When you picture your nursing career, where do you see yourself working? In a hospital, a doctor's office, or on the go? If the idea of being confined to a single location 40+ hours a week makes you uneasy, becoming a home care registered nurse may be a good fit for you.

Home care patients need regular medical care—often long-term care—that doesn't require a visit to a doctor's office or hospital. The procedures and treatments they need, though essential, can be administered at home (which is doubly important because many of these patients suffer from limited mobility). Home care registered nurses provide that treatment.

There are more than 33,000 home care and hospice organizations in the US, providing in-home care nursing and personal care aides to patients with chronic illnesses and disabilities. In 2012, approximately 3.4 million Medicare recipients received home care at a cost of $18 billion, according to American Nurse Today.

This article explains how to become a home care registered nurse providing that care. In the guide, we'll cover:

• Home care registered nurse job description
• Job outlook for home health nurses
• Home care registered nurse education and training
• Certification and licensing for home care nurses
• Should you become a home care registered nurse?

Home care registered nurse job description

Home care registered nurses—sometimes called home health nurses—assist patients with care in their homes. They help families manage that care as well. Under the supervision of a patient's doctor or another healthcare provider, these registered nurses manage the expectations and delivery of an at-home healthcare plan.

What are the duties and responsibilities of a home care registered nurse?

Some of the typical tasks home care registered nurses perform include:

• Taking patient histories
• Performing diagnostic tests
• Administering medications
• Assisting with bathing, feeding, and dressing patients
• Cleaning and dressing wounds
• Developing patient home care plans in coordination with other healthcare team members
• Educating patients and their family members about conditions, treatments, and more
• Ensuring patient safety and quality of care
• Helping patients manage their chronic illnesses and disabilities
• Recording and reporting changes in the patient's condition

What is it like to be a home care registered nurse?

Nurses working in home-based settings must adapt to changing environments, which can be a challenge and transition for some in the profession, according to American Nurse Today. The work can require a more personal, intimate touch than does hospital work, which suits some nurses well and others not at all. Home care registered nurses typically get to spend more time with patients than do their hospital-based peers, enabling them to effect a greater impact on critical issues, such as diet and exercise. That can lead to better outcomes.

The National Association for Home Care & Hospice shares varied stories from home care nurses on their day-to-day experiences and life with their patients:

• "My patient has made me a better nurse. I became her home care nurse on her 85th birthday, following a knee replacement… She and I worked together until we could walk together, and when she no longer needed my help, the feeling was bittersweet. Although we both missed our visits together, we managed to stay in touch." —Mary Beth Cline, a home health and hospice nurse in Alabama
• "My patient is 16 years old with spina bifida, a congenital heart defect, and complications in her venous and autoimmune systems. She was looking forward to her 'Sweet 16' but knew her usual celebration wouldn't be possible. I discovered her favorite animal was a sloth, and arranged for the new sloth at our local zoo to make a home visit. It was a wonderful moment to give her an emotional treat..." —Karen McDay, a home care and hospice nurse in Mississippi
• "My patients live in impoverished areas, and I understand why socioeconomic challenges and suboptimal living conditions may prevent them from following a doctor's plan of care. I like to leave no stone unturned when it comes to finding resources for discounts or free items for my patients..." —Sylvia Cruz, a visiting nurse in Pennsylvania

Job outlook for home health nurses

What is the average salary of a home care registered nurse?

Specializing as an RN can pay off. That's because RNs who work as home care nurses can earn more than the average registered nurse, according to available data. The average salary of a home health registered nurse is $79,536 annually or $38 an hour, compared with the average RN hourly pay of $29.30.

What are the projections for the home care registered nurse job market?

Within the broader field of RN jobs, the US is facing a nursing shortage. According to the Bureau of Labor Statistics, job growth within nursing is expected to increase by 12 percent through 2028—much faster than the overall average for all occupations.

The BLS has also identified home healthcare as the fastest-growing healthcare employment sector. Home care employs nearly 1.5 million Americans, about 181,000 of whom are registered nurses. That makes home care employers the third-largest employers of RNs (after hospitals and doctor's offices).

Home care registered nurse education and training

What should you study to become a home care registered nurse?

Some home care nurse employers hire licensed practical nurses (LPNs) or licensed vocational nurses (LVNs)—or nurses who have completed a one-year certificate program at a community college, trade, or vocational school and who have successfully taken (and passed) the National Council Licensure Examination (NCLEX-PN) to become licensed.

Even so, home care registered nurse employers typically prefer registered nurses. To become an RN, you will need at least a two-year associate's degree in nursing.

Completing a higher level of education, such as a four-year Bachelor of Science in Nursing (BSN) or a two-year Master's Degree of Science in Nursing (MSN) may not be required, but these degrees will qualify you for more and better jobs. They will also position you for subsequent career advancement.

How long does it take to become a home care registered nurse?

To become an RN requires either a two-year associate's degree in nursing or a four-year bachelor's degree in nursing, which both qualify you to take the NCLEX-RN exam and earn your registered nursing certification.

Certification and licensing for home care nurses

What is the certification process for becoming a home care registered nurses?

Beyond completing the minimum education requirement to work as an RN—either the two-year associate's or four-year degree bachelor's—you must also earn licensure. All 50 states, DC, and US territories require RNs to be licensed; each state's requirements are different. All share a few qualifications in common, however:

• Your degree must come from an accredited nursing program
• You must pass the National Council Licensure Examination (NCLEX-RN).

Many states require a criminal background check as well, although this is not universally true (for the record, the six states that do not require background checks are: Colorado; Hawaii; Maine; New Hampshire; New York; and Wisconsin).

Additional certification is not required by law, but certifications are always worth considering. They confirm expertise and indicate to employers your commitment to the specialization of home care nursing. The American Nurses Credentialing Center (ANCC) previously offered a Home Health Nursing Certification (RN-BC), but this certification has been retired and is available only for renewal by current holders. You may want to consider certification in areas common to home health care practice, such as:

• The Ambulatory Care Nursing Certification (RN-BC) also offered by ANCC. This certification is for nurses who provide ambulatory nursing care (outpatient care) episodically in healthcare facilities, community settings, schools, workplaces, homes, and via telemedicine or telehealth visits.
• The Gerontological Nursing Certification (RN-BC), again offered by ANCC, confirms expertise in the care of the elderly, who constitute a significant portion of the home care population.

Should you become a home care registered nurse?

America's aging population is creating numerous opportunities in healthcare, including in the home care sector. It's a challenging sector, however, one that's complicated by:

• Advances in healthcare that are allowing people to live longer, with more severe conditions
• The sometimes prohibitive cost of home health care can be for many, especially elder patients living on fixed incomes
• The geographic dispersal of families, limiting family members' ability to contribute to home care

To succeed in this profession, you'll need not only the skills to provide quality care but also the ability to advocate for your services and profession and to communicate effectively with family members who may live halfway across the country.

If you're up to the challenge, the job outlook is promising. As a home care registered nurse, you'll specialize in connecting with people in their most comfortable, personal spaces. You will also create relationships with your patients that can have a real impact on their physical and emotional well-being. That level of compassion is its own brand of specialization—and you may find you're a better nurse for it.

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