Registered nurses have many different work setting options. In some cases, their duties vary by work setting, as is the case with home health and acute care nursing. Both begin their careers in the same way and practice under the same license. Home health and acute care nurses must earn an associate degree, nursing diploma or bachelor’s degree and must pass the NCLEX-RN licensing exam. Certification is available in both specialties, but is optional for practice.

Working Alone

An acute care nurse is typically surrounded by other patients, nurses and health professionals in a hospital environment. However, a home health nurse works alone. Although she can contact a central office if necessary, she is solely responsible for a patient’s care and must make independent assessments. All nurses must communicate their findings to the physician managing the patient’s care, but the home health nurse literally acts as the doctor’s eyes and ears. Acute care nurses typically have direct contact with physicians at the patient’s bedside, while a home health nurse often has only phone contact.

The Daily Work

Acute care nurses may care for otherwise healthy patients who have had surgery or are injured, as well as those who have a serious illness or traumatic injury that requires hospitalization. Many home care patients are elderly, in poor health and have low incomes. In the case of acute care nursing, the patients are very ill and the nurse must use a variety of complicated equipment. The acute care nurse might manage only one or two patients due to the severity of their illnesses, while a home health nurse usually sees multiple patients each day and must often travel from one home to another. In some cases, however, a home health nurse will care for only one patient for a full shift.

Collaboration, Coordination and Goals

The goal of the acute care nurse is to help the patient get well enough to go home from the hospital, while the goal of the home health nurse is to keep the patient at home and prevent hospitalization or long-term care in an institution such as a nursing home. Both acute care nurses and home health nurses coordinate care provided by other health professionals. Many of the same services are available in both the hospital and the home, so both home health and acute care nurses might collaborate with respiratory therapists, occupational therapists, social workers and speech-language pathologists.

Other Differences

Home care nurses spend more time with paperwork and reimbursement issues than acute care nurses, according to “Patient Safety and Quality – An Evidence-Based Handbook for Nurses.” Patients who are hospitalized must be admitted by a physician, but in the home care setting, family members or caregivers can request services. In the home setting, patients have much more autonomy than in the hospital, where physicians, nurses and other medical professionals often make decisions they feel are in the patient’s best interest.

Making Your Choice

Nurses who work in home health must be able to work independently, with minimal support, and must be comfortable making decisions alone. They also have the opportunity to build long-term relationships with patients, while an acute care nurse might see a patient once in a lifetime. Acute care nurses are often the sort of people who thrive in a high-pressure environment and enjoy the challenge of working with sophisticated equipment on a daily basis. Both acute care and home health nurses might work shifts, weekends and holidays.