How to Become a Home Healthcare Nurse

Home healthcare nurses have the same core training and skills as other licensed nurses (RNs and LPNs), but they choose to apply their skills outside of hospitals. They typically work for home care agencies, and their patients are often seniors who are disabled, are adjusting to new diagnoses, or are recovering from an operation or illness.

How Do Home Healthcare Nurses Differ from Other Home Care Providers?

The different members of a home care team typically visit the patient alone and they perform different roles, but they have the same basic goals of improving patient health and preventing the need for hospitalization. To truly understand the home health nurse’s role, you need to compare and contrast that role with a few other key home care positions.

The Family Caregiver’s Role

In many cases, home care nurses will have regular contact with a patient’s family caregiver, often a spouse. Family caregivers are frequently unpaid for their labor, and they may have little training and be very stressed by their roles. If a caregiver (family or otherwise) is paid, they are accountable to the family and/or patient plus any agency that’s involved. The term caregiver can be vague, so another word or phrase may also refer to the same basic role.

Regardless, people who are called caregivers typically provide companionship and assist the patient with numerous Activities of Daily Living (ADLs) like dressing, using the restroom, eating, and bathing. They typically also help with “Instrumental” ADLs related to managing the household and providing transportation. They may be authorized to make medical decisions on behalf of the patient. This role has a lot of overlap with direct care roles (below), but there are distinctions.

Home health nurses may have no authority over a caregiver, but they do have the responsibility to keep the caregiver informed on the patient’s health. Nurses often spend time providing family caregivers and patients with education and hands-on training. It’s good to keep in mind that every situation is different, however. Some of your patients will have no designated caregiver, and some will have multiple part-time caregivers and/or a combination of paid and unpaid caregivers.

The Direct Care Worker’s Role

Home health nurses, especially RNs, often have a supervisory relationship to direct care workers. You may be unfamiliar with the term direct care workers but recognize the two main subtypes, Home Health Aide (HHA) and Certified Nursing Assistant (CNA). CNAs and HHAs typically complete similar 75 hours of required training, but a CNA has a higher level of medical training than an HHA. CNAs and HHA perform many of the same ADL tasks that caregivers do, so they help prevent the caregiver from becoming burned out. They may also fully take over tasks that have become too difficult for the caregiver.

A CNA additionally helps with things like medication management, taking vital signs, updating medical records, and providing limited wound care. Depending on the state, an HHA may be permitted to do some of the same tasks. As a nurse, you will have more training than the HHAs and CNAs that you supervise, but they often have more face-to-face time with the patient. Direct care workers are often the first people to speak up about a problem, and supervising nurses respond by providing additional assessments and expertise.

What Types of Care Do Home Healthcare Nurses Provide?

The responsibilities of a home health nurse are diverse, and the pacing and variety of tasks within a workday will vary considerably. That’s part of the appeal of home health work for many nurses – the position is inherently flexible. You may like the fact that its challenges are different from the challenges presented in hospitals.

Key Tasks and Skills in Home Healthcare Nursing:

• Assess home/patient safety, offering solutions and suggestions
• Monitor progress and symptoms, looking for sores, loss of skills or alertness, changes in vitals, and other warning signs
• Assist in Activities of Daily Living (ADL) as needed
• Perform diverse skilled nursing tasks and work with special equipment/devices (dialysis machines, IV equipment, catheters, feeding tubes, ventilators, etc.)
• Provide hands-on training and education to families/patients, addressing any concerns
• Manage and administer medications, problem-solving when issues arising from incorrect dosing, drug interactions, and expired medications
• Keep medical records and communicate with other care providers while adhering to HIPAA requirements
• Handle emergencies and initiate action to address urgently needed changes, including reporting elder abuse when needed
• Remotely supervise and advise CNAs/HHAs (exact responsibilities vary)

A Day in the Life of a Home Healthcare Nurse

Starting the Day and Understanding Scheduling

As a home health nurse, you would probably start your day by hopping in your car which should be stocked with medical and office supplies. Home health nurses won’t necessarily check into a central work location daily – they’re more likely to just go straight to their first patient’s home. Nurses often contact their patients about appointments the night before. Since you’ll be seeing about 6 patients in a day, you might use specialized scheduling software to minimize your time on the road. The exact amount of time you spend with patients will be determined by the purpose of the visit and the policies of the agency and/or the involved insurance company.

Visiting Patients in Their Homes

Virtually all patient visits will involve taking vitals and chatting with the patient and/or family. You’ll often be following up on needs that were brought to your attention by someone else. Your plans for the visit may change dramatically if you arrive and see an urgent, unmet need. On any given day, you might draw blood for lab tests, administer an intravenous drug, speak with a patient about medications or mental health, teach a caregiver a new skill, replace a catheter, dress a wound, or perform any number of other skilled tasks. You’re also likely to perform some tasks that are considered ADLs. It’s often true that such tasks could be done by someone less skilled, but by taking part in them, you gain insight into how the patient is doing.

Keeping Records, Coordinating Care, and Advocating for the Patient

All home healthcare nurses will need to efficiently complete a significant amount of work that is not really patient-facing at all. You’ll do this work throughout the day, keeping neat records. If you’re an LPN, you’ll likely be in touch with a supervising RN (though the RN is not physically present). If you’re an RN then you’ll be a contact person for LPNs and CNAs

RNs often communicate with patients’ primary physicians, social workers, and specialists. The frequency and method of communication varies, but if you’re an RN, then you are working hard to coordinate care. When multiple chronic conditions and doctors are involved, nurses may catch contradictions in what’s been recommended by different parties. Advocating for the patient in such situations is part and parcel of being a skilled nurse. In urgent situations, RNs get in touch with emergency services or expedite the patient’s admission to a facility that can best handle the current need.

Formal Education and Vocational Training for Home Healthcare Nurses

Home healthcare nurses are either Registered Nurses (RNs) or Licenced Practical Nurses (LPNs)*, and they do not typically need to have any additional certifications. However, some training programs may provide special opportunities to focus on home healthcare skills. Home health agencies also often want you to have 1-2 years of work experience in a hospital or other setting before they hire you, but this will vary. Below you can explore the differences between training to be an LPN and an RN.

*Residents of California and Texas should note that LPNs are called Licensed Vocational Nurses (LVNs) in their states.

LPNs at a Glance

An LPN has trained vocationally for about 1 year and has passed the NCLEX-PN exam. LPNs work directly with patients, providing skilled nursing help, but they are prohibited from doing some tasks that RNs can do. They typically report to other on-staff RNs. In some situations, CNAs may report to LPNs.

RNs at a Glance

An RN has trained in higher education for 2-4 years and has passed the NCLEX-RN exam. RNs work directly with patients, performing the full range of skilled nursing tasks. However, RNs usually also provide supervision to LPNs and CNAs, and they may delegate tasks as needed.

Choosing a Training Pathway

If you want to be a home health nurse, choosing between the RN and LPN training pathways may be very difficult for you. The difference between time commitments and costs can make aiming to become an LPN more appealing in the short term, but the earning potential for RNs, particularly those with BSNs, is much higher. Ultimately, there’s no one right answer. As you explore your options, you should keep in mind that there are also “bridge” programs designed to help LPNs transition to careers as RNs. Below you can see how much different training pathways tend to cost.

The net costs for different schools are derived from complex calculations that factor in things like room and board (not in all cases), financial aid, tuition, fees, and more. Visit the U.S. Department of Education College Affordability and Transparency List to see how individual schools compare and to learn more about how net costs are calculated. Note that the Department of Education provided no net average for LPN programs, so we have listed the full range. LPN programs tend to be inexpensive, despite some high-cost outliers.

Other Costs to Consider

In addition to the net costs in the table above, you may face other costs that are difficult to calculate. You’ll need to buy numerous textbooks and supplies, including scrubs. You’ll probably be affected by lost wages since participating full-time in both work and school/unpaid training hours won’t be possible. For some, going to school may necessitate paying for extra childcare, buying a new computer or car, moving, taking on a student loan, or making other changes that will be costly. When you finish your formal education, you’ll also need to pay to take an exam called the NCLEX-PN or NCLEX-RN.

Resources for Starting Your Training as an LPN or RN

Getting into a career in home health nursing will require a lot of hard work, but for the right person, it can be very rewarding in both practical and intangible ways. Below you can explore compensation, and you can also consider some obstacles so that you’re fully prepared for challenges you may face.

Compensation and Industry Outlook

The median annual earnings of a home healthcare LPN is about $48,000 yearly and for home healthcare RNs that median income jumps to about $66,000. In contrast, a CNA working in the home care setting may make only about $28,600 annually. Though paying for the required schooling may be difficult, the long-term financial benefits of training to be a home healthcare nurse are clear.

It’s worth noting that currently, median compensation for home health nurses is lower than compensation in hospitals (the difference may be about $5,000 per year in some cases), but that may change soon. Industry insiders are pushing for equal pay. As seniors favor home care more and more, the work is only likely to be valued more highly. Moreover, some unique, emerging positions in the home health nurse market (like “on-demand” nursing positions) actually pay nurses better wages and provide payments faster than is average for hospital nurses.

Key Questions to Ask When Considering a Home Health Nursing Career

The following questions are designed to alert you to potential career obstacles. These questions may be useful prompts to guide further research or conversations.

• How ready are you to commute? You’ll need a reliable vehicle with which to visit patients and a good driving record with no DUIs. You should also consider whether you cope well with the numerous mental and physical challenges of commuting and if you can maintain punctuality and professionalism with an ever-changing route.
• How clear is your written and verbal English? Working without other staff nearby may amplify any challenges you have with communication. If you struggle due to English being your second language, can you work to improve your language skills before you begin your career?
• How flexible, independent, and organized are you?: Will you mind working alone most days? Are you more likely to be intimated or exhilarated by the level of autonomy- and increased responsibility- that you will have compared to nurses in other settings?
• How will you react to non-compliance?: When you’re in a patient’s home, you’re going to more easily observe when doctors’ orders are being ignored. Will you be able to offer reminders and assistance with compassion and professionalism? If you witness and have to report elder abuse, how will you cope with the experience?
• How well do you advocate for yourself?: There’s no doubt that working alone in a variety of homes presents risks to your safety. You can’t just call another staff member if a patient becomes violent. You also can’t always anticipate who else will be present in a home or how safe and clean the environment will be. Will you be confident enough to advocate on your own behalf with your employer if you deem a particular situation to be excessively dangerous?

Seek Mentorships and Industry Connections

While still in training, try to develop good connections with teaching staff, practicing nurses, and your fellow students. Talking about career development with those who have been there can be invaluable. Any experienced nurses that you know might be able to provide insights you just can’t get from a textbook. They may also be able to advise you regarding up-to-date hiring practices.

Even peers who are as new to nursing as you are may be able to help you by sharing their job hunting victories and mistakes. Moreover, peers can also help you with referrals later on. According to Glassdoor, an employee referral can increase your odds of landing a job by up to 6.6%, yet including referrals on applications is relatively uncommon.

Investigate Local Employment Trends

As you near completion of your schooling, it’s a good idea to research employment trends for nurses in your area. One way to start is to use this Medicare.gov search tool to look up home health services in your zip code. This can give you some information on top local employers. Other options for learning more include local news websites, state or county employment websites, and advisors at your school.

The good news for those interested in home health nursing is that many nurses aspire to and apply only to highly-competitive hospital jobs. This means you may find that there’s an urgent need for home health staffing in your area. However, home health agencies frequently require 1-2 years of prior work experience in nursing. Some will just require/prefer a year of experience in homecare of any kind, not necessarily nursing. If that’s the case, prior experience as a CNA or other direct care worker will be invaluable.

If your chances of landing a home health nursing position right away are low, then consider an entry-level position elsewhere. Even if you don’t prefer it, it will give you the experience that you need in order to later do the job you really want. If the job market for nurses in your area is highly competitive, you may even wish to consider a temporary location change.

Focus on Nursing-Specific Job Posting Sites

You will see many job postings for home health nurses on general-purpose job sites, but you will probably find that nursing-specific search tools will be more useful. Many such sites will often have free resources with tips for resume writing, interviewing, and more. Below we’ve provided suggestions for top job search tools for nurses.

A Word on Job Postings that Indicate a Nursing Specialization

Many job postings that you see will refer to specializations such as palliative care, hospice, mental health, or even specific chronic conditions. Ultimately, for many of these postings, you will not need additional certification in the specialty mentioned. The specialization may be included in the title just to let you know what the focus of the work is. However, read the posting carefully to make sure that you are qualified or to learn if you can take steps to become qualified.

The following resources are a great place to start if you’d like to dig deeper into becoming a home health nurse. A few of the items below address topics that all prospective RNs and LPNs will find useful regardless of specialty, while others specifically address home healthcare nursing topics.

Is home healthcare nursing a common career choice for men?

No, home healthcare nursing is not a common career choice for men at this time – this workforce is still overwhelmingly female. However, men do seem to be choosing nursing more than they used to. According to a 2015 NYU study, the percentage of males in nursing grew from 8.8% to 13.6% between 2005 and 2015. Men who choose this rewarding career path may face some social stigma, but the trend is towards better options for men in healthcare.

Can home health nurses pursue education beyond a bachelor’s degree?

Yes, home health nurses may pursue higher levels of education. For example, you can study and train to become a Nurse Practitioner. Nurse Practitioners have graduate degrees and earn much higher salaries than RNs and LPNs. The practicality of pursuing certification as a Nurse Practitioner for the purpose of advancing in home health nursing will vary. Some Nurse Practitioners do indeed visit patients in their homes, but such positions may be relatively hard to find at this time.

How can home healthcare nurses stay healthy and avoid burnout?

To avoid burnout, nurses need to pay special attention to their safety and mental and physical health. Nursing, in general, is a stress-filled profession, and home health nurses in particular face challenges related to commuting, working alone, and entering uncontrolled home environments. Home nurses may benefit from digging into the resources provided by the Healthy Nurses Healthy Nations Grand Challenge.

Can a CNA be a home healthcare nurse?

CNAs are nursing assistants, and cannot fill the same role that a home health RN or LPN fills. However, becoming a CNA is the first step toward a full nursing career for many people. CNA work can give you a feel for what interacting with patients is like. It can also help you get your foot in the door with an employer who may later hire you as a nurse if you continue your education.

Which states have the most home healthcare and home health nursing jobs?

Texas, California, Nevada, Florida, and Michigan are the states with the most home healthcare jobs (as measured by the number of home healthcare providers per county). Sometimes finding information on exactly how many home healthcare nurses are in a state is difficult, but general home healthcare trends are a good indication of how many home healthcare nursing jobs there are. In general, areas with unusually high percentages of seniors will provide the most job opportunities.