An NP’s Guide to Becoming a Home Health Nurse
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Home health care is provided to home-bound patients who cannot leave their homes unassisted. It includes a wide range of services from skilled nursing, physical therapy, occupational therapy, speech therapy, home health aide, and social worker. It is frequently used to help patients recover from surgery, injury, or acute illness. It is also used in chronic illnesses such as cerebral palsy or patients needing tracheostomy care.
A physician or provider has to order the home health services and certify that the patient is homebound. An RN or LPN will work through a home health agency to deliver skilled nursing services to the patients. A home health agency is a licensed organization that offers nursing and therapy care to eligible patients, in agreement with relevant federal, state, and local requirements. Although the geriatric population are frequent users of home health services, adults and pediatric patients may also require home health care after acute injuries or with chronic disabilities.
As the proportion of older Americans increases in size, the demand for healthcare is expected to grow drastically. Home healthcare plays a significant role in reducing hospital stays and costly readmissions. As a result, home health nurses play an important part in the patient care continuum and in compliance with treatment regimens that ensure better outcomes.
The Role of Nurses in Home Care
Compared to a hospital setting, home health nurses often work independently, providing one-on-one care in a patient’s home. The home health nurse serves as a liaison between the patient, the patient’s family, and the patient’s healthcare provider. These visits or shifts can last from anywhere between one hour to 12 hours. Home health care nurses range from RNs, LPNs, and CNAs. All nursing levels are trained in basic life support and know how to respond to emergencies.
RNs perform the initial assessment of home health patients and create and oversee the care plan. They work with other clinical healthcare professionals to coordinate and collaborate with everyone involved in the patient’s care plan, such as doctors and therapists. They also manage case management. They administer medications and intravenous infusions and draw labs. RNs clean and dress wounds, while monitoring healing progress. They change and provide catheter care. They even address home safety. RNs educate patients and non-medical caregivers on their illnesses and medications.
The RN reports their findings to the physician or provider that ordered the home healthcare. They update care plans and note changes in condition. They evaluate patients’ progress and responses to treatment. The RN typically supervises LPNs and CNAs who are providing in-home care as well.
LPNs typically provide day-to-day skilled nursing care and must document each patient visit. They monitor patients and report patient concerns to supervising RNs. They assist with activities of daily living and mobility. They take vital signs and administer medications. Similar to RNs, LPNs can also manage wounds and catheter care. They can provide patient education on their illness and medications. Depending on the patient’s insurance, the home health nurse can care for the patient daily or several times a week.
CNAs perform task-based nursing care and provide basic hygiene needs. They assist with activities of daily living, such as bathing and feeding patients. They assist with mobility and grooming. CNAs report any patient concerns to their supervising LPN or RN.
Examples of tasks of home health nurses include:
- Traveling to patient homes to deliver nursing care
- Taking and monitoring vital signs
- Educating patients and their caregivers about their illness, medications, and symptoms
- Help patients manage pain or other symptoms
- Provide wound care to facilitate the healing of an acute or chronic wound
- Change urinary catheters and teach catheter care
- Help patients manage and take their medications
- Administer tube feedings
- Provide tracheostomy care and education
- Monitor patient symptoms to provide medical intervention as needed
- Assisting patients with their activities of daily living such as grooming and eating
- Assessing patients’ condition each visit and recording this information in the patient’s chart
By entering a patient’s home, the home health nurse typically establishes a trusting relationship with the patient and their family. They can also set expectations with the patient to prevent any misunderstandings. Before the home visits, the nurse should maintain inventory to ensure they have the necessary supplies for each patient visit.
Goals of Home Health
The home health team will set goals that are specific to the patient. One of the goals is to keep the patient independent at home as long as possible. Home health will help the patient feel better and recuperate after an illness or injury. It can prevent the need for a patient to be in long-term care such as a nursing home.
Another goal of home health is to help patients maintain the highest possible level of health and control over their activities of daily living while living with a chronic illness. Home health care can teach patients and their caregivers how to manage their health at home. It can prevent unnecessary emergency room visits and hospitalizations.
Below are the most common diagnoses for home health patients:
- Diabetes
- Hypertension
- Stroke
- Heart Failure or Heart Disease
- Fall or aftercare for surgery
- Dementia
- Chronic Obstructive Pulmonary Disorder or Pneumonia
- Cancer
- Osteoarthritis
- Chronic Kidney Disease
- Pressure Ulcers
For diabetes, the home health nurse monitors the patient’s blood sugar levels and teaches them how to manage their condition. They also assist with their medication regimen and notify the patient’s PCP if their glucose remains elevated. The nurse will educate the patient on a diabetic diet and the symptoms of uncontrolled diabetes.
For hypertension and stroke, the nurse will monitor the patient’s blood pressure. They will coordinate with the home health therapists who are helping the patient recover from stroke complications and improve functionality. They may have to administer tube feedings if necessary. For heart failure, heart disease, and chronic kidney disease patients, the nurse monitors the patient’s weight and blood pressure. They offer education on diet and monitor for signs of a heart attack or heart failure exacerbation.
Patients who have a history of falls, arthritis, or are recovering from a recent surgery may have limited mobility. The home health nurse will work with PT and OT to help the patient regain flexibility and strength. The nurse will perform a home assessment to see what changes can be made to prevent falls. They will make recommendations to improve safety in the home, such as to avoid having loose rugs or adding a shower bar.
Home health nurses can also help patients with dementia. If needed, they can get a social worker involved and assist with medication compliance. They can request an evaluation by a speech therapist if there are concerns about problems swallowing.
With patients with COPD, the nurse teaches them proper breathing techniques and when to use supplementary treatments such as a nebulizer machine or incentive spirometry. They can monitor the patient’s lung sounds for worsening symptoms.
Cancer patients often require home health services. The nurse can help manage their pain levels and monitor for signs of infection since they are at higher risk. Patients with chronic ulcers will need regular wound care from nursing staff. Depending on the complexity of the wound, the nurse can teach the patient and their caregiver how to change the wound dressings themselves. The nurse will monitor the healing process and notify the ordering provider of any changes.
Benefits of Being a Home Health Nurse
Being a home health nurse allows more independence and autonomy than in traditional nursing roles. The nurse can create their own schedule, offering greater flexibility. They are not committed to shift work like in a hospital setting. The home health nurse can also choose to work with one patient on a long-term, full-time basis, or can choose to visit multiple patients each day. Home health nurses regularly find the job rewarding because they create long-term relationships with the patients that can even have a greater impact on patient well-being.
Additionally, working in home health can be less stressful. Nurses provide one-on-one care to patients in their homes. This is beneficial since they do not need to manage multiple patients simultaneously. The patients’ acuity level is also lower than those found in a hospital. The patients are usually more stable.
Sometimes the role of a home health nurse can involve more critical thinking and innovation potential. The nurse is not micromanaged in this setting, but they can reach out to a supervising RN or physician when needed. The RNs can practice at the top of their license, using their clinical skills to give outstanding care.
The job outlook for home health nurses is projected to grow 22 percent between 2022 and 2032, making it one of the fastest-growing occupations in the country. This is extremely high and can deliver job stability and opportunity for nurses looking to enter this specialty. The best part is nurses do not need to specialize in home health nursing to work in this field. They can even become a home health nurse straight after graduating from school.
Resources for Home Health Nurses
National Association for Home Care and Hospice: NAHC is the largest professional association representing the interests of patients who need home care and the caregivers that provide them with in-home health services.
International Home Care Nurses Organization: Founded in 2009, IHCNO’s mission is to develop and support a worldwide network of nurses who promote excellence in providing optimal health to patients living in their homes through education and research.
Sophia Khawly, MSN
WriterSophia Khawly is a traveling nurse practitioner from Miami, Florida. She has been a nurse for 14 years and has worked in nine different states. She likes to travel in her spare time and has visited over 40 countries. Being a traveling nurse practitioner allows her to combine her love of learning, travel, and serving others. Learn more about Sophia at www.travelingNP.com.