Get Out of the Hospital and Into Home Health Nursing

July 31st, 2012

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By , BSN, RN

Being a registered nurse (RN) is the best! And apparently it’s going to stay that way according to the folks at to U.S. News & World Report. In their annual rankings of the best career choices in 2012, nursing topped the magazine’s list.

Using measures such as projected job growth, average salary, and predicted job prospects, healthcare-related occupations filled five of the top ten picks. Number one, of course, was nursing with pharmacist, medical assistant, physical therapist, and occupational therapist filling other high- ranking spots.

If you are a student trying to decide on a career path, clearly nursing could be a good choice. If you are looking for a career that offers many opportunities for growth and advancement, nursing is a good choice. And if you worry about getting bored, nursing is a great choice because there are so many different fields in nursing.

Home Health Nursing

Some areas of nursing are wide open as soon as you pass your licensing exam. Other areas require some experience before you can move into that specialty. If you are looking for a job in healthcare that isn’t necessarily 9-to-5 with lots of independence, home health nursing just might be for you.

Now, before you can embrace a career in home health you do need a couple of years experience in med/surg or ICU nursing or even the emergency room. You need to cement your day-to-day nursing skills. But once that is done, you are probably ready to get out and meet the public.

The focus of home healthcare nursing is individuals and their families. According to the American Nurses Association (ANA) home health nursing is a “synthesis of community health nursing and selected technical skills from other nursing specialties,” including medical/surgical nursing, psychiatric/mental health nursing, gerontology, parent/child nursing, and community health.

History of Home Health Nursing

Home care has been an organized system of nursing in the United States for over 100 years. It developed in response to the needs and preferences of families to care for family members at home and because of the limitations and costs associated with institutional care.

Lillian Wald is widely regarded as the founder of visiting nursing or home healthcare in the U.S. and Canada. She is described as a nurse, social worker, public health official, teacher, author, editor, publisher, women's rights activist, and the founder of American community nursing.

In 1893 she started teaching home classes on nursing for women living in the tenements on the Lower East Side of New York City. Not long after that she began to provide care for the ill and infirm residents of the same area.

Along with another nurse, Mary Brewster, she was the founder of the Henry Street Settlement, dedicated to bringing nursing care, and eventually education to the immigrant poor on Manhattan’s Lower East Side. By 1906 she had expanded her services so much she had 27 nurses working by her side. The Henry Street Settlement is still in business today.

Home Health Care Today

Home health nurses will tell you there are significant advantages to caring for individuals and families in their own homes. The home setting is intimate. It helps foster familiarity, sharing, connections, and caring between clients, families, and their nurses. Behavior in the home setting is more natural, cultural beliefs and practices are more visible and there is often exposure to multiple generations of family.

When working in the home environment all the rules of the nursing process apply but some of the processes are a little different or expanded. For example, you don’t just assess the client, you assess their living space.

The home health nurse obtains a health history for the client, reviews documentation, examines the client, observes the interaction between the client and the caregivers and assesses the environment. Parameters can include client and caregiver mobility, client’s ability to perform self-care, the cleanliness of the environment, the availability of caregiver support, safety, food preparation, financial supports, and the emotional status of both the client and the caregivers. Now you see why you need a wide range of experience before stepping into a home health career.

The home healthcare nurse is not just a care provider but also a teacher and an advocate for the client and their family. The nurse may have to intervene to mobilize resources of the community or a hospital to provide patient appropriate care.

Home health nurses have first-hand knowledge of the burdens of caregiving. There are many costs involved. Sometimes the caregiving demands can go on for months or years, placing the caregivers themselves at risk. Facing reality too, home health nurses must often enter homes where the living conditions and support systems are inadequate. When additional support or improved care cannot be obtained the home health nurse faces difficult decisions.

Doing the Job

There are some great benefits to working in home health. If you are tired of literally punching a time clock and being inside a hospital or clinic all the home health gives you frequent changes of setting. Want to be more your own boss? Home health offers lots of autonomy and less office or desk time than many jobs.

You have the opportunity to create your own schedule when you are a home health nurse and working part-time is always an option. There are literally dozens of agencies in every city that provide home health care nurses. Of course, you have to keep in mind that home health care is not usually a quick visit, patients and families take more time, and you should probably enjoy driving and working out of your car.

The most common patient base in home health is the elderly or the disabled young. You will look at a lot of decubitus ulcers, check a lot of urinary catheters and you should have good blood draw skills.

According to the home health nurses I know you need to have a good sense of humor, be open minded, and be flexible. Your day will never go the way you plan, whether it’s traffic slowing you down or the need to jury-rig an IV pole out of a broomstick and vacuum cleaner for a rolling base, it’s probably not what you had planned when you first got in the car.

Home health is a big industry, and it is unlikely to get smaller since shorter hospitalizations are the rule of the day and people are becoming more demanding about their healthcare options. If you truly like your patients and their families and often get talked to at work for spending too much time talking to your clients home health nursing just might be for you.

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