Challenges of a Home Health Nurse

1. Home Care is Delivered at Home - People's homes are their castles, refuge from the storm. They celebrate happy moments at home and when they don't feel good, they spend it at home in their beds. The majority of most people's time is spent in their home.

2. Home Care Keeps Families Together - This is vital in times of illness and one of the most important social aspects of life.

3. Home Care Helps the Elderly Maintain Independence - No one wants to be totally dependent on someone else. With some assistance at home, many people can remain in their own home and still function in society.

4. Home Care Prevents or Postpones Placement in Institutions - Without some assistance such as home therapies, home nurse, aide,.. many people who meet criteria for placement could (or should) end up in a nursing home or personal care home. There are many agencies that provide 24 hour care.

5. Home Care Promotes Healing - Studies show that many patients heal better in their own home.

6. Home Care Represents the Best Tradition in American Healthcare - Most healthcare has been delivered in the home. Being admitted to the hospital is usually the exception rather than the rule.

7. Home Care is Safer - 20% of people who enter hospitals develop complications, such as infections. The incidents of these occurring at home are nearly zero.

8. Home Care Allows Individuals to Maximize their Personal Freedom - A hospital and many other facilities are usually regimented and regulated. At home, there is more freedom.

9. Home Care is Personalized - It is the one-on-one care tailored to each patient that meets the individual needs and promotes wellness.




10. Home Care Allows for the Individual and Their Families to Participate More in Their Own Care - When someone can participate in their own care and not be so regulated and on a schedule as in the hospital, it allows them a 'little say' in their recovery.

11. Home Care Reduces Stress - Home care decreases the stress of a stay in the hospital or other facility.

12. Home Care is the Most Effective Form of Health Care - Consumers report high satisfaction with care delivered at home.

13. Home Care is Delivered by Special People - Home care nurses and aides consider what they do as a calling rather than a job. They are motivated by the positive emotional reaction of their clients.

14. Home Care is the Only way to Reach Some People - In many rural or dense urban areas of America, home care is the only available form of healthcare. Nurses and aides visit some people on horseback or by jeep. In certain urban areas, they may have to be accompanied by armed guards to deliver their healthcare in high crime areas.

15. Home Care Extends Life - Visits by Home care personnel help people spiritually as well as medically.

16. Home Care Improves the Quality of Life - Home care not only helps add years to life, but also life to years. Many people on home care are more satisfied with life as a whole.

17. Home Care is the Most Efficient Form of Healthcare - Home care cuts down on expenses because it is personalized, delivered in the home, involves family, cuts down on trips to the E.R. and minimizes costly hospital stays.

18. Technology is making Home Care the Preferred Method of Healthcare Delivery - The Internet will increasingly make it possible to diagnose, monitor and treat illness at a distance.

19. Home Care is the Preferred Form of Health Care for the Infirm and Disabled - Infirm individuals prefer Home care over institutional. Those facing terminal illnesses are electing hospice.

When my daughter was 1, she was diagnosed with asthma and over the next few years after that, she was in the hospital several times. I knew then that I wanted to do something in the nursing field, or at least a hospital setting. Little did I know I'd actually go through with it! I went back to school when my kids were 4 and 1 1/2 and have NEVER regretted it.

When I became an RN 16 years ago, I wanted to work with kids. I thought it would be great to work in pediatrics and play with all the little ones and comfort them when they cried and all the mooshie stuff. Well, I was living a fantasy because the only kids that wanted me when they were sick were my own.

So, I moved on to med/surg, and helped out in maternity once in awhile, night shift, which was nice because the newborns were a little more receptive to all the strangers poking and pawing at them. I thought about bidding on a position and staying in maternity until one night we delivered preemie twins that were only 20 weeks and there was a laceration on one of the babies scalp from the forceps and that did it for me in maternity.

So, I stayed in med/surg part time 3-11 and also worked at a local nursing home part time 11-7, and I would leave the hospital and go directly to the nursing home as night supervisor and didn't have any hands on with the patients. So after doing this and bouncing all over the hospital trying to find my niche, a job became available in Home Health. I bid on the job, got the position and have been there ever since...13 years.

I love it. I hate it. I get up some mornings and don't want to go at all. Now here's my question. Could you be a Home Health nurse? Now I'm not talking about the charting, computer work, OASIS, regulations, policies, mandatories, doctors and all that other stuff that goes with every nursing job, in-house or not. I'm talking about the hands on care I lacked in the nursing home. Trust me; I've long since been paid back for that. My co-workers and I have said a hundred times we should write a book, I'm sure it would be good reading.

Could you drive 90 miles in one day just to find out that the patient who said he'd be home decided to go to Wal-Mart, but he'll be back shortly says his wife?
Could you handle looking into the corner of the room at a cage you thought had a bird in it, but after closer inspection, you realize it's a rat that's about a foot long? or see a cockroach crawling across the table and watch as the patient smashes it with her coffee mug and leave it lay?

Could you be greeted at the sliding door by a snapping and growling German Shepherd that's telling you you're NOT getting in this house? Or, play with the sweet little dog that's jumping on you as you walk up to the porch and then try to keep the cat out of your nursing bag while you're talking to the patient?
Could you deal with 5 family members grilling you about every med known to man that their Mother's on and not have a drug book with you? Could you see a patient that you never saw before with a laptop that has a dead battery?

Could you go to a remote part of the county with a cell phone you know won't have a signal and maintain your cool when the neighbor looks like Charles Manson?
Could you drive to that same remote area with a quarter tank of gas and the only gas station ran out of gas this morning? Could you do any of these things at night when you're on call?

Could you make a nursing decision about a wound, medication or medical condition without waiting to get the Doctor's OK or without being able to run to the store room for supplies or ask the opinion of another nurse?
Could you go for hours without peeing because the only house left to go to now is the one with no running water and an outhouse in the backyard?

Could you drive out in the country after the snow storm of the century hits and you can't even find the patients driveway because of the snow and you have her on the phone and she's telling you "Honey the driveway is right there, just turn left" and you turn into what looks like an open field of about 3 feet of snow because her son didn't get out to plow yet?

Could you handle the office calling a 4th time to stop and get this urine specimen, take dressings to this patient or we forgot to get Mrs. Jones labs yesterday, could you stop and get them on the way in and you're already so busy you know you'll have overtime?
Could you handle walking in on a patient that's lying on the floor and she isn't injured, just needs help getting up, and she weighs 200 lbs and there's no one else around but you?
Could you handle being in a home that is so cluttered you can't find a place to sit and so dirty you don't know if you want to?

Could you handle calling a doctor you aren't familiar with on a cell phone and the doctor's on a cell phone and the connection is bad and he's foreign so you can't understand him and you hope you got the order right, but you didn't think asking him to repeat it a 3rd time would be a good idea?

Could you just have a bag of pretzels in the car with you because you KNOW you won't get a lunch break, again? Could you handle unruly family members without security to call?

There are more challenges and dilemmas I could tell you about, I could write for days. But ya know those incidents are just chalked up as a bad day at work. No biggie, moving right along to the next day just becomes force of habit. And if anyone reading this says "No, I don't think I could handle it" maybe you need to hear what helps ME handle those sticky moments.

Like the patient that can't wait for you to visit because she doesn't have any company but you all week.

Or the one that shows you how to plant tomatoes just right in the garden so they grow champion tomatoes at the end of summer.

Or when you go to that cluttered, dirty house with the outhouse at 10:00 at night, and it's pouring buckets of rain but the patients catheter isn't working, so you gotta go and they send their 2 little nieces out to meet you at the car with an umbrella.

Or when you give an enema and remove an impaction and the patient is so grateful she calls you an angel.

Or when your birthday rolls around and one of your elderly lady patients remembered how much you liked the hand tatted doily on her table and you find it wrapped in some tissue paper and stuck in your bag when you get back to the office.

Or the Christmas cookies and cards you get every year from patients and their families, along with a handwritten recipe card of that special cookie you thought was so good.

Or the husband that comes to the end of the dirt lane in the dead of winter because he just knows your car won't make it back into the house.

Or when it's time to discharge the patient from Home Health and they hug you like a daughter and every time you see them at Wal-Mart they speak to you and talk to everyone within range about how good you were to their Mother.

Maybe it'll change your mind when I tell you that these patients remember you, favor you over other nurses, talk to you at the grocery store and remember you, sometimes even when you can't remember their names. They don't forget who helped them with their pills when they came home from the hospital or who was there to check on them when their husband or close friend died. The patients remember it all.

When you work in the hospital, that's medical staff territory and there's a routine to follow and scheduled breaks and other staff, doctor's, maintenance, security and other departments to help you through your tasks each shift. But when you're a Home Health Nurse, you're in the patient's territory. And you're GOING to share it with unruly family, nosey neighbors, friendly and not so friendly dogs, cats that scratch, birds (or rats), dirt lanes and snow drifts, the 'name that pill' game, cluttered houses, dirt floors and outhouses. That's a given. No getting around it and if you CAN'T handle it, I guess you should stay in the comfort of the hospital's 4 walls.