Since the start of the COVID-19 pandemic, public health emergency waivers have facilitated hospital-at-home, a service providing patients with acute-level care in their homes. Moreover, concerns over exposure to the virus have prompted people to leave hospitals as soon as possible, transitioning to home health care when necessary.
Nevertheless, the pandemic has not been the only reason home health is growing in popularity. Due to financial pressures, patients are being discharged sooner from hospitals. Home health care is a more cost-effective option than traditional health care or skilled nursing facilities. Furthermore, there is a large and growing older adult population in the United States who, for the most part, prefers to remain in their own homes for as long as possible instead of moving to assisted living facilities. In this context, there is a significant demand for home health nursing.
Are you interested in becoming a home health nurse? The first step is learning all there is to know about this nursing specialty. Read on for the answers to all your questions on home health nursing.
What Does HH Stand For?
In the medical setting, HH can stand for many terms, including “hereditary hemochromatosis” and “hitting head”. However, when it comes to nursing specialties, HH stands for “home health.” Home health refers to a variety of health care services that can be given at home for illnesses and injuries, among other reasons.
What Does Home Health Mean in Medical Terms?
Here is a definition of home health in medical terms: This type of healthcare includes a wide range of services offered in the home setting, including occupational and physical therapy, speech therapy, and skilled nursing. Of these services, the most common type of care in home health is nursing. In conjunction with physicians, nurses create and carry out care plans for patients.
This care plan may include the following healthcare services:
- Dressing wounds
- Ostomy care
- Intravenous therapy
- Administering medication
- Monitoring patients’ general health
- Pain management
Furthermore, home health usually includes activities of daily living, such as bathing, dressing, and eating.
Home health has many advantages as opposed to care in a hospital or skilled nursing facility. Home health is less expensive, more convenient, and equally effective. The aim of home health is to help patients recover from illness, surgery, or injury by assisting them to regain independence, become as self-sufficient as possible, and maintain their level of function. In other cases, the goal is to slow patients’ decline and delay the need for long-term or nursing home care.
Home health nurses have many work options: They can work with a single patient full time or care for many patients each day. HH nurses can also specialize in one or several areas, such as gerontology, pediatrics, medical-surgical, public health, and mental health.
Where Do Home Health Nurses Work?
Most home health nurses work for home health agencies, hospitals, or public health departments licensed by the state. Other nurses may be hired directly by patients or their families. Nevertheless, home health nurses work in patients’ homes regardless of the employer.
What Is a Home Health Unit in a Hospital?
Home health nurses often work for hospitals, but there is no such thing as a home health unit because home health nurses care for patients in their homes after hospital discharge. If a patient requires additional care after a hospital stay, a discharge planner, in consultation with the patient’s physician, will set up home healthcare for that patient.
What Does a Home Health Nurse Do?
In general terms, home health nurses typically carry out duties such as the following:
- Managing what patients are eating and drinking
- Checking vitals
- Managing medications
- Managing pain
- Making sure patients are safe
- Educating patients regarding their care
- Coordinating care with physicians and other caregivers
However, not all home health nurses have the same responsibilities. A home health nurse’s duties vary depending on their particular position, which is mainly dependent on their qualifications.
What Is the Role of Each Type of Home Health Nurse?
Nurses are qualified to carry out different roles in the home health setting based on their years of study and work experience.
Certified nursing assistants (CNAs) primarily assist patients with activities of daily living, such as getting out of bed, walking, bathing, and dressing. They also report patient concerns to supervising nurses.
Licensed practical nurses (LPNs) direct CNAs and also assist with activities of daily living. Furthermore, they take vitals, manage wounds, administer medication and IVs, monitor patients, and report patient status or concerns to a supervising registered nurse (RN).
Registered nurses may do all the above and also have additional responsibilities, such as the following:
- Performing physical assessments
- Obtaining samples for lab work
- Monitoring patients’ responses to treatment, such as medication and patients’ overall progress
- Assessing patients’ needs and developing care plans in conjunction with physicians
- Overseeing care plans and managing patients’ cases
Finally, advanced practice registered nurses (APRNs), because of their extensive training and experience, have a higher level of autonomy and responsibility. Here are some of the responsibilities of a home health APRN:
- Assessing patients and recording their progress
- Prescribing medication
- Performing minor procedures
- Ordering and interpreting the results of diagnostic tests
- Educating patients and family members or other caregivers on how to manage health conditions and overall wellness
- Determining the need for referrals to physicians or other healthcare professionals
How to Become a Home Health Nurse?
There are different levels of home health nursing, each with its own training and other requirements. However, in general, many home health positions are entry-level, meaning that nurses can find work in home health after graduation.
How Long Does It Take to Become a Home Health Nurse?
The duration of training and work experience requirements depend on the type of nursing degree.
CNAs, although not nurses per se, can work in the nursing field after a short course—sometimes as short as four weeks. LPNs can begin working in home health after a one-year nursing program. RNs can complete training in two to four years, depending on whether they pursue associate’s or bachelor’s degrees in nursing. Finally, becoming an APRN takes a minimum of six years and often much longer since most master’s nursing programs require nurses to have a minimum of work experience before beginning graduate studies.
Furthermore, since home health nurses often must visit multiple patients’ houses in one day, most home health jobs require nurses to have their own insured cars and valid driver’s licenses.
Home Health Nurse Certifications?
All nurses should obtain a Basic Life Support (BLS) certification, but this certification is even more important for home health nurses since they are often the only health care providers in a patient’s home at any given time. Therefore, they must be prepared to offer patients basic life support in emergency situations. Along these same lines, nurses should also consider obtaining an Advanced Cardiovascular Life Support (ACLS) certification and, depending on the population that home health nurses work with, a Pediatric Advanced Life Support (PALS) certification may be helpful as well.
In addition, home health nurses who work primarily with older adults may consider pursuing the Gerontological Nursing Certification (GERO-BC™) offered by the American Nurses Credentialing Center. This certification is available for RNs after initial licensure. To be eligible for this certification, RNs must fulfill the following requirements:
- Holding a current, active RN license
- Having worked full-time as an RN for a minimum of two years
- Having accrued a minimum of 2,000 hours of clinical practice in gerontological nursing within the previous three years
- Completing thirty hours of continuing education in gerontological nursing within the last three years
The American Nurses Credentialing Center also offers the Home Health Nursing Certification (RN-BC), although this certification is currently only available for renewal.
Furthermore, although not exclusively related to home health, many additional certifications would increase the qualifications of a home nurse and the level of care nurses can provide their patients. Some valuable certification areas include the following:
- IV therapy
- Wound care
- Diabetes management
- Case management
- Infection control
- Chronic pain management
- Dementia care
Home Health Nursing Salary?
Nurses with different qualifications can work in home health: LPNs, RNs, and APRNs. Plus, many CNAs work in home health as well. Interestingly, LPNs and APRNs who work in home health earn more than the average for their qualifications, whereas CNAs and RNs who work in home health earn less than average.
Here are the average salaries of nurses with different qualifications in and out of home health.
Average CNA salary:
- National average salary: $33,250
- Average home health salary: $29,930
Average LPN salary:
- National average salary: $51,850
- Average home health salary: $52,670
Average RN salary:
- National average salary: $82,750
- Average home health salary: $78,190
Average APRN salary:
- National average salary: $118,040
- Average home health salary: $133,170
What Is Home Health Nursing Like?
The most unique aspects of home health nursing are that nurses care for one patient at a time and that they see patients in patients’ own homes. These patients may be elderly, critically ill, disabled, pregnant women, or new mothers; they may also be recovering from surgery, injury, or accidents.
Caring for one patient at a time allows nurses to develop much deeper relationships with patients. These deeper relationships allow nurses to truly get to know their patients, which can significantly impact their care. For example, a nurse might realize that their “noncompliant” patient is not taking medication because they can’t afford it. This understanding could help the nurse be more compassionate with the patient and give nurses the incentive to help their patients get the care they need at a cost they can afford. Furthermore, nurses may feel more fulfilled by this long-term one-on-one work because they can see the fruits of their efforts in their patients’ improvement over time.
In regard to seeing patients in their own homes, it adds an element of unpredictability to the job. Based on nurses’ personality profiles, this unpredictability can be nice for those who enjoy change, but it can be challenging for nurses who crave control and planning.
Other characteristics of this type of work include greater autonomy, since nurses are often the only healthcare workers present at any given moment, and flexibility since nurses are usually able to pick their own schedules.
Is Home Health Nursing Hard?
Although the flexibility, autonomy, and one-on-one nature of home health nursing make this an attractive option for many, the challenges may outweigh the benefits for others.
Here are some of the challenges of home health nursing from nurses’ first-hand experiences:
“Sometimes you encounter sick people whose caregivers are very elderly. You may be dealing with difficult patients who are noncompliant, and you need to figure out how much you can change the situation to be helpful while respecting their autonomy. You go into really messy houses and other difficult situations because patients’ home lives can be very dysfunctional. Also, you’ve got to love dogs,” says Katie Noonan, RN of Hallmark Health VNA/Home Health Foundation.
“Cons: So. Much. Driving. And I don't even dislike driving. But yesterday for example, I drove to 5 separate clients and they were all 30 to 45 minutes apart. I started at 10 am and got home at 10 pm. It drained me! Sometimes I don't want to work because it means traffic lol”
“It can be isolating in a way. You're on your own, no colleague to have "take a look" at something that doesn't seem right. You can call if you have a supportive team, but it can be hard to get an answer sometimes.”
Why Choose Home Health Nursing?
Even though home health nursing may be hard at times, many nurses wouldn’t change it for any other type of work. Here are some of the reasons nurses choose to work in home health:
“No pressure from admins breathing down your neck while you're giving report. No call lights. No AMAs screaming in your face. No huddles or staff meetings. So much of the militant hospital torture just goes away and all that is left is you, your skills, your clients, and passion for what you get to do. Sure we make the occasional call to an MD and argue for orders or deal with aggravating non-compliant clients, but it is all worth it for the rewarding cases and the freedom.”
“PROS: Many jobs allow you to set your own schedule, day time hours, seeing the outside and enjoying the weather. Most of the patients and families are so grateful for everything you do. You aren't running around like a chicken without a head. I love wound care too. It is so satisfying to see the wounds heal over time. There is a lot of autonomy in the job. Usually the weekend/holiday requirements aren't as strict as the hospital.”
“Waking up late/sleeping in some days when you have 1 client or none…Working HH has allowed me to pick up a part time hobby gig that I love doing. I can easily make time for friends and family and my holidays aren't always booked with work.”
What Makes a Good Home Health Nurse?
Specific knowledge, abilities, and skills are essential for a great home health nurse:
- Knowledge of home health standards of care
- Knowledge of acute and chronic illnesses
- Interpersonal skills
- IV therapy skills
- Ability to teach patients and their families self-care skills
- Collaboration with other healthcare providers
- Physical strength
Home health nurses also must prioritize and develop certain values, such as the following:
- Respecting differences in cultural, spiritual, and socioeconomic backgrounds
- Respecting patients’ and family members’ choices regarding treatment
- Incorporating patients’ cultural, spiritual, and other belief systems into their care plans
- Recognizing personal values and not allowing them to interfere in the care nurses offer
- Communicating ethical conflicts to supervisors and helping to solve problems
- Maintaining patients’ privacy and confidentiality
Tips for New Home Health Nurses?
Since the start of the COVID-19 pandemic, the demand for home health care and the approval of these services has skyrocketed because keeping people in their homes has been one of the main strategies to curb the spread of the disease. As COVID-19 continues to be a concern for many people, new home health nurses should consider the following tips:
- Review patient symptoms over the phone to avoid entering an exposure situation unprepared.
- Wear masks and gloves and practice good hand hygiene.
- Properly clean equipment after each visit.
- Visit patients with COVID-19 last to avoid spreading the virus.
Is Home Health for You?
At this point, you should have an idea of whether this nursing specialty is right for you. If you are still unsure, continue exploring different nursing specialties until you find one that meets your needs and preferences. If you are inclined to pursue a career in home health, start by picking up some per diem nursing jobs to get some hands-on experience in this area. After a few jobs, you will know if you want to stay or move on.