A quick review of job postings for home healthcare jobs throughout the country reveals one commonality, with very few exceptions: requiring 1 year of nursing experience to qualify for the job. It's a commonly held belief that this experience needs to be in medical-surgical nursing. For decades, this "one year experience" requirement has made sense to us for many reasons-home healthcare is an independent practice setting, a new grad doesn't have the critical thinking skills necessary to function in home healthcare, we couldn't possibly afford to invest in extensive orientation programs for new grads, and so on.
It's time to reconsider our position on this issue. We need new nurses in home healthcare. We need their expertise, their energy, and their passion for the profession of nursing. It's time to figure out how to address the barriers to new graduate employment in home care agencies, and to ask the question: Is home care a viable career entry option for new BSN graduates? Before we delve into that topic, let's address the other elephant on the page-the required educational preparation level for registered nurses (RNs). Although that conversation is beyond the scope of this commentary, we acknowledge and understand that currently, RNs with all levels of educational preparation (bachelors' degree, associates' degree, and diploma) are welcome in home healthcare-as long as they have 1 year of experience. What if we changed that paradigm to say that new BSN graduates with no home care experience are welcome? What would have to happen in colleges of nursing and home healthcare agencies to make this commonplace instead of rare, as it is today?
One suggestion is to consider the current definition of "med-surg" experience. According to the American Association of Medical-Surgical Nurses (http://www.amsn.org), "medical-surgical nursing is the single largest nursing specialty in the United States. Registered nurses in this specialty practice primarily on hospital units and care for adult patients who are acutely ill with a wide variety of medical problems and diseases or are recovering from surgery." The site goes on to state that "the most distinguishing characteristic of med-surg nurses is that they are master coordinators." If you read this definition from the frame of reference of a home healthcare nurse, would you think-that describes me? I would suggest that, given the complexity of the patients receiving care at home, community-based nursing care is a viable option for gaining med-surg experience. The variety of clinical diagnoses, the need to coordinate and collaborate to help patients achieve positive outcomes, the interaction with family members, the importance of assessment and patient teaching-all of these descriptors apply to home healthcare nursing. Imagine if a future ICU nurse or nurse practitioner started his or her nursing career gaining this skill set!
New Graduate Perceptions of Home Healthcare
If you were to survey BSN nursing students in their final semester, you would find very few who state that their intended employment upon graduation is in a home healthcare agency. Instead, they most commonly state a preference for intensive care, labor and delivery, or emergency department. The reasons that home-based care does not appear on this list are unknown. It could be lack of exposure to this practice setting, lack of understanding of the role of the home healthcare nurse, a perception of home healthcare as a less desirable practice setting, or a desire to obtain initial nursing experience in a more highly controlled and/or acute care setting. It may be well-known among nursing students that RNs are required to have at least 1 year of "med-surg" experience before applying to work in home healthcare. In order for new graduates to even consider home healthcare nursing, all of these issues will need to be addressed.
Home Healthcare's Role
In determining whether home healthcare is a viable option for initial nursing employment, it will be important to examine the attractiveness of home healthcare as a practice area. Home healthcare agencies will need to work with nursing schools to establish clinical partnerships in BSN programs that expose future nurses to this setting and inspire them to make this choice. Agencies will also need to develop high-quality nurse residency programs for new graduates, and assure that employment opportunities exist postresidency. The home healthcare work environment needs to be desirable-including pay, benefits, work culture, and opportunity for advancement.
The Role of Nursing Programs
To create a pipeline of future nurses willing to enter into home healthcare after graduation, students will need to have exposure to home healthcare, both in the classroom and in the community. Nursing programs would need to include didactic content with synergies in "care of the older adult" courses, and would need to be open to providing clinical experiences in home healthcare agencies for their students. Even if colleges of nursing had a greater emphasis on home healthcare nursing in their BSN programs, it's unlikely that the new grad would be able to find a job in a home healthcare agency today. Although new graduate residency programs have become commonplace in acute care settings, they remain relatively rare in home healthcare agencies. There are some notable exceptions:
* VNA of Care New England in Rhode Island is currently accepting applications for its third cohort of nurse residents. This yearlong program progresses new graduates through from 100% supervision to independent practice with one full-time preceptor for six new grads. (http://www.vnacarenewengland.org/for-nurses/nursing-residency-program.cfm)
* Home healthcare agencies or companies primarily serving the pediatric population often offer a residency program for new graduates. Because of the special needs of the medically fragile infants and children that they serve, organizations like Bayada, PSA (Pediatric Services of America), and others have developed extensive training programs-some designed as residencies-for both experienced RNs and new graduates.
The Road Ahead
The road ahead may be a six-lane freeway. Future nurses have to be inspired by the idea of working in patient's homes, with a patient population made up mainly of older adults with multiple chronic conditions. The home healthcare industry will need to develop strong partnerships with colleges of nursing. The colleges will need to have champions within nursing programs who can influence curriculum development and clinical partnerships. Home healthcare agencies will need to embrace the idea of developing home healthcare nurses starting with their college experience, including providing high-quality clinical rotations for nursing students. Beyond graduation, home care agencies will need to invest in new grads throughout their first year of employment-offering residency programs and ongoing mentoring. If the return on this investment is a new cadre of home healthcare professionals who are committed to serving this population, to home healthcare as a practice setting, and to the organization that invested in them, it may be a road worth taking.