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Ten tips for transitioning from home care nurse to nurse manager


Sarah made the transition from inpatient hospital nurse to home care (HC) nurse 6 years ago. She enjoys her practice and likes helping the patients and families whose cases she manages. Her performance evaluations have been very good.

When her HC organization posts a job opening for nurse manager, Sarah considers applying for it—but wonders to what extent her nursing skills and knowledge would transfer to the manager position.

When I first became a HC nurse manager, no one taught me what I needed (or thought I needed) to know. Based on my conversations with peers, this pattern holds true for many HC nurses who’ve transitioned to a manager position. The tips below can help HC nurses recognize and leverage the knowledge and skills they already have to become effective managers.

1. Flexibility

Effective HC nurses are multitaskers whose days often are scheduled and rescheduled based on patient, family, or organizational needs. With priorities changing frequently, flexibility is an important asset for any manager.

2. Critical thinking skills

To help patients meet agreed-upon goals, HC nurses must be able to think critically and to use their skills and perform tasks within defined time frames. This same level of energy and commitment can help them transition to the manager role, where the organization needs their enthusiasm and critical thinking skills to solve problems.

3. Technological proficiency

HC nurses need to be proficient with technology to effectively support patient-care planning, scheduling, and other operational requirements. Most HC organizations have a computer or documentation system that nurses take to the patient’s home and use to interview patients and document findings and care provided. The best systems are point-of-care and mobile; the technological skills required to use them are directly transferable for HC nurses making the change to manager.

4. In-depth understanding of the nursing process

All nurses are familiar with the steps of the nursing process—assessment, planning, implementing, and evaluation—used to provide patient care. The nursing process also is invaluable for solving problems that mangers face, including organizational ones.

5. Public health knowledge

HC nurses focus on public health—for instance, asking patients about immunizations and other wellness issues—as well as safety, outreach, education, and disease and chronic care management. Their broad-based view of health care transfers well to the manager position. Also, due to the complex regulatory environment of HC and HC nursing, nurses are accustomed to cost accounting for care and services, such as patient visits. Documentation and compliance play a large role in HC nurses’ practice. Such skills and knowledge are extremely useful for managers.

6. Effective communication and coordination skills

We continue to learn more about how effective communication can promote patient safety—and how ineffective communication can jeopardize it. HC nurses are used to communicating and coordinating with the interprofessional team, including nurse colleagues, aides, therapists, physicians, and others who may be involved in a patient’s care (such as teachers going to the patient’s home). These skills are crucial for a smooth transition to the manager role.

7. Knowledge of quality improvement

In HC, certain areas of care are identified, analyzed, and tracked or trended for improvement. Examples include infections and infection-control activities, complaints, and patient experience surveys. HC nurses who become managers can apply their knowledge of data measurement and management at a higher level.

8. Nonjudgmental attitude

The ability to be open, nonjudgmental, and sensitive to cultural, lifestyle, and other differences is crucial when caring for patients of diverse cultures in their homes. HC nurses provide care for many different types of patients and families, with many different lifestyles. This experience helps nurses in a management position to interview, build, and lead their team.
I’ve found most HC nurses can talk to nearly anyone about anything. It takes a special person to be able to walk into someone’s home as a stranger and comfortably interact on the patient’s turf immediately, assessing and providing care on that first visit. Humor, flexibility, and excellent nursing skills all come to the forefront during home visits. The HC nurse who becomes a manager transfers these interpersonal skills and applies them to such situations as meeting new peer managers, interviewing prospective new team members, and more.

9. Ability to work with team members remotely

In HC, most of your team members aren’t down the hall. They may be two or three counties away, or even across a state line. Managers must communicate and coordinate with team members who work at a distance and whom they may see only at certain times of the day or week. They must be able to screen, orient, and provide leadership, direction, and feedback for team members—often remotely.

10. Understanding that you can’t know it all—and being OK with that

To perform their jobs effectively, HC nurses need to learn continually. They must stay abreast of new products and technology, such as when a patient is discharged home from a tertiary hospital with a high-tech medical device they’ve never seen before. They must learn the new technology and become competent in using it.

When you transition to the nurse manager role, you go through a similar process, starting with a new set of skills and new terms to master. You must continue to ask questions and learn.
To help you grow into your new role, you’ll need to identify both vertical and horizontal mentors. I recommend that you read management books and anything else you can about healthcare models, innovation, and change. Realize there’s always more to know.

Model yourself after a leader you admire. When stressed, ask yourself: What would this person do? Elicit feedback from your mentors and, when possible, meet with a small group of new nurse leaders whom you can learn from and with.

New role, new responsibilities

As a nurse manager, you’ll have a new purview and a new level of responsibility. Expect team members to bring questions and problems to you; encourage them to come up with solutions and answers on their own. Identify staff who are innovative and helpful. Keep in mind that you need to develop the next nurse leaders in your organization.

Whenever possible, smile and be open. If needed, work on improving your likeability. Leaders don’t have to be stern or authoritative at all times. When it comes to the regulatory and compliance aspects of HC, there’s no room for flexibility. But to promote team building and nurture team members’ respect and trust, just be yourself.

By working with organizational leadership, possessing a clear definition of your role and responsibilities, and continually working on your management skills, you’ll be well on your way toward becoming an effective HC manager. Embrace this new opportunity to lead, inspire, influence, and spark enthusiasm in your team.

If you’re a new nurse manager in HC and have a question, please email me at news@marrelli.com. I’m eager to hear what you brought from your practice as a HC nurse that helped in your transition to becoming an effective manager.

Tina M. Marrelli is president of Marrelli and Associates, a healthcare consulting and publishing firm in Venice, Florida. She is also on the editorial advisory board of American Nurse Today. You can reach her at news@marrelli.com.

Selected references

Allen NE. Survivor! 10 Practical Steps to Survey Survival. 4th ed. Jacksonville, FL: Solutions for Care, Inc.; 2014.

Marrelli T. Handbook of Home Health Standards: Quality, Documentation, and Reimbursement. 5th ed. St. Louis, MO: Mosby; 2012.

Marrelli T. The Nurse Manager’s Survival Guide: Practical Answers to Everyday Problems. 3rd ed. St. Louis, MO: Mosby: 2004.

1 Comment. Leave new

  • You make great points in your article. Especially the one about needing to work well with your team remotely – communication is key. Thanks for sharing.


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