A Day in the Life of a Home Health Nurse

April Rowe, RN

First Off, Going into the Homes of Patients

First of all, you have to ask yourself if you would mind walking into the homes of strangers over and over again. We go into many different types of homes. There are beautiful and clean homes, and homes in deplorable conditions, with bug or rodent infestations and/or animal waste. If you don't particularly enjoy going into people's homes, do not fret, it is something you can get used to.

Do not let unsavory homes scare you. Dirty homes really do not bother me anymore. You go in, you get your job done, and you head off to the next home. One of the biggest challenges of providing nursing care in the home is that the environment is not controlled as it would be in the hospital. Let's say that you need to do a sterile PICC line dressing change and the patient has terrible lighting, cats are wandering around, and it is all cluttered where your sterile field is supposed to be. It can get tricky, but you make the best of the environment you are in.

This is why Home Health nurses are rock stars! Not only are we expected to perform nursing skills that are not usually done by a floor nurse in the hospital setting (implanted port access, wound vacs, leg wraps, venipuncture), we must perform them in uncontrolled environments. We are alone and without anyone around to ask for help if needed. Clinicians who decide to try out Home Health will not only greatly improve their nursing skills, but will master critical thinking skills, along with time management skills.

Common Nursing Skills Performed in the Home

So, what exactly does a Home Health nurse do all day? We perform comprehensive head-to-toe assessments and obtain vital signs on everyone. Some patients are only on Home Health services for education on disease processes and medication management. The focus for these patients is education on their diagnoses, symptoms, treatments, and discussing things like why eating a low-sodium diet helps with hypertension. There's A LOT of educating in Home Health.

Other patients require skilled nursing procedures. Wound care is a very common skill performed. You don't know anything about wounds? No worries! You will be trained, and you will learn how to perform wound care well. Wound vacs are also common in Home Health. Leg compression wraps/Unna boots are another common procedure performed.

Other types of skills include central line dressing changes and lab draws, venipuncture, catheter changes, pleurX draining, ostomies, and let's not forget, implanted port access. The first time I jabbed that giant needle into someone´s chest was quite nerve-wracking, but now it's like a day in the park!

Wound care really scared me at first. It grossed me out too, but now I am used to it. I did not have any prior experience and most hospitals have a wound nurse who gets the job done. I did not know how to describe wounds, stage them, or know how to treat them. There is a lot to learn about wound care. Although you will be trained, you will continue learning as the years go by and research is constantly changing policies and procedures.

The Home Health Schedule

I work for a hospital Home Health. There are also private Home Health companies. Each company does things a little differently. For my job, our schedule revolves around a point system. I am expected to complete 6 points in a day. For example, standard nursing visits are 1 point, start of care visits are 2.5 points, discharges and re-certifications are 1.5 points. I usually do not see more than 6 patients in one day.

In order to be able to get my kids off to school and be home for them afterward, I have become very efficient. I usually see my first patient around 9 am and see my last patient by 3 pm. I always chart when I'm in the visit so that I am not charting when I get home. This helps to keep me sane. Be efficient with your charting and your time, and you will enjoy Home Health! You will always have some lingering charting, emails to address, chart reviews, and looking at your upcoming schedule to do at home, but at least you are at home when doing so.

If you are unorganized, and spend way too much time talking in a visit instead of working and charting, you will fall behind and spend your entire day seeing patients and then have to complete your charting at home. Multitasking is your best friend. You can chat about all kinds of things while you are getting vitals and doing an assessment.

There is A LOT of charting in Home Health. Getting into the habit of completing the charting for routine nursing visits before you drive off to the next house is the best way to go. Certain types of charting take a lot longer to complete. For example, the start of care charting will take at least an hour to finish. I usually complete these at home, in my pajamas.

Pros vs. Cons

Home Health nursing has one of the most flexible schedules in the field. Being able to schedule your patients around your life is one of the perks and is surely one of the reasons I am a home health nurse. I am able to get my kids off to school and be there for them afterward. This type of schedule is not easy to find in the nursing world!

Driving can either be a pro or a con. It depends on the person. I enjoy driving, so it is not a con for me. Companies should be paying mileage reimbursement. The current going rate where I work is 62 cents per mile. You will keep track of your miles each day so that you are paid accordingly.

Rain or shine, you will see patients. For me, this is a pro and a con. It's wonderful not being stuck inside all day with your only excursions being a trip to the bathroom, break room, or cafeteria. I enjoy being out and about in the sunshine. If I can squeeze in a stop at Target on my way to the next patient, fabulous! I know nurses who go to a restaurant every day to eat, relax, and enjoy their break. They schedule that time into their day.

Depending on where you live though, you will also be faced with being exposed to the elements. I recently moved to the South and have gotten used to getting wet during rainstorms. We also have the rare occasion of icy/snowy conditions. Having a good car and all-weather tires is a plus. You will spend a lot of time in your car, so keep that in mind. Keeping your car clean and organized will help keep you organized.

A definite con is the fact that you will no longer have trunk space! You are required to keep supplies in your car. This is why keeping it clean and organized is important. If I am going on a road trip, I will remove my supplies until I return and head back to work.

Finding clean and available bathrooms is certainly a con. There is nothing worse than being a Home Health nurse and having an upset stomach! This is why it is smart to carry a small cosmetic bag filled with useful items. I have one with lotion, bug spray, eye drops, headache medications, Imodium, and Febreze fabric spray. I have found my favorite gas station bathrooms that I frequent often. Starbucks is another great option for clean and safe bathrooms. When in doubt, you learn to hold it!

A pro is if your company supplies you with a cell phone to use. You will call your patients the night before to schedule them for the next day and you will also be calling doctor's offices, DME companies, etc. It is best to have a company phone so that you are not bothered with calls on your personal phone.

A Typical Day for a Home Health Nurse

Around 5 pm, I look at my schedule for tomorrow, use the map app that is within our charting system, and determine how I will schedule patients. You want to plan your schedule around addresses and patient needs. Sometimes I start my day with a Zoom conference call that we do every other week to discuss our patient's needs and any issues, then I hit the road and see patients. Here's an example of a typical day:

0815 - 45 minute Zoom meeting every other week.

0900 - PleurX draining that is done weekly

1000 - Wound care patient

1100 - Acute Kidney Failure teaching patient

1200 - Patient needing education for new insulin regimen

1300 - Foley catheter change that is done every other week

1400 - Wound care patient

Be home by 1500

There are days when my schedule ends up changing or being delayed. Being adaptable is crucial. You may have a patient cancel on you, and then you are asked by the office to see a different patient at a different time. It happens. I go with the flow. If I am unable to be flexible that day, I simply explain the situation to the schedulers at the office.

In Conclusion: Why Home Health Nursing ROCKS!

As you can see by my schedule above, the Home Health schedule is amazing, but you have to help make it this way by being efficient. I feel like I am actually helping people. Your patients allow you into their personal space and open themselves up to you. You get to know them and see their progress and then discharge them. It's almost always a happy ending. Your nursing skills, time management, and critical thinking will be TOP NOTCH after working in home health.

Home Health is not easy, but it is worth it. Some days are more stressful than others. Some patients create problems, while others are absolutely wonderful to deal with. You spend a lot of time getting to know yourself. It's just you, your car, your music, your snacks, and the patients you see that day. Home Health nursing is challenging, but it is also fun and rewarding. Give it a shot and maybe you will find your niche in nursing!