The Good, Bad, and Ugly of Homecare Nursing, From a Nurse

by Natassja Sheils, Home Care Nurse

When I first met the Youngdales, I was a night-shift nurse working with three different kiddos. I was used to being one of ten to fifteen nurses rotating through each case. It was a good system—efficient, organized, predictable. You got to know the family, and you got to know the child.

What you didn’t get was a relationship.

In homecare nursing, relationships matter. I never understood just how much until I switched to day shift and started working with Declan. He was my only case, and his family preferred to keep his team small. Two day-shift nurses and one night-shift nurse—that was it. That structure gave all of us more flexibility, improved communication about his care, and allowed me to truly get to know the entire family. I wasn’t just a nurse coming into their house; I was someone they trusted enough to let into their lives.

No one wants a stranger walking into their home. But when you have a medically complex child, your choices are limited. You either do it all yourself, or you accept the help—which means letting strangers in, sometimes before you’re emotionally ready. Many times, the hospital won’t even discharge a trach/vent-dependent child unless homecare nursing is arranged. The transition can be overwhelming, whether families like it or not.

While homecare nursing is an overwhelming adjustment for parents, it can be an equally huge adjustment for the siblings of a medically complex child. Declan’s twin brother had been living with this reality for almost ten years. He understood that when I was in their home, my priority had to be Declan. He knew that even when we were playing together, I might have to stop abruptly to take care of his brother.

I remember one day in particular. He really wanted to play soccer. Normally, Declan would happily watch us, but that day he wasn’t having it. When I told his brother that I couldn’t play but maybe we could find something Declan wanted to do, he looked at me and said, “Why do you always only do stuff that Declan wants to do and not me?”

That question has stayed with me.

Even though I made an active effort to include him, and even though he understood on a logical level that his brother needed more care, he was still a child—one who wanted attention, too. He wanted the same connection and interaction from the same people who cared for Declan. Thankfully, his parents worked hard to make sure he didn’t feel like a “glass child,” unnoticed or overshadowed.

Not every sibling can process this transition so gracefully. Many don’t understand why someone coming into their home isn’t there to play with them, or why their parents have to stop spending time with them when nursing isn’t available. These shifts can lead to misbehavior, withdrawal, or feelings of being less important.

This is another often unseen burden families carry when they accept help from homecare nurses—the emotional weight it places not just on parents, but on siblings who are trying to make sense of a world that suddenly feels very different.

Now, working as a float nurse, I see the full spectrum—the good, the bad, and the very ugly—of homecare nursing. The families who rely on float nurses are often brand-new to homecare, usually brand-new to the world of having a medically complex child. Imagine giving birth only to learn your newborn needs extensive medical interventions, possibly a trach and ventilator, and then being told, “By the way, you’ll need a nurse in your home 24/7.”

It’s a lot.

While homecare nursing can be incredibly helpful, it can also feel like a burden. Many families have told me that the only thing worse than having homecare nursing… is not having it. And I believe them. The help is essential. The loss of privacy is real.

Most of the families I meet, that are utilizing the float team, are still in the “this really sucks stage.” They have strangers in their home every day—strangers they’re supposed to trust with their child’s life. Their living room is overflowing with medical supplies they don’t yet know how to organize. And they’re trying to adjust to life outside the hospital after months of survival mode.

Whenever a new family feels overwhelmed and asks for advice, I find myself thinking back to my time with Declan. My number one piece of advice is this: if you don’t like someone, you don’t need a reason to say no to having them in your home with your child. Your instincts are enough.

Ashley’s book goes into more detail about what happened to Declan in his own home—his supposed safe space—yet hearing his story was a turning point for me. Not every nurse is in this field for the right reasons. Not every nurse is a safe person. And families do not have to let anyone through their front door if something feels off.

I hear parents say things like, “We don’t love this nurse, but we need the help,” or “I’m worried I’m being too picky, and the office will stop sending staff.”

Newsflash: you are allowed to be picky. You should be.

On the flip side, my experience with Declan also allows me to share the beautiful side of homecare nursing. The side where the team truly knows your child. Where the people walking into your house are no longer strangers. Where you feel safe enough to go get groceries or get your hair done without worrying whether your child’s needs are being met.

Declan was an incredible child who taught me more than I can put into words. He taught me what homecare nursing can be at its very best, and also how hard it can be on families. My time with him and his family shaped me into a better nurse, a stronger advocate, and someone who can guide other families through this complicated system.

Because of Declan, I am better—professionally and personally. And I hope that makes a difference for every family I care for moving forward.

Throughout my career, I’ve often heard comments like, “The family is so lucky to have the extra help,” or “It must be nice that they have you,” along with other remarks that suggest families receiving home-care nursing are fortunate to have what amounts to free childcare. I hope this article helps shed light on the real challenges faced by families who rely on nursing support — as well as the incredible difference it makes when they find the right fit

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