The Job of a Home Health Nurse

We spoke to Visiting Nurse Associations of America (VNAA’s) Senior Director of Clinical Education and Quality Initiatives Heather McKenzie, RN about what it was like to work in the hospice, nursing home and home health areas of nursing. Here’s what she had to say.

What is the role of VNAA in a nurse’s life?

VNAA is the nonprofit trade association for nonprofit home health and hospice organizations. The VNAA advocates on behalf of these agencies and their respective staff including nurses.

In addition the VNAA provides educational opportunities through conferences like our Annual Meeting and through distance education formats like Webinars. We are an approved provider of continuing nursing education and provide contact hours for these educational activities to nurses many times for free.

Nonprofit home health and hospice organizations play a major role in their communities served and many times impacts a nurse’s life on many different levels. Charitable organizations and nonprofit home health and hospice organizations go beyond providing healthcare in the home and extend its reach by providing community benefit programs. Typically community benefit programs include:

  • Formal discounted and/or free health services programs also known as charity care to the community.
  • Annual activities or programs to improve community/public health.
  • Annual continuing education programs to educate health professionals in the broader community.
  • Grant funded research.
  • In-kind and/or financial contributions made to other healthcare organizations addressing community health needs.
  • Voluntary opportunities for employees to support community benefit programs and services.

When community benefit programs exist it increases nurse opportunities for personal and professional growth, career mobility, acquisition of new clinical and leadership skills as well as building and strengthening community relationships while supporting a mission-driven organization. For example, healthcare programs that are offered beyond core services increase the opportunities for nurses to transition between specialty care programs, thus allowing for acquisition of new clinical and leadership skills. As the nurse increases his or her clinical and leadership experience, the opportunity for increased job flexibility and career mobility also increases. It is the core operating philosophy of a nonprofit to meet the mission that also offers nurses the ability to meet their personal and professional yearning to help their own community at-large.

What is the job outlook for those who want to work in hospice, nursing homes or home healthcare?

As projected by the Bureau of Labor Statistics “Overall job opportunities for registered nurses are expected to be excellent, but may vary by employment and geographic setting. Some employers report difficulty in attracting and retaining an adequate number of RNs. Employment of RNs is expected to grow much faster than the average and, because the occupation is very large, 581,500 new jobs will result, among the largest number of new jobs for any occupation. Additionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation.

Employment of registered nurses is expected to grow by 22 percent from 2008 to 2018, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly. However, employment of RNs will not grow at the same rate in every industry.

The projected growth rates for RNs in the industries with the highest employment of these workers are:

Home health care services 33 percent…Employment in home healthcare is expected to increase in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures.”

VNAA agrees there will be tremendous opportunities in home health and hospice as the population continues to age. In addition to changes to the overall healthcare structure which includes accountable care organizations, medical homes and chronic care management models there will be an increasing need for nurses who can help transition patients between different care settings and back to home in a safe manner.

What special qualities should a person have to work in the this field?

Many nurses that transition into homecare and hospice are veterans desiring a practice setting change with the ability to provide independent nursing service.

To be successful as a visiting nurse the individual must have the ability to function independently and autonomously in the community environment with strong clinical skills in a practice specialty. Most common specialties and/or visiting nurse positions include age related roles such as mother/baby, pediatrics and gerontology. Other visiting nurse positions focus on diseases or conditions including wound care, diabetes, chronic obstructive pulmonary disease (COPD) and heart failure. While other positions may focus on the processes and procedures to support specific service programs like immunizations, IV therapy, Medicare admissions, personal care supervision or managed care case management.

In addition to strong clinical skills the visiting nurse must have reliable transportation and/or like driving or traveling from home to home and/or to other community facilities. In addition, he or she must be extremely resourceful to address patient needs while always being prepared with a well-stocked traveling supply bag.

Homecare is the only practice setting in which there are federal Medicare and state Medicaid nursing assessment requirements for medical and personal care programs. The visiting nurse must have a willingness to complete government-mandated assessment items in a timely manner.

Lastly, visiting nurse work hours are highly variable including nights, weekends and holidays and is dependent on the type of care that is needed and the insurance covering the nursing service. Typically hourly/shift work requires visiting nurses to provide medical and personal care services to a single patient who requires long term-care due to disability and/or severe de-compensation from injury, illness and/or disease. Many in homecare refer to this as Private Duty Nursing. Per visit work requires a visiting nurse to provide medical care services to multiple patients recovering from acute injury, illnesses and/or disease. Many in homecare refer to this as Skilled Nursing. In addition there are other programs that require a visiting nurse to provide supervisory/case management visits on a per visit basis.

What training or education course do you recommend for those who want to work in this field?

Minimum requirements typically include:

For a Practical/Vocational Nurse (LPN/LVN)

  • Graduation from an approved school for practical/vocational nursing
  • Licensure as a practical/vocational nurse by the State in which practicing.
  • Minimum 1 year post nursing program medical/surgical experience required.

For a Registered Nurse (RN)

  • Graduation from an approved school of registered nursing.
  • Licensed as a registered nurse by the State in which practicing.
  • Minimum 1 – 2 years experience required in nursing specialty like medical/surgical, pediatrics, mother/baby or gerontology.

For more information about this type of nursing, visit VNAA’s site.


Learn More: How to Become a Home Health Nurse