NEW HORIZONS

Considering home
healthcare nursing?
STURTI /iSTOCK

By Brenda Elliott, PhD, RN HAVE YOU EVER considered leaving the acute care setting and stepping out
into the world of home healthcare? Practicing in a community setting where
you’re mobile and on the go, not always within the four walls of a hospital,
may be enticing. This specialty affords an opportunity to practice in a setting
within a community where autonomy and coordination of care are the focal
points. Keeping patients safe at home, avoiding hospitalizations, and helping
them return to an optimal level of functioning are at the heart of home
healthcare nursing.
This article provides a general overview of home healthcare nursing for
nurses considering a change in practice setting. The focus is on caring for
adult patients. Here’s what you need to know before making this decision.

Experience needed
Most home healthcare agencies require nurses to have a BSN and at least
2 years of experience as an RN in a medical-surgical setting.1 Nurses
who’ve worked in medical-surgical or critical care areas generally succeed
in home healthcare settings due to their broad range of assessment skills.

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Although no specific certification
is available for home healthcare
nursing, some nurses choose to
maintain certification in medical-
surgical nursing.
Most patients in home healthcare
settings are older than 65 and have
multiple medical diagnoses and
chronic health issues.2 Some of the
more common include heart failure
and other cardiac problems, diabe-
tes, chronic obstructive pulmonary
disease, pneumonia, and osteoar-
thritis.2 Nurses with experience in
these areas are a good fit for home
healthcare:
• cardiac diseases
• pulmonary disorders
• orthopedics
• diabetes
• wound care.
Who’s best suited?
If you’re an organized person
with good time management skills,
you’re well on your way to being
successful as a home healthcare
nurse.3 Critical thinking is impor-
tant in any nursing specialty, but
this skill is especially important
for nurses working in patients’
homes, away from the resources
of a hospital setting.4 Being able
to make on-the-spot decisions
about a patient’s health status or
needs is crucial. Being a good lis-
tener and effective teacher are also
important to help plan needed care
and education.1
Excellent written and verbal
communication skills help nurses
succeed in home healthcare. Coordi-
nating care among services includ-
ing physical, occupational, and
speech therapy; social work; and
home health aides as well as with
healthcare providers’ offices draws
on these skills daily. Communicat-
ing with families, caregivers, and
community resources or agencies
also requires these critical skills.
58 l Nursing2014 l December
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Keeping patients safe
at home and avoiding
hospitalizations are
at the heart of home
healthcare nursing.
Critical assessment skills
One of the main goals of home
healthcare is to keep patients in
their homes or community and out
of the hospital.1 To achieve this,
nurses in this setting must be skillful
at detecting early signs and symp-
toms of decompensation and act
quickly to keep a patient stable.4
Sometimes this means advocating
for a change in medication regimen
or a primary care appointment
within 24 to 48 hours. Now that
preventing rehospitalizations is a
priority across the healthcare con-
tinuum, these skills are crucial.
Monitoring lab values over time and
noting trends are also important.
Medication management is an-
other critical skill needed in home
healthcare. Older adults are taking
more medications now than in any
other time in history. Due to the
number of trade, generic, and over-
the-counter medications that people
take and the number of prescribers
who may be involved, keeping the
medications organized can be over-
whelming for patients.5,6 Many home
healthcare nurses arrive at a home to
find that patients haven’t filled pre-
scriptions provided at hospital dis-
charge. Nurses may uncover such
problems as multiple bottles of the
same medication with different dos-
ages, half-used containers of pre-
scribed medications, and duplicate
medications with different drug
names. Nurses may spend an hour
getting medications sorted out before
they can even perform a physical
assessment.5
Nurses working in a home envi-
ronment need different assessment
skills than their acute care counter-
parts. For example, assessing the
home environment and living con-
ditions can help to maintain pa-
tient safety. This can range from
determining if the patient has a
fire escape plan and working
smoke detectors to ensuring that
walking paths are clear of clutter
and throw rugs.
Nurses work autonomously to
determine if patients need further
support services and community
resources such as Meals on Wheels
or transportation services. Home
health nurses also need to assess
family and caregiver involvement
in care and evaluate their potential
needs.
Weighing the pros and cons
As in any area of practice, home
healthcare nursing has both rewards
and drawbacks. Home healthcare is
a highly regulated field of nursing
that can be challenging to learn.3 It
takes about a year to 18 months to
really understand all the aspects of
home healthcare practice, making
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it potentially overwhelming. Even
experienced acute care nurses may
feel like novice clinicians again.
Although the work day can be
flexible, it can also create a false
sense of having more time; some
find it difficult to complete their vis-
its and documentation in an 8-hour
shift.3,4 Learning to get everything
done takes discipline.
Home healthcare nurses must be
flexible and work around patient’s
schedules, healthcare provider ap-
pointments, and the weather, to
name just a few other challenges.
Tracking mileage, recording time
spent in patients’ homes, and
lengthy documentation are all po-
tential drawbacks to this area of
nursing. Home healthcare nurses
may work in homes that aren’t clean
or where pets have taken over. Some
nurses work in areas that present
risks to their own safety; knowing
how to stay safe is a priority. (See
Staying safe on the road.)
Despite the drawbacks, home
healthcare nursing offers as many if
not more rewards than other fields of
nursing. One of the biggest benefits
many nurses seek when moving into
home healthcare practice is a sched-
ule that allows for some flexibility
based on the nurse’s case load, pa-
tient preferences, and skills needed.
Many home healthcare nurses start
work between 0800 and 0900 and
finish by 1600 or 1700. They may
have less work on weekends and hol-
idays than other nurses, depending
on the agency’s size and structure.
Nurses in home healthcare find
their practice to be autonomous and
challenging, giving them many op-
portunities to put their assessment
and teaching skills to use.3,4,6 Home
healthcare is unique in that nurses
and other healthcare professionals
can care for patients one-on-one in
the comfort of their own homes and
in their own communities. These
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Staying safe on the road
• Keep your car in good working condition.
• Call ahead so the patient knows when to expect you.
• If you’re worried about safety, request an escort if your agency offers one or
make a joint visit with another provider if possible.
• Carry only a small amount of money.
• Don’t bring medications with you.
• Park in a well-lit area where others can’t block you in.
• Don’t leave electronics, a purse or wallet, or any other valuables out in
the open.
nurses might be the only person who
checks in on a patient all week:
Many patients have no family or
caregiver support.
Typical day requires flexibility
Whether home healthcare nurses are
case managers or are working per
diem, most plan their days ahead
of time. After determining their as-
signments for that day, they gather
necessary supplies and make phone
calls. Many nurses call patients the
night before or the morning of the
visit, giving them a window of time
for their arrival. Once nurses leave
the office or their own home, they
travel from one patient to the next,
completing visits, documentation,
and phone calls along the way.
Based on their findings, nurses
must determine when each patient
should be seen again or discharged,
coordinate care with other disciplines
as needed, plan and prepare for the
next day, and complete any incom-
plete documentation or follow-up
calls before ending their workday.1,4,7
Most home healthcare nurses
would say that the planned sched-
ule often changes over the course of
the day, but that’s all part of meeting
the demands of this patient popula-
tion. Being flexible and adjusting
to change are characteristics these
nurses need.
Still considering?
Home healthcare can be a great
option for nurses today. Helping
patients after hospital discharge
to get the resources they need to
resume their optimal level of func-
tioning within the community
can be very satisfying and highly
rewarding. ■
REFERENCES
1. American Nurses Association. Home Health
Nursing: Scope and Standards of Practice. 2007.
http://www.nahc.org/assets/1/7/am13-501.pdf.
2. Caffrey C, Sengupta M, Moss A, Harris-Kojetin
L, Valverde R. Home health care and discharged
hospice care patients: United States, 2000 and
2007. National Health Statistics Reports; no. 38.
Hyattsville, MD: National Center for Health
Statistics; 2011. http://www.cdc.gov/nchs/data/
nhsr/nhsr038.pdf.
3. Hartung SQ. Choosing home health as a
specialty and successfully transitioning into home
health nursing practice. Home Health Care Manag
Pract. 2005;17(5):370-387.
4. Ellis I, Chater K. Practice protocol: transition to
community nursing practice revisited. Contemp
Nurse. 2012;42(1):90-96.
5. Hohl D. Transitions in home care. Home Healthc
Nurse. 2009;27(8):499-502.
6. Riker GI, Setter SM. Polypharmacy in older
adults at home: what it is and what to do about
it—implications for home healthcare and hospice,
part 2. Home Healthc Nurse. 2013;31(2):65-77.
7. Elliott B. A day in the life of a home care nurse in
Hawaii. Home Healthc Nurse. 2014;32(8):503-504.
Brenda Elliott, who lives in Onalaska, Wisc., is em-
ployed as an adjunct online instructor for Drexel
University in Philadelphia, Pa.
The author has disclosed that she has no financial
relationships related to this article.
DOI-10.1097/01.NURSE.0000456368.77874.01
December l Nursing2014 l 59