Each year, it’s our privilege to recognize a fraction of the thousands of nurses working in the area every day to make  patients’ lives healthier, safer, and happier. Without their skill and expertise, where would we be?

It is often said that nurses are “unsung heroes.” In this year’s feature story, we hear from nurses who are particularly unheralded, as they work outside the bright lights and camaraderie of hospital and community care settings—home health nurses.

In “Healing at Home,” writer Christina Breda Antoniades explores life for nurses who take care of patients who have been released to home but are not quite able to manage on their own. It’s a field that is only going to expand as the population ages, chronic conditions worsen, and more people require care outside the hospital.

Choosing these 158 nurses from the more than 600 nominations we received during our online submission period was a Herculean task undertaken by our panel of registered-nurse advisers, who gave their time and expertise to the selection process. Without their counsel, this list would not exist and we’re grateful for their time and insight.

DR. AMY ALSANTE
DNP, RN, NE-BC, CHEP, LSSGB
is the Chief Nursing Officer at Sunburst Workforce Advisors, with more than a decade of progressive leadership in acute and ambulatory care. Alsante holds a BSN from Towson University, an MS from the University of Maryland, Baltimore, and a Doctorate in Executive Leadership from The George Washington University. She is passionate about cultivating cultures where exemplary professional practice can flourish, mentoring emerging nurse leaders, and creating innovative, fiscally sustainable care and staffing models.

LINDA K. COOK
PHD
is an assistant professor of nursing at the University of Maryland School of Nursing, where she teaches across all levels of nursing education. She has been a registered nurse for 48 years and is passionate about nursing. Her primary clinical background is critical-care nursing.

JULIA IRWIN
is has been a nurse for 17 years, all at Mercy Medical Center on the Inpatient Oncology Unit. The oncology population has a special place in her heart and she enjoys providing patients and their families excellent, compassionate care. She was on the Clinical Ladder, completing projects on medication reconciliation and group peer review. For the last seven years, she’s been the Clinical Nurse Manager and has enjoyed growing and supporting her staff. She’s a member of ONS and ANA.

JESSICA DECKER
RN, BSN, CPN
is the manager of the Pakula Infant Specialty Care Unit at Mt. Washington Pediatric Hospital. She is also a member of the Mt. Washington Pediatric Hospital Vizient Nurse Residency Advisory Board.

CARLENE MELLO
is the nurse manager of a medical/surgery telemetry unit at GBMC. She earned her bachelor’s and master’s degrees through the University of Phoenix and was a 2016 recipient of Baltimore’s Excellence in Nursing award.

DORHONJA NICHOLS
DNP, RN, NEA-BC
is the director of nursing for critical care and behavioral health services at the University of Maryland St. Joseph’s Medical Center. She is also a 2023 American Hospital Association Next Generation Leaders fellow and University of Maryland St. Joseph Medical Center Lean for Leaders graduate.

SARAH PORTER
is a director of nursing programs at The Johns Hopkins Hospital, where she is responsible for assisting the vice president of nursing with coordination of executive priorities and implementation of operational and strategic objectives.

KAYLENE ROSS
works part-time in perioperative education at MedStar Harbor Hospital, ensuring high-quality, safe patient care to surgical patients. Her more than 45 years of nursing experience includes open-heart surgery, pediatrics, labor and delivery, education, general and orthopedic surgery, ICU, and nursing leadership.

ACUTE CARE/FAMILY PRACTICE/GENERAL MEDICINE
Kayla Taylor
RN, Gilchrist Integrative Medicine at GBMC

ACUTE REHABILITATION
Lisa Leyrer
Nursing Director MedStar Good Samaritan Hospital

AESTHETICS
Kara Bagranoff
Aesthetic Registered Nurse Belcara Health

Amanda Pittillo
PA-C, ProMD Health Bel Air

CARDIOVASCULAR
Kim Caldwell
Charge Nurse MedStar Union Memorial Hospital

Kathleen “Kate” Jacober
Clinical Nurse MedStar Union Memorial Hospital

Kristen Reynolds
Nurse Case Manager UM St. Joseph Medical Center

Norma Velasco-Flores
Nurse Practitioner/Advance Practice Provider Heart Failure Clinic UM St. Joseph Medical Center

CASE MANAGEMENT
JoAnn Parr
Senior Director of Care Management, Utilization Review, and Care Transitions Greater Baltimore Medical Center

Jacqueline “Jacqui” Wienecke
Director of Case Management MedStar Franklin Square Medical Center

CHILD ABUSE & NEGLECT 
Lily Grybauskas
Nurse Practitioner LifeBridge Health, Center for Hope

COMMUNITY CARE/AMBULATORY CARE
Ashley Clark
Nurse Navigator LifeBridge Health, Carroll Hospital

Carrie Mone
Registered Nurse University of Maryland Medical System

Priya Nair
Nurse Manager University of Maryland Medical Center

Eileen Simione
Registered Nurse Johns Hopkins Community Physicians

COMPREHENSIVE STROKE
Lindsay Goff
Stroke Coordinator BSN,RN,NRP UM Upper Chesapeake Health

Ariel Woodward
Stroke Program Coordinator MedStar Franklin Square Medical Center

EDUCATOR
Jane Balkam
Professor of Nursing Notre Dame of Maryland University

Catherine Case
Clinical Affiliations Coordinator and Nurse Educator LifeBridge Health, Sinai Hospital

Carolyn Cash
Clinical Practice & Development Coordinator University of Maryland
Medical Center

Rodnita Davis
Post-Baccalaureate Registered Nurse Residency (PB-RNR) Program Manager, Program Manager, Nursing Affiliations, Coordinator, Pathway to Excellence Baltimore Veterans Affairs of Maryland Healthcare System

Maria Julienne Diloy
Nursing Practice and Professional Development Specialist The Johns Hopkins Health System

Jennifer Dinoto
Professional Development Specialist MedStar Franklin Square Medical Center

Julie Ellis
Education Specialist Johns Hopkins Care at Home

Sarit Fleishman
Clinical Practice and Education Specialist University of Maryland Medical Center

Jessica Johnson
Professional Development Specialist MedStar Franklin Square Medical Center

Kasey Mundell
Clinical Nurse II & Clinical Instructor University of Maryland R Adams Cowley Shock Trauma Center

Sarah Steward
Supervisor – Clinical Excellence LifeBridge Health, Sinai Hospital

BENJAMIN TIMSUREN
INTERVENTIONAL PULMONOLOGY
UNIVERSITY OF MARYLAND MEDICAL CENTER

“The absolute best part of nursing is the daily opportunity I get to help someone feel better, improve their symptoms, or facilitate their treatment and recovery. I really value being able to pair the education and technical knowledge I’ve learned as a nurse with my personality and feel like I’m being my best self.”

EMERGENCY DEPARTMENT
Lydia Bonvillain
RN, Forensic Nurse Examiner Greater Baltimore Medical Center

Sara Burchill
Nurse Manager LifeBridge Health, Sinai Hospital

Donna Criss
Staff nurse LifeBridge Health, Carroll Hospital

Pattie Diegert
Senior Director, Nursing UM Upper Chesapeake Health

Corinne Ebert
RN LifeBridge Health, Carroll Hospital

Ajitha Mattathil
Lead Clinical Nurse Johns Hopkins Howard County Medical Center

Ami Miles
ED Nurse Manager UM St. Joseph Medical Center

Alma Ta-asan
RN IV LifeBridge Health, Sinai Hospital

Kristi Twigg
Director of Nursing MedStar Harbor Hospital

JOHN JOSEPH FACUNDO
INTENSIVE CARE
LIFEBRIDGE HEALTH, SINAI HOSPITAL

“Throughout the years, I have held many fearful hands, been someone’s voice, witnessed families grieve. My patients might forget my name, and that’s okay, but not the way I made them feel. That’s how I know I’m doing it right.”

ENDOCRINOLOGY
Amy Wenz
Senior Nurse Practitioner The Johns Hopkins University School of Medicine

GERENTOLOGY
Maurine Gabriels
Registered Nurse LifeBridge Health, Levindale

HOSPICE/HOME HEALTH/PALLIATIVE CARE
Barbara Bell
Registered Nurse CMAG Health Solutions, LLC

Eyerusalem Hagos
NP Greater Baltimore Medical Center

Darleen Sullivan
Hospice Clinical Manager Gilchrist Integrative Medicine at GBMC

INFORMATICS
Connie Gibbons
Senior Clinical Systems Analyst LifeBridge Health

Ashley Shelter
Clinical Nursing Informatics Specialist MedStar Union Memorial Hospital

INTENSIVE CARE
Jennifer Delaney
Registered Nurse Ascension Saint Agnes Hospital

John Joseph Facundo
Charge Nurse, RN III, PCCN-CMC LifeBridge Health, Sinai Hospital

Amie Hyle
RN UM St. Joseph Medical Center

Melissa LaRue
Critical Care Registered Nurse Ascension Saint Agnes Hospital

Everette Livado
Registered Nurse LifeBridge Health, Sinai Hospital

Kayla Mandrykin
Registered Nurse LifeBridge Health, Sinai Hospital

Margaret McGregor
Charge Nurse LifeBridge Health, Northwest Hospital

Larisa Pokras
RN LifeBridge Health, Sinai Hospital

Amanda Zambrano
Senior Clinical Nurse II University of Maryland Medical Center

INTERMEDIATE CARE
Fely Carillo
Clinical Nurse MedStar Good Samaritan Hospital

INTERVENTIONAL PULMONOLOGY
Ben Timsuren
Senior Clinical Nurse I University of Maryland Medical Center

INTERVENTIONAL RADIOLOGY
Jessica Dunn
Inpatient Nurse Navigator Interventional Radiology Greater Baltimore Medical Center

Holly Thorn
Interventional Outpatient Nurse Navigator Greater Baltimore Medical Center

LONG TERM CARE/POST-ACUTE
Lisa McKoy
Certified Nurse Educator LifeBridge Health, Levindale

MAGNET CORDINATOR
Abby Brzezenski
Magnet Coordinator MedStar Good Samaritan Hospital

MANAGEMENT/NURSE EXECUTIVES
Ashley Bandurchin
Assistant Director Professional Practice, Education, & Research Greater Baltimore Medical Center

Kristen George
Nurse Manager University of Maryland R  Adams Cowley Shock Trauma Center

Andrea L’Heureux
RN, BSN LifeBridge Health, Sinai Hospital

Cathy Mays
Chief Nurse Officer CMAG Health Solutions LLC

Glynda Murphy
Nurse Manager LifeBridge Health, Northwest Hospital

Sharon Owens
Executive Director of Nursing for Surgery The Johns Hopkins Hospital

Cindy Roles
Assistant Vice President of Nursing Operations MedStar Franklin Square Medical Center

Kristen Sudano
Nurse Manager UM St. Joseph Medical Center

Leslie Taylor
Manager and Provider LifeBridge Health

GAIL ZEPHYR
MEDICAL-SURGICAL NURSING
MEDSTAR FRANKLIN SQUARE MEDICAL CENTER

“Nursing is synonymous with being empathetic, compassionate, caring, and being in service to others…I’ve learned to be grateful that I was able to care for patients and their families, to be gracious that on my next shift I would care for the same patient once they remained hospitalized, and grateful that they went home to continue their recovery.”

MEDICAL-SURGICAL NURSING
Sibley Barnes
Clinical Nurse IV MedStar Franklin Square Medical Center

Nancy Bloom
RN LifeBridge Health, Carroll Hospital

Louela Cari-an
Registered Nurse II LifeBridge Health, Sinai Hospital

David Hiett
Clinical Nurse MedStar Union Memorial Hospital

Melanie Hullana
Registered Nurse LifeBridge Health, Sinai Hospital

Leah Lewis-Garber
Nursing Outcomes Leader LifeBridge Health, Sinai Hospital

Hyeyon Kwon
Registered Nurse Baltimore Veterans Affairs of Maryland Healthcare System

Morgan Lutz
Charge Nurse LifeBridge Health, Northwest Hospital

Katie Pasqualini
Registered Nurse IV Greater Baltimore Medical Center

Karen Ponlaroche
Charge Nurse LifeBridge Health, Northwest Hospital

Gherell Regalado
Staff Nurse LifeBridge Health, Sinai Hospital

Sharon Romero
RN III Johns Hopkins Howard County Medical Center

Alyssa Wilkerson-Dietz
Clinical Nurse II UM St. Joseph Medical Center

Duncan Zeller
Clinical Nurse II University of Maryland Medical Center

Gail Zephyr
Director of Nursing MedStar Franklin Square Medical Center

JODI FELIPE
WELLNESS NURSE
BRIGHTVIEW SENIOR LIVING ANNAPOLIS

“I’m a caregiver. I do whatever my residents need done and always smile, be kind. I believe the residents’ appearance and mood are a direct reflection of the care I’ve provided.”

MEMORY CARE/ASSISTED LIVING/GERIATRICS
Jodi Felipe
Wellness Nurse Brightview Senior Living Annapolis

NEUROLOGY/PSYCHOLOGY/BEHAVIORAL HEALTH
Edwin Juma
NP University of Maryland Medical Center

OCCUPATIONAL HEALTH
Christie Simon-Waterman
Nurse Practitioner The Johns Hopkins Hospital

ONCOLOGY
Kristie Davalli
Nurse Practioner LifeBridge Health, Sinai Hospital

Angela Galoppo
RN III The Johns Hopkins Hospital

Carol LaMere
Quality and Safety Nurse Ascension Saint Agnes Hospital Cancer Institute

Emily Little
Senior Clinical Nurse The Johns Hopkins University School of Medicine

Matthew Magness
Registered Nurse UM Upper Chesapeake Health

Kimberly Mildner
RN Ascension Saint Agnes Cancer Institute

Kathy Mooney
Clinical Program Director Cellular Therapy The Johns Hopkins Hospital

Neelam Saini
RN I LifeBridge Health, Sinai Hospital

Kirsten Tomaschefsky
Assistant Nurse Manager/Interim Nurse Manager University of Maryland Medical Center

OPERATING ROOM
Jake Allam
BSN, RN Mercy Medical Center

Jeanne Delaney
RN, Assistant Nurse Manager University of Maryland Medical Center

Mac Gary Garcia
Senior Clinical Nurse I University of Maryland Medical Center

Nancy Gonzales
Clinical Nurse II MedStar Harbor Hospital

Donna McCormack
Clinical Nurse MedStar Union Memorial Hospital

Marshelle Morlock
BSN, RN Mercy Institute for Foot and Ankle Reconstruction

Sarah Prock
OR RN II Greater Baltimore Medical Center

Clare Zimmerman
RIAO RN Team Leader LifeBridge Health, Sinai Hospital

Holly Watson
Clinical Nurse MedStar Union Memorial Hospital

ORTHOPEDICS
Rachel Nazareno
Registered Nurse LifeBridge Health, Sinai Hospital

Bianca Tilkens
Clinical Unit Coordinator Ascension Saint Agnes

Sara Trone
Staff Nurse LifeBridge Health, Sinai Hospital

PEDIATRIC CARDIOLOGY ICU
Candace Spock
RN II The Johns Hopkins Hospital

PEDIATRICS
Vicki Lowe
Lactation Specialist Johns Hopkins Howard County Medical Center

Thomas Shelley
Ambulatory Nurse Manager LifeBridge Health, Sinai Hospital

PEDIATRICS EMERGENCY
Jenna Spencer
Clinical Nurse Specialist The Johns Hopkins Hospital

PEDIATRICS: NEONATAL
Dorothy Jones
Clinical Nurse II MedStar Harbor Hospital

Angel Masemore
Clinical Practice Manager MedStar Harbor Hospital

Lindsay Sneller
Senior Clinical Nurse I University of Maryland Medical Center

PEDIATRICS: NON-NEONATAL
Samantha Amedore
RN Mt. Washington Pediatric Hospital

Kim Bilott
RN LifeBridge Health, Sinai Hospital

Tina Humbel
Nurse Manager University of Maryland Children’s Hospital

Jennifer Knox
Clinical Nurse II University of Maryland Children’s Hospital

Amanda Morris
Nursing Professional Development Specialist Mt. Washington Pediatric Hospital

Hannah Riffey
Clinical Nurse IV – Inpatient Kennedy Krieger Institute

Emily Steer
CNII University of Maryland Children’s Hospital

Daisy Valladeres
CNII University of Maryland Children’s Hospital

PERIOPERATIVE SERVICES
Sara-Ann Ballard
BSN, RN, FNE-A, CAPA Mercy Medical Center

Annajeane Chua
RN LifeBridge Health, Sinai Hospital

Angela England
Assistant Nurse Manager LifeBridge Health, Sinai Hospital

Patty Guthrie
RN III The Johns Hopkins Hospital

Everlyne Onyango
RN LifeBridge Health, Sinai Hospital

Lisa Wisniewski
RN LifeBridge Health, Sinai Hospital

PSYCHIATRY
Janice Binns-Hines
RN I LifeBridge Health, Sinai Hospital

Tracey Burdock
Clinical Nurse II MedStar Harbor Hospital

Jamie Cherry
Psychiatric Nurse Coordinator – Outpatient Kennedy Krieger Institute

Andrew Fausto
Nurse Coordinator University of Maryland Medical Center

Davinder Varde
Registered Nurse LifeBridge Health, Carroll Hospital

Tina Vest
Nurse Practitioner The Johns Hopkins University School of Medicine

RADIOLOGY
Caitlin Kwedar-Wamba
Interventional Radiology RN III
Greater Baltimore Medical Center

CAROL LAMERE
ONCOLOGY
ASCENSION SAINT AGNES HOSPITAL CANCER INSTITUTE

“We’re always told: Don’t get too attached. Don’t care too much, because you have to be objective. But it doesn’t matter. You do care too much. And if you didn’t care too much, you wouldn’t be a nurse, you’d be something else.”

REHABILITATION
Jessica Leeper
Clinical Nurse MedStar Good Samaritan Hospital

STROKE COORDINATOR
Lindsay Goff
Stroke Coordinator BSN,RN,NRP UM Upper Chesapeake Health

SUPPLY CHAIN
Stacy Fisher Hill
Value Analysis Coordinator LifeBridge Health

SURGERY
Valerie Elliott
Lead Nurse Practitoner The Johns Hopkins Hospital

Tikiki Linston
RN III The Johns Hopkins Hospital

Cindy Walker
Wound Care Specialist Johns Hopkins Bayview Medical Center

SURGERY/MANAGEMENT/NURSE EXECUTIVE
Heather Cullen
Assistant Nurse Manager The Johns Hopkins Hospital

Kim Damon-Gant
Assistant Patient Care Manager Johns Hopkins Bayview Medical Center

Rose Karlan
Nurse Manager The Johns Hopkins Hospital

SURGICAL INTENSIVE CARE
Symone Everrett-Day
Clinical Nurse Specialist The Johns Hopkins Hospital

Madison Goundry
Lead Clinical Nurse The Johns Hopkins Hospital

Shannon Trainor
Lead Clinical Nurse The Johns Hopkins Hospital

TRAUMA
Farah Wittmeyer
Clinical Nurse II University of Maryland R Adams Cowley Shock Trauma Center

TRAUMA/SURGERY
Christina Interrante
Trauma Prevention Coordinator The Johns Hopkins Hospital

WOMEN’S HEALTH: GENERAL
Alexius Hall
Director of Nursing MedStar Franklin Square Medical Center

Ashley McAree
Forensic Nurse/ Human Trafficking Liaison Greater Baltimore Medical Center

Leah Ruppe
Director of the Perinatal HIV Practice University of Maryland Medical Center

WOMEN’S HEALTH: LABOR AND DELIVERY
Michelle Hayes
Clinical Nurse II MedStar Harbor Hospital

Heather Johnson
RN LifeBridge Health, Sinai Hospital

Florence Okeke
Clinical Nurse II MedStar Harbor Hospital

Heidi Ransford
Clinical Nurse II MedStar Harbor Hospital

Summer Twist
RN LifeBridge Health, Sinai Hospital

WOUND, OSTOMY, CONTINENCE CARE
Christina Encarnacion
Wound Care Nurse MedStar Franklin Square Medical Center

Sindhu Koneru
Wound Care Nurse MedStar Union Memorial Hospital

Walking into her first home health care visit 10 years ago, registered nurse Keli Gallagher didn’t know exactly what the next hour or  two would hold. Would her patient be doing well in his transition from hospital to home? Open to working with a stranger to move
toward better health and independence? Or struggling with his new reality?

Whatever the case, Gallagher knew that to really succeed—to ensure a patient recovering from a serious health crisis could heal and even thrive outside of a hospital setting—she’d need to provide more than medical care.

“Your first goal is to build that bond of trust,” says Gallagher, who provides services in Baltimore City and County for Bayada Home Health Care. “Then you get them to understand why you are in their home and what they can do themselves. Once you get that to happen, it’s amazing how much better people feel.”

Like many people released from the hospital to recover at home, Gallagher’s first patient was nervous. An avid baseball and football fan, the elderly man had suffered a serious exacerbation of his chronic illnesses and, though he was home, his challenges were far from over.

“He was overwhelmed and anxious about everything he had on his plate,” Gallagher recalls. After assessing him and ensuring he was safe, Gallagher got to work providing nursing care, plus a healthy dose of education and assurance. “I taught him and his wife how to manage his wounds and explained the chronic disease processes,” recalls Gallagher.

Over the next few weeks, Gallagher would return to the home regularly to provide care, assess her patient’s progress, offer encouragement, and connect the couple to community resources.

“The goal is to allow the patient to be confident and independent and then we just back off and supervise for a while,” she says.

Home health nurses like Gallagher are increasingly in demand due to an aging population, a rise in the prevalence of chronic conditions, shorter hospital stays, and a strong desire by many patients to remain in their home while they receive care. Such nurses provide essential skilled services—wound care, medication administration, post-surgical care, and disease management—and prepare patients and their families to manage their own treatment longer term.

For a patient hobbled with a fractured hip and newly home from the hospital, for example, Gallagher might visit one to three times a week for several weeks. “We go in to educate them on pain management, medications, diet, fluids, and fall prevention,” she explains. “I’m responsible for ensuring patients are safe and that they and their families are comfortable, confident, and competent in managing their care independently.”

To get the job done, Gallagher often coordinates with physical, occupational, and speech therapists, caregivers (like a spouse), and other health professionals involved in a patient’s care. She is among the roughly three percent of registered nurses who work in home health care, according to National Council of State Boards of Nursing.

Home health care is not the same as a private duty nurse, who may visit for longer blocks of time, for longer-term care, or to provide respite for family members or caregivers, with patients usually paying out of pocket. Home health nursing is often paid for by insurance, Medicare, or Medicaid for a limited period of time for patients deemed unable to leave their home for outpatient care.

“The benefit to the patient is that they get to stay in their home environment, they get one-on-one attention, a personalized plan of care, and a complete focus on them to meet their goals,” says Sarah Caro, a registered nurse and clinical assistant professor for Towson University’s Department of Nursing.

“Medicine is such a scary endeavor for so many people…I can’t tell you how many times people have said to me, ‘I’ve never had a nurse who taught me this,’ or ‘I didn’t know this is available.’”

Caro, a nurse for 30 years, has worked in hospital settings as well as in home health care and hospice. “We know people do better at home. With proper support, they really can have positive outcomes.”

It’s a benefit that has ripple effects beyond the patient, with care provided in a patient’s home—whether it’s in a house, apartment, assisted living facility, or other space—freeing up inpatient resources and lessening the burden on families once a patient is discharged.

For nurses, home health care offers autonomy, flexibility, and the chance to move beyond the confines of a facility. There’s also—for patients on the path to recovery—the reward of seeing someone regain independence, says Caro.

“Often in the hospital we don’t get to see that,” she says. “We’re happy when they get to go home, but we don’t get to see that independence come back.”

Even when recovery isn’t in the cards, there is the opportunity to develop deep and lasting connections with patients and their families. Caro’s career is peppered with such connections, including a special bond with one elderly patient in failing health. She’d often linger to chat—and frequently laugh—with her after the visit.

“I would usually save her for late in the day because we sure did enjoy visiting,” Caro recalls. “We worked together so long and she sat me down one day and she said, ‘I just need to tell you—and I don’t want you to argue with me—I am ready to be comfortable.’ She felt like she had to break it to me gently that she wanted to be a hospice patient. It was really precious.” (Caro’s response: “Sweetie, we can do whatever you want.”)

Beyond the relationships there’s also the opportunity for nurses to employ a wide range of skills as they encounter varied health conditions. While some care boils down to the basics, home health nurses also may also find themselves providing the type of complex care that was once limited to inpatient settings. Thanks to increased access to telehealth, remote monitoring, and other advances, these services can now be delivered at home.

“One of the things I really like about home care nursing is it gives me the opportunity to really use all the tools in my toolbox and to continue learning as well,” says Dawn Workman, a clinical nurse manager with Johns Hopkins (JHU) Care at Home’s Personal Care division, which provides private pay services for patients seeking the care of a nurse or certified nursing assistants.

On a typical day this spring, Workman started her day with a visit to a post-partum patient, then moved on to an elderly woman who needed drain and dressing care, plus help with medications, then on to a kidney transplant patient to draw labs and collect a urine sample. The day ended with a quick check-in on a patient who had a debilitating medical condition that has required extensive surgeries.

The variety requires home health nurses to be “expert generalists,” as JHU’s Care at Home likes to think of them. “There is really nothing typical about it,” says Workman, whose 26 years in nursing have included time in emergency care and as an EMT and a medic. “It is truly ever evolving.”

At times, the work requires tackling problems with skills you might not think of as traditional nursing. Polly Easton, a Stella Maris start-of-care nurse, recalls one patient early in the pandemic who was COVID-19 positive and recovering at home.

“So here I am with a double mask, gown, and shield, sitting in someone’s bedroom to go through her medications. She brought out a rolling suitcase filled with medication, and I was like, ‘What do I even do with this?’” Easton recalls with a laugh. A little digging revealed that the patient wasn’t actually taking the medications, unbeknownst to her doctors.

“They’d see her blood pressure was high and add another prescription, and she’d collect them all but never take them because she was too overwhelmed,” says Easton, who quickly devised a solution, working with the medical team to whittle down the medication list. “This is nursing,” she says, “but it’s not really what they teach you in school.”

As rewarding as it can be, providing nursing care outside of a facility brings its own challenges, the least of which may be the logistics of handling weather and traffic when you travel to multiple homes each day. While the autonomy that comes with the job can be appealing, it also brings weighty responsibility. While home health nurses work within a care plan, with an interdisciplinary team, and with a support team a phone call away, “you really are out there by yourself,” says Caro. “It can be a little daunting,” especially for nurses just starting out in home health care.

Home health nurses may also have to push past the worries patients and their families have as they take on medical responsibilities for themselves or their loved one.

“Medicine is such a scary endeavor for so many people and that creates more fear and more resistance,” says Gallagher. Often, she finds patients are surprised by what they can accomplish. “I can’t tell you how many times people have said to me, ‘I’ve never had a nurse who taught me this,’ or ‘I didn’t know this is available, I didn’t know that I could do this.’”

Another possible roadblock is the home itself. Easton has encountered patients whose homes had already been modified—with grab bars, wide doorways, even an elevator—for a parent or spouse. But often, homes are not ready to be makeshift care centers. Loose rugs, stairs, and slippery showers pose hazards for the elderly and infirmed. And then there are the pets.

“The pets are always interesting. There have been some that were small and mighty and gave me a run for my money,” says Caro, who once had a patient with a pet duck that would greet her at her car with a few not-so-friendly ankle pecks.

For Easton, the challenges of providing care in a home are also an opportunity. Walking into someone’s kitchen for example, Easton might notice their food is stored in hard-to-reach cabinets, or that their walk from the living room to the bathroom requires navigating a walker through a too-narrow path.

“I love that I can really figure out what people need that they may not be able to verbalize for themselves but that can really change their quality of life,” she says.

“The pets are interesting,” says Caro, who once had a patient with a pet duck that  would greet her at her car with a few not-so-friendly ankle pecks.

One of her easiest problems solved didn’t require any in-home modifications but instead involved removing a logistical obstacle. The elderly patient had always walked to a local pharmacy to pick up prescriptions, but after a hospitalization could no longer make the trip.

“He had been home from the hospital for three days and he didn’t have his meds yet,” she says. A quick call to switch the patient’s prescriptions to a pharmacy that delivers resolved the issue.

Of course, sometimes the problems are trickier, with medical needs that can’t be met in the home. “You come into the house and they’re like, ‘I don’t know if this looks good,’ and you’re like, ‘No, that does not look good, we’re going to call 911,’” says Easton, who developed the knowledge and skills to make such decisions over nearly 20 years of nursing.

Many home health nurses get their start in other branches of nursing, and some aren’t even aware the career path exists. For Caro, an introduction to in-home care came while she was working full-time on a telemetry unit in a small community hospital that sent nurses into the homes of congestive heart failure patients.

“Had I not had that opportunity early in my career I don’t know that I would have known how amazing home care is,” she says.

As a professor, Caro often encounters students who envision themselves tending to patients in an emergency room or an ICU after graduation. But she believes that nursing’s varied career paths are part of its appeal. “I don’t think people realize just how broad the field is and what can be done.”

The national nursing shortage has tightened the supply of all nurses—and that includes home health nurses. In response, the Home Care Association of America and the National Association for Home Care and Hospice have proposed a range of efforts, including implementing more loan forgiveness programs for nurses entering home health care, making salaries more competitive, and getting the word out so that more nurses consider home health nursing as a career option.

For Gallagher, home health nursing has been not only a viable and exciting career path, but also thoroughly rewarding. “It’s a really emotionally draining position but there are so many instances where it’s just a beautiful thing,” she says.

Often, the payoff comes as patients progress to confidently managing their own care. “I tell people all the time, the best thing is when I see them smile, when I know that they are comfortable enough and happy enough to be able to look forward to tomorrow instead of being scared,” says Gallagher, who recently had a patient burst into happy tears because she could finally leave the house on her own and take a bus to her doctor’s appointment.

Other times, the reward comes later. Gallagher will always remember her first home health patient, not just because she built trust and saw him improve enough to no longer need her care, but because a year later she got a call from his cardiologist with an update.

“He said, ‘I just saw the patient, he was in my office with his baseball cap on and he was about to go to an Orioles game,’” Gallagher recalls. “He thanked me and said, ‘You really made a difference.’”

Being an integral part of the team that helped the patient return to health and independence was its own reward, says Gallagher.

“That’s what makes us motivated to do what we do.”