What Do People Think You Do?
People hear “home health nurse,” and an image comes to mind of a nurse traveling from home to home, seeing patients too sick to go out and about. Many assume the nurse will bathe, feed, and groom the patient, perhaps give some medication, and check their blood pressure. While this picture is partially accurate, home health nursing encompasses so much more!
What Do You Really Do?
In reality, the primary job of a home health nurse is to help patients progress toward their goals. Ultimately, the aim is to increase independence and return to the life they want. While many patients begin home health service after a hospitalization, service can also be initiated at the request of their primary doctor. Upon beginning service and about every 60 days, a thorough assessment is completed, asking questions about the patient’s medical history and examining them from head to toe.
From time to time, a patient may require an injection, IV infusion, or a lab test in-home, which the home health nurse does take care of. However, the main focus is on educating patients and their caregivers. Patients and their loved ones are taught how to manage diabetes, care for wounds, understand their medications, and much more. Patients may require the services of a home health aide (helps with bathing, grooming, and housework), physical, occupational, and or speech therapist.
These services are coordinated and managed by the home health nurse. Many patients are eventually able to reach their goals with the help of home health services. For example, recently, a patient was discharged from the hospital with 2-bed sores and had difficulty just getting out of bed, unable to get anywhere without a wheelchair. With the efforts of the home health team, the patient’s wounds fully healed, and she was able to walk about 50 feet using a cane!
The nursing team examined the patient twice a week, cleaning and dressing her wounds while teaching her how to prevent more wounds from developing an infection. Home health nurse visits range from twice a week to once a month.
Occasionally, a patient will fall or have a change in condition- when this happens, they call the home health agency, which sends the nurse to the home for an “as needed” visit. The bond between patient and caregiver is truly special. This trust between the nurse and patient is one of the most rewarding parts of the job.
A Day In The Life
The day begins as I head to my first patient’s home. We’ll call her Mary Sue. Mary has diabetes and a diabetic foot ulcer on one of her heels. I bring my equipment and clipboard with me as I enter her home with the key under the mat she told me to use.
She greets me at the door- “I’m so glad you’re here- my wound is starting to smell funny!” I begin my assessment by asking her about her pain levels, listening to her heart and lungs, and checking her pulse, blood pressure, and temperature. I examine her wound, which has started to smell and is producing drainage. Her temperature is 100.9. As the home health nurse, I know these findings indicate infection. I clean the wound and apply a special antibacterial dressing. Then I call her doctor, who orders an antibiotic.
The pharmacy calls and says it will be delivered in an hour. We chat for a bit- she catches me up on what her family has been up to and I show her a few pictures of my children. Finally, it’s time to go but not before some teaching is done. I remind her that higher blood sugars increase the risk for infection, and teach her about the side effects of her new medication.
About an hour has passed and it’s time to hit the road again- I make certain that I am tracking my mileage so the agency can reimburse me. My next patient is about a 30-minute drive away. The weather is nice, my favorite album is playing, and the traffic is light during this time. This patient is having difficulty affording her medication. I sympathize with her, and call our case manager to arrange help. The case manager enrolls the patient in a discount program. I examine the patient, record her vital signs, and teach her about her medications and disease process. We talk for a bit, she shows me the quilt she’s been working on. As I leave, she gives me a hug and wheels to the door to see me out. I visit three more patients, providing them with comfort, nursing care, and education.
Then I head back into the office to stock up on supplies and update the team on my patients’ conditions. A quick drive home, I park myself in our home office to begin charting all my work. This takes about 2-3 hours. The charting is a bit tedious- to meet Medicare guidelines; everything needs to be documented precisely. Once I have double-checked my work, I submit it to the agency.
Before my work day is finished, I review my assignment for tomorrow. I plan my route and call my patients, letting them know what time I will be there. Today’s work is complete and though I’m tired, I feel satisfied knowing that I am making a difference in my patients’ lives.
What’s The Average Income?
Around $60,000 per year
What Education If Any Is Needed?
To become a home health registered nurse, you must first obtain a college education in nursing. Fun fact- you can become a registered nurse with an Associate degree or Bachelor Degree. While a Bachelor Degree prepared nurse (BSN) makes slightly more, an associate degree nurse (ADN) is still very desirable in today’s job market. (My best advice is to get your associates and begin working for a company that offers tuition reimbursement.
Then, get your Bachelors Degree online at your own pace while you’re still earning money!) After completing the course, you must take an exam called the NCLEX. Passing this exam will earn you a nursing license from your state board of nursing.
Once you are hired on to a home health agency, they will provide training specific to home health. You will shadow another nurse for several home visits, practice charting in the office, and do some supervised visits as well before you are on your own.
Something Important To Know
It’s important to know that you can’t “fix” everyone. Some patients simply aren’t interested in taking the initiative to manage their health. While the deep bonds between yourself as a nurse and your patient are truly rewarding, it can be devastating when you lose a patient. Strong emotional coping skills are crucial as a registered nurse in any field. Make sure to take care of yourself first- you can’t give your all to your patients if you are running on fumes.