Home Care Nursing—Is It Right For You?

Do you remember when you first decided to be a nurse? How did you imagine your relationship with patients? Did you envision closeness and the chance to make a difference in their lives? Too often, institutional nurses are pulled in so many directions they don’t have the time to “see” their patients. Staffing shortages and too many patients result in few opportunities to look beyond the medical chart. For many, this inability to spend time with patients is frustrating and at odds with why they entered the nursing profession. For nurses in this position, home care may be the solution.

Many view home care as the purest form of nursing. Florence Nightingale herself said, “…the ultimate destination of all nursing is the nursing of the sick in their own homes.” Home care nurses cite the richness of their relationships with patients as one of the greatest benefits of the job. “Nothing in nursing is quite as rewarding as making a patient comfortable and safe in the coziness of his own home, where he wants to be,” says Ann Baiada, RN, rehabilitation manager for Bayada Nurses.

Variety of Cases and Schedules

The opportunity to work on a wide variety of cases is another reason many nurses choose home care. Increasingly, home care nurses are specializing in areas such as pediatrics, geriatrics, and rehabilitation. “The home care field offers nurses the opportunity to use high-tech skills because the technology is available. Nurses with specialized skills are highly valued,” says Mark Baiada, president of Bayada Nurses. The diversity and complexity of today’s home care cases are attributed to earlier discharges mandated by managed care and the “graying of America.”

Home care nurses are also able to assume a wider spectrum of responsibility than institutional nurses. Because they are often the only health-care professional seeing a patient regularly, excellent judgment and clinical skills are essential.

Another advantage of home care nursing is flexible schedules. “Opportunities in home care nursing are exploding,” says Mark Baiada. “Qualified nurses can have their pick of cases and schedules—a real benefit for nurses with busy home lives.”

Unique Challenges Require Special Individuals

However, home care nursing is not for everyone. “It takes a special individual to meet the challenges of the field,” cautions Mark Baiada. “Bayada Nurses recognizes the unique obstacles of home care, which is why we call our employees Heroes on the Home Front.”

One challenge particular to home care is a sense of isolation. Unlike institutional settings where nurses work closely with other caregivers, home care nurses are usually out in the field alone with their patients. This sense of isolation can be troublesome to those new to the field. “The key to overcoming isolation is to choose an agency that recognizes how challenging this aspect of home care can be. Knowing that you are part of a team and professionally supported can truly make a difference,” says Baiada. To help combat feelings of isolation, Bayada Nurses provides its nurses with 24-hour professional support and a team environment—allowing its nurses to maintain a feeling of community with other caregivers.

Shift in Dynamics

Home care nursing also derives its challenges from its unique work environment—the patients’ homes. Unlike institutional nurses, home care nurses work on the patient’s home turf—a shift that often changes the dynamic of the patient-nurse relationship from authoritarian to collegial. One of the most important aspects of home care nursing is answering the question “Who’s the Boss?”

Finding this answer requires tact, creativity, flexibility, good humor, patience, and negotiation skills. Home care nurses walk a uniquely fine line to maintain the delicate balance between the need to provide safe, comprehensive, and efficient care and the need to respect patients’ preeminence in their homes. Yet most home care nurses will tell you this shift in dynamics produces the greatest rewards—allowing home care nurses to achieve closer and richer relationships with their patients than is possible in other settings.

Deep Sense of Satisfaction

Although home care nursing is frequently challenging, the rewards are tremendous. Many home care nurses report a deep sense of fulfillment and satisfaction from their jobs. “To many of our nurses, the opportunity to help patients remain involved in their family life and stay at home is deeply satisfying,” says Ann Baiada. “They tell me they wouldn’t change it for the world.” For institutional nurses seeking the opportunity to develop closer relationships with patients, assume more responsibility for patient care, and work on a variety of cases, home care nursing may be the answer.