Tips for Home Health Nursing

As a Registered Nurse, this year marks my 20th year in home health nursing. It has been a wonderful ride and I have met some interesting patients and co-workers along the way. I have worked in the field and in the office. I have done private duty and Medicare intermittent visits. I have cared for patients in mansions on the ocean, and intercity homes with holes in the floors and roaches so big that they almost carried my nursing bag off. I have collected my own and fellow nurses' stories and strategies through out the years.

The following are some tips I have learned from experience and my peers:

1. Have a good sense of humor. You have to learn to laugh at yourself. This is a good practice for most aspects of your life. But if you take yourself too seriously, no career will be enjoyable.

2. Be open minded. Toto, we are not in the hospital anymore. In the patient's home, you are no longer in a controlled environment like a hospital or doctor office. You still have to follow your agency's policies, safety rules and perform procedures correctly, but if the patient requests you enter their home and take your shoes off because of religious reasons, you do. The beautiful woman that presents as your patient, turns out to be a man. (You learn this without warning when they drop their drawers for the dressing change you came to perform. The scheduler thought it would be funny if you were surprised.) Diversity is one of the wonderful aspects of home care, you learn how other people really live. Learn to appreciate different cultures.

3. Learn to modify. You have to hang an IV. It's after hours and the pharmacy forgot to send the IV pole. The hanger over the door may work, or the broom handle straped on the upright vacuum suddenly creates a wheeled IV pole. But always make sure that your modifications are safe and appropriate, otherwise it will come back to bite you in the ....

4. Be flexible. The day you planned will change, guaranteed. There is an accident on the freeway, now you are late. The patient has a doctor's appointment they forgot to tell you about and now they aren't home. Someone called in sick so now you have 5 extra visits. If you can't be flexible, home care may not be your bag.

5. Be prepared. Sure enough, the dog ate the patient's box of dressings, or the patient has a bed sore that did not show up on the hospital discharge information. Your car trunk should look like a supply closet.

6. Be organized. For those home health nurses that drive a car between patient visits, your car is your office. It should contain supplies, paperwork, computer and cell phone battery chargers, pens, marketing flyers, etc., etc., etc. Learn to plot your visit route. With the cost of gas now-a-days, you don't want to have to drive needless miles.

7. Have basis computer skills. If you don't have them, learn them. Many home health agencies have already gone to field staff carrying lap top computers into the patient's homes. It is the way of the future.

8. Be alert and be safe. You may be presented with many new dangers that you won't see in the hospital. Take a self defense class. Learn what areas are the "unsafe neighborhoods" in your territory. Visit those places early in the morning. Always be alert to your surroundings. Don't talk on your cell phone while driving. Follow safety rules.

9. Don't be afraid of paperwork. If you work for a home health agency that performs Medicare visits, YIKES, what paperwork (thanks in part to the Medicare Paperwork Reduction Act?)!! An OASIS is not a desert paradise. Those agencies that have laptops for their field staff have part of this licked. However the questions still need to be asked and documented. Practice does help speed up the documentation process.

10. Keep your skills up. Take continuing education classes on-line. Attend seminars. Read articles. Knowledge is power. You are very autonomous in the patient's home and good skills and quick thinking are mandatory to survive.

In closing, home health is a wonderful way to care for patient's. You are able to interact with the family and really do one-to-one education. Whether it be with a Medicare agency, Hospice, private duty or other home care venue, it is an enjoyable and full-filling division of nursing. Remember, many home health nurses believe:

A bad day in home health is better than a good day in the hospital.