When people think about a career in nursing, most envision working in a doctor’s office or a hospital; however, the future of nursing is actually returning to the profession’s roots – home health nursing. As health care providers and third party payers search for ways to rein in costs, hospital stays are shorter, which means many patients return home who still need acute care. Additionally, research studies show that patient’s health care outcomes are better when they recover at home. Since home health nursing is a growing specialty area, as a new nurse, you need to decide whether home health nursing is a career path that you want to pursue.
What to Expect as a Home Health Nurse
Duties and Schedules:
As a home health nurse, you have many of the same duties as you would in a hospital or nursing
home setting, but you are working in the patient’s home. Additionally, home health nurses also work much more with the family teaching them how to care for their loved one. As part of a multidisciplinary team, home health nurses serve as the ears and ears for the rest if the treatment team, so you need to have solid verbal and written communication skills, keen observation skills, and ability to attend to small details. Since you are working independently with patients, you need to be able to maintain strict, but reasonable, personal and professional boundaries.
Some home health nurses just make short visits with patients to monitor vital signs, assess the patient’s condition, and verify that medications are taken as directed. Other home health nurses spend four to eight hours with a patient to provide more intensive care and monitoring. Both schedules permit you to spend more one-on-one time with patients so you develop a more personal relationship with them. In most cases, home health nurses have more flexibility in their schedules and work shorter shifts than hospital-based nurses.
Supervision:
Certified Nursing Assistants work under the guidance of either a LPN or RN. As a LVN or LPN, you will work under the supervision of a RN who will make periodic visits with the patient. Unlike working in a hospital, home health nurses work with patients with a high degree of autonomy. This means that you need to have confidence in your skills, recognize the boundaries of your scope of practice, and exercise exceptional critical thinking skills and clinical judgment. Fortunately, you do have access to your supervision or the patient’s doctor via pager or cell phone.
Documentation:
Given the high degree of autonomy you have as a home health care nurse, the documentation requirements are much more detailed and extensive than what you would have in a hospital, doctor’s office, or nursing home. With the increased prevalence of electronic health records, many home health agencies issue nurses tablet or small laptop computers to take with them on visits. Some of the mobile devices are equipped with GPS tracking that transmits your location to the agency office to verify that you actually made the visit. Other agencies require that you keep a written log of your visits that you have the patient or family member sign to attest that the visit occurred.
The Different Types of Home Health Nurses
Home health agencies tend to specialize in the care they offer that parallels the different 
departments in a hospital. While most people associate home health nursing with attending to the medical needs of elderly patients, nurses provide home care to infants who are just released from the NICU, children who have respiratory or heart problem, and adults who are still recovering from surgery. Hospice agencies employ nurses to provide palliative nursing care in their home. Additionally, as medical technology advances, nurses will find that they will be caring for patients who use high-tech equipment in their homes.
In addition to working for a home health agency, nurses have the option to contract directly with a family to provide nursing services in the home. Private duty nurses tend to work with only one patient at a time and work longer shifts. Additionally, they assume much more responsibility for the well-being of their patient since they have less supervision than home health nurses who work for agencies.
The Advantages and Disadvantages of Home Health Nursing
Many nursing professionals find the concept of working outside the hustle and bustle of a hospital setting appealing. Others like that home health nursing provides them with greater independence and autonomy. Some home health nurses enjoy spending more one-on-one time with their patients and their families.
Veteran home health nurses find their practice especially rewarding because they gave the 
opportunity to see patients recover more quickly in their homes than they would if they were in a hospital, rehabilitation center, or other institutional setting. They also have the satisfaction of watching the family members develop a sense of empowerment as they learn how to care for their patients. Other nurses like that they develop long-term relationships with patients and their families.
While these are some of the advantages of home health nursing, this nursing specialty is not without its downside. As a home health nurse, you do not have the stress of responding to several patients who push the call button at the same time, but you also have to deal with driving from one appointment to another and dealing with traffic. While some home health agencies provide cars for their nurses, others require that you use your own vehicle and they reimburse you for mileage. If you work in rural areas and drive your own car, you will find that you need to spend more money on maintenance costs than you would otherwise.
As a home health nurse, you are likely to work with patients who live in less than desirable neighbourhoods that appear dangerous. In most communities, local police are willing to provide home health nurses with escorts when they visit patients who live in high-crime neighbourhoods. Additionally, some agencies allow nurses to work in teams if a patient lives in a high-risk area.
Another challenge with working with patients in their homes is that people have different housekeeping standards, so you might work in a setting that is not as tidy as you would like.
Preparing for a Career as a Home Health Nurse
If you want to pursue a career in home health nursing, most home health agencies require their nursing staff to have a minimum of one-year experience in hospital-based home health nursing. This experience provides you with the opportunity to develop sound clinical judgment and refine your critical thinking skills. For CNA’s, agencies require that you work at least a year in a nursing home or hospital.
While home health nursing is not for everyone, many nurses find it a rewarding career option.
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