Key Responsibilities and Required Skills for House Nurse

🎯 Role Definition

A House Nurse (also called Home Health Nurse or Private Duty Nurse) provides comprehensive, in-home clinical care to patients across the lifespan, including adults, seniors, and pediatrics with complex medical needs. This role delivers skilled nursing assessments, medication and IV therapy, wound and ostomy care, respiratory support, and family education while working independently in patients’ homes, coordinating with physicians and interdisciplinary care teams. The ideal candidate is a licensed RN with strong clinical judgment, excellent documentation skills, experience with home care protocols and telehealth, and the ability to maintain patient safety and quality outcomes in non-hospital settings.

📈 Career Progression

Typical Career Path

Entry Point From:

Staff Registered Nurse (RN) in medical-surgical, telemetry, pediatrics, or ICU settings
Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) transitioning to RN or private duty roles
Home Health Aide or Certified Nursing Assistant (CNA) promoted into nursing roles with further licensure

Advancement To:

Home Health Clinical Manager / Supervisor
Nurse Case Manager or Care Coordinator
Clinical Educator / Staff Development Specialist for home health services
Private Duty Lead Nurse or Director of Community Nursing

Lateral Moves:

Hospice Nurse / Palliative Care Nurse
School Nurse or Community/Public Health Nurse
Travel Nurse with home health or outpatient assignments

Core Responsibilities

Primary Functions

Conduct thorough initial and ongoing in-home nursing assessments of patients’ physical, functional, cognitive and psychosocial status, documenting baseline and changes in condition to inform individualized home care plans.
Develop, implement and revise person-centered nursing care plans based on physician orders, evidence-based home health protocols and patient/family goals, ensuring plans address medication regimens, therapy needs and safety in the home environment.
Administer medications safely (oral, topical, injections), monitor for side effects and drug interactions, update MARs (Medication Administration Records) and collaborate with prescribers to reconcile and optimize pharmacotherapy.
Perform complex clinical skills in the home setting including peripheral and central line IV therapy, infusion setup and monitoring, blood draws, enteral feedings (NG/PEG), catheter care, ostomy care and protocol-driven wound management.
Provide skilled wound assessment and treatment including staging, debridement when indicated, advanced dressing selection, negative pressure wound therapy oversight and infection prevention strategies tailored for home environments.
Provide respiratory care including tracheostomy and ventilator management, suctioning, oxygen titration, nebulizer treatments and respiratory assessment for patients with COPD, neuromuscular disease or ventilator dependence.
Monitor and manage chronic disease conditions (e.g., CHF, COPD, diabetes, renal disease) through regular vitals, glucose monitoring, edema assessments, diuretic monitoring and patient education to reduce hospital readmissions.
Conduct falls risk assessments and implement individualized fall prevention strategies in the home, including environment modification recommendations, mobility aids and caregiver coaching.
Initiate and document skilled teaching sessions with patients and family caregivers on medication administration, wound care, catheter/ostomy management, symptom recognition and emergency plans to promote self-management.
Coordinate interdisciplinary care by communicating with physicians, home health aides, therapists, social workers and community resources to ensure integrated in-home services and timely follow-up of orders.
Triage acute changes in patient condition, provide immediate clinical intervention within scope, escalate to physicians or emergency services when necessary, and complete post-event documentation and care plan updates.
Complete accurate, timely and compliant documentation in electronic medical records (EMR) or agency charting systems, including OASIS or home care-specific outcome measures, to meet regulatory, billing and quality metrics.
Ensure regulatory compliance with Medicare/Medicaid home health requirements, municipal/state licensing, HIPAA confidentiality rules and agency policies while preparing for surveys and clinical audits.
Facilitate safe transitions of care by performing medication reconciliation, communicating discharge instructions and arranging home equipment, supplies and therapy services to minimize gaps after hospital or facility discharge.
Provide palliative care support and symptom management for home-based hospice or comfort-focused patients, including pain control, family support and coordination of end-of-life documentation and DNR orders.
Maintain infection control standards in the home by using universal precautions, sterile technique when required, safe disposal of clinical waste and caregiver instruction on hygiene and isolation precautions.
Deliver culturally responsive care, assessing language, beliefs and family dynamics to tailor education and build trust with patients from diverse backgrounds and socioeconomic contexts.
Use telehealth technologies and remote monitoring tools to conduct virtual visits, triage concerns, review vitals and maintain continuity of care when appropriate for patient safety and access.
Participate in quality improvement initiatives, tracking key performance indicators such as readmission rates, wound healing outcomes and patient satisfaction, and implementing corrective actions to improve home care outcomes.
Mentor and provide clinical oversight for junior nurses, CNAs and home health aides during visits, ensuring delegated tasks are completed safely and documenting supervision as required.
Manage supply inventories and home medical equipment checks, arranging for maintenance, replacements and durable medical equipment delivery to support clinical needs in the home.

Secondary Functions

Support care coordination by scheduling follow-up visits, arranging transportation or community services, and serving as a liaison between the family, primary care physician and specialty providers.
Participate in agency in-service training and competency validation sessions to maintain up-to-date clinical skills and certifications relevant to home health practice.
Assist with authorizations and documentation required for insurance billing and durable medical equipment (DME) approvals to ensure coverage for medically necessary in-home services.
Contribute to patient education materials and discharge packets that improve comprehension of home care instructions and disease self-management across literacy levels.
Collect and prepare clinical documentation for utilization review and payer audits, providing clinical justification for skilled nursing services delivered in the home.
Participate in case reviews and multidisciplinary care conferences to identify care gaps, escalate complex cases and recommend interventions that improve patient safety and outcomes.
Engage in community outreach or agency marketing activities that promote home health nursing services and educate referral sources on the scope and benefits of in-home skilled nursing.

Required Skills & Competencies

Hard Skills (Technical)

Active, unencumbered Registered Nurse (RN) license in the practicing state and knowledge of state home health regulations.
Proficiency in skilled nursing procedures: IV insertion/maintenance, infusion therapy, phlebotomy, and central line care.
Advanced wound care skills including assessment, staging, dressing selection, and experience with NPWT (negative pressure wound therapy).
Tracheostomy, ventilator and respiratory support competence including suctioning and oxygen therapy management.
Enteral/feeding tube (NG/PEG) management, including bolus/continuous feeds, tube care and troubleshooting.
Strong medication administration skills, familiarity with controlled substances handling, medication reconciliation and MAR management.
Experience with home health EMRs, electronic documentation best practices, OASIS assessment tools and telehealth platforms.
Competency in infection control and sterile technique applicable to in-home settings.
Ability to perform comprehensive patient assessments, vital signs interpretation and use of point-of-care testing (glucose, INR, pulse oximetry).
Understanding of Medicare/Medicaid home health benefit documentation, billing requirements and clinical justifications for skilled services.
Basic life support (BLS) required; ACLS and PALS preferred depending on patient population served.

Soft Skills

Exceptional communication skills for patient/family teaching, interdisciplinary collaboration and clear clinical handoffs.
Strong clinical judgment and critical thinking to assess risk, prioritize care and make timely decisions in independent home settings.
Empathy, patience and culturally competent bedside manner to support patients and families through chronic illness and end-of-life care.
Self-motivation, reliability and ability to plan and manage a varied caseload with strong time management and organizational skills.
Problem-solving skills to adapt clinical plans to unique home environments and resource constraints.
Conflict resolution and boundary-setting skills when navigating family dynamics and caregiver interactions.
Flexibility and adaptability to work across diverse home settings, schedules and occasional on-call or weekend coverage.
Attention to detail and commitment to documentation accuracy for compliance, billing and clinical continuity.
Teaching and coaching ability to empower caregivers with practical, safe home care skills and emergency response strategies.
Teamwork and collaboration skills to work effectively with therapists, social workers, physicians and home care aides.

Education & Experience

Educational Background

Minimum Education:

Associate Degree in Nursing (ADN) or diploma in nursing with active RN licensure.

Preferred Education:

Bachelor of Science in Nursing (BSN) preferred for complex care coordination, leadership and quality improvement roles.
Certifications in home health, wound care (WCC), IV therapy, ACLS/PALS as appropriate to patient population.

Relevant Fields of Study:

Nursing (ADN/BSN)
Community Health or Public Health Nursing
Gerontology and Chronic Disease Management
Pediatric Nursing (for pediatric home nurse roles)
Clinical Education or Healthcare Administration (preferred for supervisory roles)

Experience Requirements

Typical Experience Range:

1–5 years of direct nursing experience; many employers prefer 2+ years in acute care, ICU, pediatrics or prior home health/private duty nursing.

Preferred:

2+ years of home health, hospice, pediatric home care, or specialty nursing experience (ventilator-dependent, trach, complex wound care, infusion therapy).
Demonstrated experience with EMR charting, OASIS or equivalent home health assessment tools, and familiarity with payer documentation requirements.
Previous private duty or case management experience and proven ability to work autonomously in patient homes.