MSN, RN
Like many newly employed nurse graduates, I started my career as a registered nurse caring for patients in the hospital setting. Eventually, I also saw patients through the lens of a home health nurse — a view that gave me a clearer understanding of the whole patient.
While in nursing school, my professors continually reminded me that I would get the best experience working in a hospital as a new nurse. I would develop my clinical skills more quickly and have the regular support of other nurses.
Although working long shifts in the hospital was overwhelming, tiring, and challenging at times, they were right. I sharpened my skills each shift, asked many questions, learned from my peers, and never stopped growing. It was exactly where I needed to be as a new nurse.
A few years into my career, like many seasoned nurses, I thought about leaving the bedside. I was itching to see what else was out there for me. With two young children, a nursing position with more flexibility would be ideal.
During one particularly stressful shift, I expressed my desire to explore other nursing positions to a colleague. She told me about a friend who worked as a community health nurse and thoroughly seemed to enjoy her job. She passed my number on to her friend, who called me later that week.
Her friend answered all of my questions and let me know the most critical question to ask myself.
She reminded me that I would be assessing and educating patients without the assistance of other medical staff. It would be up to me to recognize when an ambulance had to be called rather than calling the patient’s doctor. These were critical factors I hadn’t considered.
She also wanted me to know that many home visits come with unique challenges that could cause stress, both mentally and physically — difficult family members, unruly pets, and less-than-ideal home environments.
Aside from some problematic family members, I recognized these were obstacles to delivering optimal care that I hadn’t encountered in the hospital. Thankfully, she also shared some positive aspects of being a home health nurse.
Patients seen by home health nurses and other essential staff had a better chance of improving their health and were less likely to be hospitalized. This is a win for the patient, the nurse, and the hospital’s outcomes — something I wanted to be a part of!
After much consideration, I decided to continue working at the hospital where I had been employed for many years and accepted a per diem position as a home health nurse. I wanted to explore this field of nursing.
I felt fortunate to continue working in the hospital while also caring for patients at home. My hospital job was a part-time role that required me to work 12-hour shifts, two to three days per week, with a monthly weekend commitment.
The home health nurse position was more flexible. It allowed me to put my children on and off the school bus. It was an excellent way to earn extra income in a field I loved and work around my children’s schedules.
I did not anticipate that I would sometimes care for a patient in the hospital I would visit at home. Over time, I realized this was advantageous for me and the patient. It gave me a complete understanding of the patient’s health and home environment, which allowed me to provide the best, most suitable care. It was also comforting for the patient to see medical staff familiar with their health.
While caring for my patients outside of their homes, I learned about their support systems, home environment, and potential barriers to following physician orders.
Seeing a patient at home also allowed me to assess what additional home care services would be necessary. I would inform the doctor if I felt they could benefit from in-home physical therapy and a home health aide to help with activities of daily living (ADLs).
I loved clearly understanding a patient in both settings, which helped me deliver the best care. I quickly learned most aging patients want to stay in their home environment, and I would be happy if I could help them do that safely.
I’m happy to report that most of my home visits were pleasant.
Seeing patients in their homes involves physical assessment and the ability to learn about their support systems or lack thereof. A home health nurse should assess safety and nutritional issues and help make the patient’s home environment conducive to healing.
However, over time, it became clear that goals for one patient were not always suitable for another patient with a similar diagnosis.
In the hospital, most patients follow the doctor’s orders — taking specific medications, following a special diet, going for tests, and participating in physical therapy.
Eventually, the patient would be discharged home with a list of medications, follow-up appointments, and instructions on managing new diagnoses, which often included dietary restrictions. Fortunately, patients did not usually dispute these instructions. Once a family or friend arrived to take them home, they agreed and quickly signed their discharge papers.
Most were excited to be going home!
If a physician had ordered home health services for a patient, I might be the nurse seeing them in their home if the visit was in my assigned territory.
However, I quickly learned that the patient I knew in the hospital might be less agreeable in their home.
For instance, they would sometimes refuse to take a particular medication because of the frequent trips to the bathroom or the adverse side effects they learned about. Another patient might admit they wouldn’t follow a specific diet because family dinner on Sunday was vital to them. They didn’t want to change what they ate and drank for the last 40-50 years.
I explained the importance of following what the doctor had ordered and how it would benefit their health. Eventually, they might agree to all or some of the instructions.
Of course, I’d call the doctor to let them know if the patient was not compliant with their orders. The doctor would see the patient in the next few days and revisit the conversation.
Long after graduating from nursing school, I never stopped learning. I learned how to best communicate with patients, family members, doctors, and peers. I recognized that being flexible was vital in an always-changing work environment.
I improved my critical thinking, attention to detail, and assessment skills as I grew to understand the human body and disease processes better. I learned how medications worked and an ongoing list of new medical devices and necessary procedures.
But one of the biggest lessons I learned was that it is ultimately the patient’s decision how they manage their health. Most did not want to give up their independence and activities that brought them joy just because of something the doctor ordered — even if it did help improve their health.
Of course, to help the patient understand the importance of doctor’s orders, I would talk to their caregivers. They would agree to continue educating the patient about the importance of following the doctor’s instructions.
Taking care of patients at home allowed me to see them through a different lens, in a clearer light. My main objective was always to help them heal from an injury or illness, recover, and regain independence.
They gave me a better understanding of how to care for the whole patient, whether in the hospital setting or at home, as a gift of knowing. Along with a conversation with their doctor, we could help them set goals and meet them where they were.
Caring for patients means knowing what’s wrong with them and listening to what matters to them — a lesson I never forgot.
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