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Is home health nursing the job for you?

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Question:
I’ve worked in hospital nursing for the past decade.  Do you think I can make a change to home health nursing? I know our inpatients have shorter stays than ever, and I’d like to try home health in the future.

Answer:
You have identified one of the big trends in health care and in nursing.   Shorter acute care stays are resulting in increased demands for home health care workers.  Another factor is an aging population.  The Centers for Disease Control estimates that home care will grow by over 40% in the next five years. 

 Registered nursesare the team leaders in home health care.   RNs assess patient needs, develop care plans, coordinate care and referrals with other providers, supervise LPNs and aides in the home, and evaluate outcomes.  RNs often provide high tech specialized care in the home that in the past was done in the hospital.  Examples are the management of intravenous therapies, central lines, and ventilators.  Patients with diagnoses such as heart disease, diabetes, stoke, cancer, hypertension, and traumatic injury are commonly discharged to home care after their condition is stabilized.

Home care has advantages for patients (convenience and comfort), for nurses (relationships and information that improves outcomes), and for third party payers (lower costs).  Additional advantages for nurses are the opportunity to be more autonomous, and to more completely understand the family and cultural factors that impact patient care.  This high level of independent practice and assessment means that many nursing jobs in home care will require a BSN degree.  Providing patient education and advocating for patients are nursing roles that are important facets of home care.

Since your experience is in the hospital, you should be well prepared to handle procedures and technical measures, but you will need to adapt to the home setting.  Nurses working in the patient’s home need to be particularly respectful of the fact that they are guests as well as care providers.  Providing care in the home will require you to be flexible, resourceful, and creative.  Good  communication and cross cultural skills are a must.   You will also need to develop a knowledge of reimbursement systems and referral sources.

Other advantages of a move to home health care are likely to be the opportunity to have flexible hours, and to manage your own schedule. You will have opportunities to manage patient care from hospital discharge to completion and  to assist patients with recovery and regaining function.   By providing early identification and treatment of potential complications, home care nurses play an important role in preventing rehospitalization.  Patients frequently heal better, feel better, and have fewer infections with  care in their own home environment.

Nurses who work in home health are employed by agencies that may be owned and operated by the acute care hospital system.  Other agencies are non profit such as the Visiting Nurses Association.  Still others are privately owned and operated for profit agencies.  According to the VNA website,

… the history of visiting nurse agencies dates back to the 1880s in New York, where free nursing care was provided to the sickest and poorest who otherwise would not have access to healthcare. The influx of immigrants to the Northeast spurred several VNAs to emerge to address the increased prevalence of illness and infectious diseases, such as polio and small pox. Lillian Wald, the pioneer of public health nursing, advanced the principle that “Society benefits when healthcare is provided in the least costly and most comforting setting-most often the home.”

You are wise to consider joining this proud tradition of home care nurses!


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