Specialty to Consider: Home Health & Hospice Nursing
Calling the shots as a guest in the patient's home
Many nurses find home health nursing personally and professionally rewarding. While hospital nurses work in an environment surrounded by colleagues, home health nurses find themselves working relatively autonomously in the field, seeing patients in their private homes. They often work as case managers, and can be faced with patients in need of intravenous therapy, complicated wound care, and a vast array of medications and treatments that require close management and attention.
Hospice, a subspecialty of home health, involves direct care with patients facing issues surrounding death and dying, and care focuses on symptom management, comfort, and the spiritual and emotional needs of the patient and their loved ones. Hospice nurses perform detailed assessments, but also provide education about the dying process to the patient and their caregivers. Nurses who work in hospice perform regular physical assessments and help to provide relief from a variety of symptoms, but they must also take into consideration the very deep spiritual and psychological dynamics that death and dying bring to the patient, their family members and the home environment.
An Administrator With Heart
Jan Huckins, RN, BSN, is director of performance improvement for the VNA and Hospice of Southern California. She has worked in home health since 1977, first as a field nurse and then as an administrator. She now focuses on performance improvement, writing policies and procedures, making sure the agency is ready for Medicare certification surveys, and preparing managers and staff for JCAHO inspections.
Huckins said that most important thing in home health is, “Good documentation. Nurses must paint a complete picture of the patient’s condition from one assessment to the next.”
When hiring nurses into this specialty, she said she looks for nurses who are “autonomous and independent thinkers.” They must be able to perform accurate assessments and make independent decisions, and “organization, keen assessment skills, and a friendly and outgoing personality,” she added, are essential tools in the home health toolbox.
“Be friendly, be able to look at people face to face, and be comfortable with who you are," she advised. "You must be able to walk into someone’s home as a guest but also be the nurse. You call the shots, but you’re a team player; and being able to get everyone to work together is truly the art of home health.”
A Passion for Home Health
Evelyn Fowlks, RN, has been a dedicated home health nurse for two decades, and is currently a case manager for Best Care Home Health of Southern California. Her passion for home care is contagious.
“I really enjoy it," she said. "I just love being in a patient’s home and assessing their home situation. Patients are overwhelmed when they come out of the hospital and require a lot of support. There’s just so much for them to digest.”
Fowlks is quick to illustrate her love of this specialty with anecdotes and stories, many of which reveal not only her sense of humor, but also her underlying love of the patients whom she serves.
“You have to be able to adjust to different environments," she said. "You never know what you’re walking into. Sometimes a home is so cluttered there’s nowhere to sit down. Patients have different personalities, and they don’t necessarily want you in their private space. We have to respect the patient’s home, lifestyle and environment.”
“You can choose to make your visits enjoyable," she added. "I do that every day, and I always come back with a story.”
A Hospice Nurse Extraordinaire
Mary Ellen Blakley, RN, MSN, is administrator and director of patient care services at Hospice Partners of Southern California, a division of Wilshire Health and Community Services in Santa Monica, and she defined the hospice experience as “the embodiment of everything that most of us went into nursing to do.”
“Hospice is not task-oriented; it is determined by what the patient needs," she added. "Hospice is a true team environment, and it’s the only branch of health care in which volunteers are required by Medicare to provide direct patient services.”
When asked who on her team should be interviewed for this article, Blakley did not hesitate to recommend Laurel Lewis, RN, BSN, a nurse she feels truly epitomizes what a hospice nurse should be.
Lewis is a Hospice Partners nurse with a deep understanding of death and dying. Having recently completed a master's degree in spiritual psychology at the University of Santa Monica, she is now doing post-graduate work in “consciousness, health and healing” while continuing her work in hospice.
She feels that doing hospice work has as much to do with the nurse’s own self-knowledge than his or her clinical or assessment skills. “What I have found is that the more clear I am about my own intentions, motivations and conditioned beliefs, the more easily I can see what the needs of my patients and families are," she said. "Self-knowledge makes me a more active participant in the care that I provide. I’m more able to stay grounded, even when faced with chaotic family dynamics or symptoms that are out of control.”
Discussing how challenging it can be to work with people who are facing issues of mortality, Lewis said, “I’m still awestruck by the tenderness and vulnerability of that time in life. In Western culture, it’s still a taboo subject. I’ve always had comfort in that area, and it’s never a taboo subject for me.”
Describing her journey in hospice, she said, “I feel very humbled and honored that I get to participate in a time that is so fragile and sacred, and I really appreciate that I have the capacity to do it. For me, it’s a double blessing.”
Lewis advised nurses considering this career path to look deeply into their own hearts and determine their own motivations and intentions to work with the dying. She also recommended that nurses “examine their relationship with their own death and the topic of death and dying in general.”
“You must be comfortable with your own mortality in order to guide others in facing theirs," she added. "Knowing yourself deeply is the greatest gift. And when we can alleviate some emotional, spiritual or physical discomfort for a person in distress, we’ve done our part in a beautiful and deeply emotional spiritual process.”
Is It Right For You?
Home health nursing, including hospice, is a branch of nursing for which not all nurses are well suited. The home health nurse is a relatively autonomous agent who, in providing care in the home environment, must often make decisions on his or her own without the benefit of nearby colleagues for support.
A home health nurse must carry a great deal of equipment and supplies in his or her car at all times. Being out in the field, the nurse has a great deal of freedom, but must sometimes drive great distances between patients’ homes. They work in urban, suburban and rural areas, and each of these environments offer advantages and disadvantages.
For any nurse interested in home health or hospice, the nurses in this article recommended “shadowing” a home health or hospice nurse for several shifts. Both are greatly rewarding, but also offer a unique set of professional and personal challenges. But for those nurses willing to provide such specialized care in the home setting, the rewards can indeed be without measure.
If you are interested in a career in home health, call a local home health or hospice agency and ask to shadow a nurse for a day or two in order to become acquainted with the specialty firsthand. You can also contact any of the following national organizations for more information:
Visiting Nurse Associations of America
Hospice Association of America
National Association for Home Care & Hospice
Keith Carlson is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. He is currently an expert blogger and editorial contributor to BlackDoctor.org. His own blog can be found at http://digitaldoorway.blogspot.com.