What are the responsibilities and duties of a home health registered nurse (HHRN)?

Responsibilities and Duties of a Home Health Registered Nurse

Home health registered nurses function as autonomous generalist clinicians who provide skilled nursing care across a wide range of medical diagnoses within the patient's home environment, integrating clinical interventions with the complex interactions between physiologic, family, and environmental needs. 1

Core Clinical Responsibilities

Initial Assessment and Evaluation

• Conduct comprehensive home health assessments including relevant medical history, examination of body systems, and evaluation of the patient's management of and response to medications and treatments 1
• Perform pulse oximetry at rest and with activities of daily living (ADLs), instrumental ADLs (IADLs), walking, or exercise 1
• Evaluate challenges to disease management presented by the living environment, the impact of disease on day-to-day living, and the degree to which institutional teaching has been transferred to the home setting 1
• Assess functional status, potential safety problems, ability to access emergency help, psychosocial and learning needs, patient/family coping resources, and end-of-life issues 1

Direct Patient Care Functions

• Provide skilled nursing care for patients with active comorbid conditions and high risk of developing complications, particularly those requiring close supervision and frequent cardiopulmonary assessment 1
• Observe and evaluate inhaled medication technique, airway clearance maneuvers, and management of home respiratory equipment 1
• Monitor medication management, especially for patients on new or multiple medications 2
• Perform psychiatric medication monitoring and education, assess mental status and medication side effects for patients with psychiatric conditions 3, 4

Care Coordination and Communication

Interdisciplinary Team Collaboration

• Serve as the primary link to physicians (including specialists such as pulmonologists) when patients receive home health care 1
• Function as care coordinator for patients with multiple comorbid conditions and for patients who receive services in addition to those provided by the home health agency 1
• Communicate regularly with physicians regarding treatment plan changes, patient condition updates, and continuing need for services 1
• Coordinate with home medical equipment companies, respiratory therapists, and other healthcare providers 1

Family and Caregiver Engagement

• Work respectfully and collaboratively with families, allowing parents or family members to direct care while providing safe, competent, skillful support 1
• Provide education and training to increase the ability of family members and respite care providers to deliver quality care 1
• Educate families about available resources and help secure these resources through advocacy 1

Essential Practice Competencies

Clinical Knowledge and Technical Skills

• Maintain hands-on technical skills and understand how physical processes of illness and associated complications relate to the patient 1
• Possess background in principles of teaching/learning for patient/family and knowledge of nutrition teaching 1
• Formulate nursing diagnoses and measurable goals for patient care 1

Independent Practice Capabilities

• Function independently in the home environment without immediate physician or colleague support 1
• Deal with problems in priority order and make clinical decisions autonomously 1
• Provide clear direction to patients during visits and deal in realistic and practical ways with situations confronting patients 1

Communication and Interpersonal Skills

• Demonstrate good interpersonal communication skills with patients, families, staff, colleagues, and physicians 1
• Use referrals to other agency services and community resources to meet patient needs when appropriate 1
• Recognize and address family concerns related to the patient's health problems 1

Patient and Family Education

Teaching Responsibilities

• Plan and implement activities based on treatment goals for the patient 1
• Encourage patient and family independence through education and skill-building 1
• Provide education on medication adherence, symptom recognition, and disease management 3, 4
• Teach patients and families use and care of medical equipment, monitoring safe operation 1

Holistic Care Approach

• View patient as part of a family and community, not in isolation 1
• Give time to both psychosocial and physical care during visits 1
• Demonstrate empathy for patients while maintaining professional boundaries 1
• Avoid forcing personal values on patients and families 1

Documentation and Regulatory Compliance

Medicare Requirements

• Document that patients are homebound and require intermittent skilled nursing care as mandated by Medicare regulations 2
• Certify medical necessity for services, including specific ADL and IADL impairments using standardized assessment tools 2
• Document qualifying conditions such as multiple comorbidities, unstable medical status, functional limitations, or history of emergency room visits 2

Clinical Documentation

• Document continuing need for equipment and patient response to therapy 1
• Communicate relevant patient information to prescribing physicians and troubleshoot complications 1
• Record specific barriers to homebound status and environmental modifications needed 2

Specialized Functions

Medication Management

• Enhance medication safety and ensure timely interventions for better symptom control and healthcare outcomes 5
• Provide medication reconciliation and monitoring for older adults managing chronic conditions at home 5
• Support medication management to ease the home care burden on families 5

Quality Improvement and Safety

• Participate in quality improvement leadership activities 6
• Monitor and prevent complications related to medical equipment, therapies, and disease processes 1
• Assess home environment for safety hazards and recommend modifications 2

Critical Practice Considerations

Common pitfalls to avoid:

• Never order home health aide services alone without concurrent skilled nursing justification, as Medicare will deny coverage 2, 3, 4
• Use specific, standardized language when documenting patient needs rather than vague terms like "needs assistance" 2, 3
• Do not delay documentation of equipment needs, as early adaptive equipment provision prevents complications 2
• Maintain professional boundaries while respecting the family unit and recognizing parents or caregivers as primary decision-makers 1

The home health registered nurse must balance clinical expertise with adaptability to diverse home environments, demonstrating autonomy in decision-making while maintaining collaborative relationships with the interdisciplinary team and family caregivers. 7