I’ve been a nurse for over 20 years. I have seen the good, the bad, and the ugly of home health nursing. It’s not all fun and games! Sometimes it can be downright terrifying.
Home health nurses are often caught in a tough position between patients’ family members who don’t want to take care of their loved ones themselves and those same patients who want to maintain as much autonomy as possible.
In this post, we’ll explore some common scenarios that might make you rethink your decision to become a home health nurse.
I hate home health nursing
One of my first experiences as a home health nurse was checking on an elderly woman with some type of dementia. At first, I thought it might be Alzheimer’s, but she was also hearing voices and talking back to them.
She had a hard time looking me in the eye, making statements without question attached, and it seemed like no matter what I did, she’d revert back to grilling me for information about who I was and why I was there. It didn’t help that she couldn’t stand up from the chair without going into cardiac arrest!
In order to get her to comply with my instructions (that her son had explained where necessary), I explained to her tersely that if she sat in the chair and did not get up, I would leave without doing anything. I did my best to assess her, but she seemed more interested in listening to voices no one else could hear than talking to me. I left wondering if she needed to be hospitalized or perhaps was just lonely.
Another day, another patient, this time it was at the home of a young woman who had fallen off a ladder while painting her house. She’d managed to break both legs pretty bad before crawling into bed and trying to sleep off her pain medication high while waiting for someone to find her. When I arrived, she introduced me around the room as “the nurse,” which made me feel like an interloper in what appeared to be a loving family gathering.
I made the best of it, informing everyone that this young woman was still likely very high from her pain medication and may not know what she was saying or doing. Toward the end of my visit, which consisted mostly of checking vitals and making sure she wasn’t in any immediate danger without her broken legs being treated, the patient became extremely agitated.
She stood up with help from her mother, who was mortified by her daughter’s behavior. It took three people to stop her long enough for me to explain that if she continued acting out this way, I would have no choice but to call 911 so they could restrain her for a psych hold. She didn’t believe me until I called 911 myself, then she settled down as the EMTs took over, and I left.
This is just a sampling of the situations nurses get themselves into while working in-home health care.
What home health nursing is like
Have you ever watched one of those crime shows on TV where the detectives are trying to figure out how a child or elderly mother got broken bones or bruises? The chances are that they were cared for by someone who worked at home as a home health nurse. So nursing in-home care is just like regular hospital-based nursing, right? Well, not really.
The challenges of being a home health nurse are different from being an inpatient nurse. Some of these differences have more to do with relationships than medical knowledge. A study showed that overall patient-related challenges were greater among nurses working in-home care compared to patient care unit nurses within acute-care hospitals.
The term “home health” can be because it implies that patients are being cared for at home, but that is not really the case. It implies that you are providing care in patients’ homes, which isn’t always true, either. Home health nurses provide care to their patients wherever they are inpatient facilities, skilled nursing facilities, or even hospitals.
Some home health nurses can be assigned to multiple cases within one geographic area, with some traveling as far as 100 miles from their homes to see their patients. And sometimes, the patient’s loved ones will take them out of the house just so the nurse won’t have to visit them there.
What does being a home health nurse entails?
Like most other areas of nursing, being a home health nurse means adapting your education and skills to meet specific needs. You might only work part-time or have one or two patients. You might care for a patient only once a week. Your job may be challenging because you work independently and must be self-motivated, organized, and flexible.
When the nurse is on the clock, you are on the job 24 hours a day, seven days a week, even if you have no patients. You may work with a doctor, but more often, your patient’s doctor will only communicate through you. This means that you will need to understand the doctor’s orders and be able to carry them out without being told what they are.
If a patient is having a specific problem or has a question, you can’t just ask the doctor or get more orders; you have to figure it out yourself. And every state is different in the way they allow nurses to practice; some states require that you are supervised by a doctor, while some don’t.
Challenges of home health nursing
One of the biggest challenges for home health nurses is identifying when there is more than one problem with their patients. A study found that when one problem was identified, home health nurses addressed it in only 48 percent of the cases.
Typically, when a nurse receives instructions to provide care for a patient with any type of medical condition, the instructions cover all diagnoses and problems, but this isn’t always true. The nurse must be able to recognize when there are multiple conditions or problems. Another challenge of being a home health nurse is having few resources at your disposal.
Nurses working in home health don’t have the same resources as the nurses who work in hospitals and other facilities. For example, lab reports or x-rays may take longer to review, and medications might need to be split into smaller doses than what’s available.