Transitioning from Bedside Nursing to Homecare
Maybe you have discovered that bedside nursing just isn’t for you! Let’s face it, you have excellent nursing skills, you are in demand and valued by management and your peers. However, you prefer to spend more time with your patients to provide care in a different environment, the patient’s home.
There is a belief in the public arena, and among the nursing community, that home care nursing is non-challenging or that it does not promote growth. On the contrary, home care nursing can be challenging. The clients who need nursing care at home are not only the frail elderly. There is a large population of patients in the community who are ventilator dependent for many years. Others may be receiving long-term intravenous infusion, and complex wound care utilizing various types of wound care devices. Blood transfusions are also performed in homes sometimes.
Most home healthcare agencies require nurses to have a BSN and at least 2 years of experience as an RN in medical-surgical nursing. Nurses who have worked in medical-surgical, or critical care areas, usually succeed in home care nursing because of their broad range of assessment skills. Even though there are no specific certification available for home care nursing, some nurses maintain certification in medical-surgical nursing (Elliott, Brenda)1. Home care nursing agencies also employ RNs with AS Degrees, and LPNs.
In the United States, there are countless number of children and adults who receive home care nursing through the Agency for Persons with Disabilities. Many of these clients are infants (some premature) who have complex medical problems, including neurological issues requiring highly skilled nursing. Some infants and children may have private insurance reimbursement for TPN (Total Parenteral Nutrition) and other highly skilled IV interventions.
Providing nursing care in patients’ homes have advantages, and disadvantages. One advantage is the undivided attention a client receives, including more effective therapeutic interventions and outcomes. The nurse has more time to spend with the client in the home setting, developing the kind of relationship that would not be possible if the client was hospitalized or in a long-term care facility.
Secondly, clients feel more relaxed and autonomous when they are in their own homes. In an institution, many decisions are made by the therapeutic staff, including the physician. Clients tend to feel they do not have much control over their health care. At home, however, the client is in his or her own space and, therefore, has a sense of empowerment.
One Disadvantage of home care for the nurse is having a “correct fit” with clients and their family, if they live with family. Therefore, nurses may change clients, or the clients may request different nurses until a suitable client-nurse relationship can be achieved.
Another disadvantage of home care nursing is encountering dangerous situations in the home from clients or their family members. Some home environments are dysfunctional, which puts the nurses at risk for physical and verbal abuse, and sexual harassment (Hanson et al) 2.
To ensure worker safety while maintaining quality care to the patient at home, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed (Nakaishi L, et al) 3.
In an article by the Alliance for Home Health Quality & Innovation, a 501(c)(3) foundation, they support a research-based strategic planning project on the future of home health care in America. The article states “Preferences for services at home rather than in nursing homes are widespread among persons with disabilities.
Even in the event they needed 24-hour care, 73 percent of persons with disabilities prefer services at home. Among the general population of persons 50 and older, 58 percent prefer services at home.”
The article further states “As the health care system evolves and is reformed to meet the future needs of the rapidly aging U.S. population, the value of health care delivery at home will grow because it is a patient-preferred, cost-effective means of delivery high quality care.” (The Alliance 2014) 4.
- Elliott, Brenda PhD, RN Considering Home Healthcare Nursing?
- Hanson et al. BMC Public Health (2015) – Workplace violence against homecare workers and its relationship with workers health outcomes: a cross-sectional study. 2015
- Nakaishi L, Moss H, Weinstein M, Perrin N, Rose L, Anger WK, et al. Exploring workplace violence among home care workers in a consumer-driven home health care program. Workplace Health Saf. 2013;61:441–50.PubMed Google Schola
- The Alliance for Home Health Quality & Innovation – The Future of Home Health Care Project MAY 2014