working with wound vacs, oxygen and managing other medical equipment.
Critical thinking skills: When you work in home healthcare, you are working alone for the most part. Your supervisor at the agency is assessable by phone but for the most part you have to be an independent decision maker. You must be able to recognize and handle emergency situations and have sound nursing judgment.
Supervisory skills: The registered nurse is a case manager in home healthcare. You will be responsible for overseeing the case as a whole. This includes supervising the work of the home health aide and the LPN or LVN. Good supervisory skills are imperative to assure the case runs as smoothly as possible.
Organizational skills – A home healthcare nurse has to be organized. It will be your responsibility to make your own daily schedule. Each day you will be making visits, phone calls, providing patient care, interacting with other agency staff members, contacting physicians and working with the patient’s family. You may need to adjust your schedule often. For example, if one patient cancels his visit or if your supervisor unexpectedly needs you to accept a new case, you have to organize your day to accommodate this.
Good communication skills – You will interact with a lot of people in your role as a home healthcare nurse. You must have effective verbal and written communication skills for this.
How is home healthcare nursing different from other types of nursing?
The nursing experience is broad in today’s society and each type of nursing has its unique features. Registered nurses can pretty much work in the field of their choice, wherever they are comfortable. Home healthcare does not have structured environment of hospital nursing. The doctor and other members of the medical team are not just a page away.
What will you enjoy about home healthcare nursing?
Flexible hours – Flexibility is a large part of home healthcare nursing and this is one of the main attractive features of this type of nursing. In home healthcare you will be required to work an 8-hour day but it might not be 8 AM to 5 PM. The hours you start and end your shift have a lot to do with what type of visits you will be making that day. For example, if you are scheduled to teach a new diabetic how to use their glucometer and give their morning insulin, your day will need to start earlier in the morning before they eat breakfast. On another day you might not start work until 9 AM when an IV has to be hung. Each day may be different.
Opportunity to teach – I love to teach, especially one-on-one instruction and watching my patient progress towards independence. This is one reason why home healthcare was a good fit for me. In home healthcare, you will do a lot of teaching. There are countless opportunities to teach your patient, their family and/or the patient’s caregiver regarding their care needs. Your teaching will include showing them how to manage their disease process, giving diet and nutritional instruction, teaching them about their medications, providing wound care and changing dressings, etc. You are constantly teaching and evaluating how well they have learned.
Autonomy – Many nurses enjoy being able to have the ability to work independently and enjoy working by themselves. A home healthcare nurse must be comfortable with working alone. Unlike hospital nursing, no one is “down the hall” to assist you so you must know how to react in emergency situations.
Mobility – You will move around a lot as a home healthcare nurse. Your patients will probably be located in various parts of the city. You will have to map out your route to their homes as you plan your day and drive from one location to another to service them. You must have good dependable transportation as your work will require considerable travel time. Most agencies do compensate you for mileage, and some agencies even have their own company vehicles for you to use.
The “down side” of home healthcare nursing
As with all nursing careers, there are some aspects of home healthcare nursing that may be viewed as the “down side” of this type of nursing. Let’s look at a few of these concerns.
Lots of paperwork: The home healthcare agency you work for has to adhere to government regulations and requirements to maintain licensure. Paperwork has to be completed for each skilled visit that complies with these regulations. Although many home healthcare nurses prefer to complete their paperwork in the evening after their shift is over, I found that it’s best to complete it as you go along, finishing it while the visit is still fresh in your mind. Many nurses stop working in home care because of the excessive paperwork.
Environmental factors: Remember, you are providing care in a person’s private home. You must respect that this is their house and accept the way they live. Although not always the case, you might find yourself working in home environments that are not very clean. You still must remember your duty and take care of the patient regardless of their standard of living.
Personal attachments: Working one on one with your patients can form attachments that are not usually formed in a hospital or clinic setting. You tend to become quite involved in their lives since you may visit their homes for weeks or more. You must know where your professional boundaries are and adhere to them. Always stay within the scope of what you were hired to do.
I would encourage you to give home healthcare nursing a try. I think you will find it to be highly rewarding and personally fulfilling area of nursing. For more information about home healthcare nursing you can contact any of the following agencies by clicking on the links below:
The National Association for Home Care and Hospice
Home Healthcare Nurses Association
American Nurses Association