Is HHC Nursing for You?

When I started nursing in 1974, home healthcare was far different than what it is today. Having a LPN or RN come into the home for six or more hours a day was a privilege that only those with an excellent insurance policy or the wealthy could afford. Anyone else had an occasional visit from the public health nurse or was taken care of by family members and friends. There were very few agencies and the Nurses' Registry to help you find clients. Documentation was basic and kept in the home. The only rules were those of basic nursing care and whatever the agency deemed necessary.

Today, Medicare, Medicaid, and Long-Term Care Insurance reimbursements are the driving forces for the many agencies in the business of home healthcare. Documentation is key, not only for reimbursements, but also in the many layered web for certification. The rules and regulations under which these agencies must abide are many, and their angst is passed along to the nurses in the home. Even with the pressures of multiple regulations, home healthcare (HHC) is a fast growing industry and is a highly gratifying nursing speciality.

What makes a good HHC nursing candidate? One of the most important things is the ability to be alone or without adult interaction for long periods of time. Even if you are working with a cognizant adult patient, he or she will frequently need to rest or be in the company of family and friends. Critical thinking skills and the ability to handle emergency situations alone are essentials. Most agencies require that a nurse has had at least one year of hospital experience before doing HHC. In the hospital setting you can get a feel for what speciality is most suited to your nursing style. In HHC you can choose from both high-tech and low level care pediatrics, geriatric care, terminally ill patients, long-term disability patients, and the list goes on. In any situation you must be team oriented. In a client's home you will work with two teams---the family team and medical/agency team. Always remember that you work for the agency, but you must build a rapport with the family. Almost as important as your nursing skills is your ability to communicate effectively and to be a diplomat extraordinaire. You will need to know how to set up and respect boundaries. Aside from the mandatory inservices your agency offers, you must have a willingness and a drive to learn as much as possible about the disease, disorder, or disability of your client. This is essential information to help you when communicating with the family, the doctor, and when conducting patient/family education.

When deciding on a speciality, remember that if you select pediatrics, you will need to like children in general if their are siblings in the home. Even though their care is not your responsibility, you will be dealing with their noise, curiosity, and sometimes their need for attention. Make sure this will not bother you.

Increasingly agencies are leaning to 12 hour shifts. Can you be in a home setting for that period of time and remain alert and productive? I will devote an entire future blog to the pros and cons of various shifts in HHC.

Finally, can you be secure and happy with agency work? Agency work offers flexibility and freedom, but if you work per diem or PRN you will not have the benefits of facility work. Many agencies also offer the benefits of facility work if you commit to certain guidelines in availability. Be aware that this greatly reduces your freedom and flexibility. Many offer health insurance at group rates and a 401K plan. More on all of this in a later blog.

Let me hear from you. I welcome your feedback and input, whether you are a nurse, agency, client, or family member. Next week I will talk about the basics of being in a client's home and rapport building.