Michelle Simpson, PharmD, BCSCP, MWC | Editor-in-Chief, Infusion Journal

Home infusion is often described in terms of how it benefits patients by reducing hospital stays, eliminating repeated trips to an infusion center, minimizing time away from work or family, reducing exposure to facility-based risks, and minimizing the disruption that comes with receiving care outside one’s normal life. Those benefits are real and meaningful. But when we describe home infusion only as a more convenient site of care, we risk oversimplifying the model and underrecognizing the professional work required to make it successful.

Home infusion is not a simplified version of facility-based care. It is a fundamentally different model of care, replacing the centralized infrastructure of a hospital, clinic, or physician’s office with a highly coordinated system of clinicians, medications, supplies, documentation, communication, education, monitoring, and follow-up. In a facility setting, the patient enters an environment already built for care delivery. In home infusion, that environment must be created around the patient.

At the center of that model is the home infusion nurse.

The articles in this nurse-focused issue of Infusion Journal quantify what many in the field have long understood: home infusion nursing extends far beyond the infusion encounter. Nurses assess, teach, coordinate, document, monitor, troubleshoot, communicate, and travel. They help transform a patient’s home into a safe, functional care environment. They also provide the clinical presence that gives patients and caregivers confidence that home-based therapy is not only possible but manageable. That confidence is not incidental. It is part of the care.

For many patients, the transition from hospital or facility-based care to home infusion can bring mixed emotions. A patient may be recovering from an acute illness and need a supportive caregiver. They might be managing a chronic condition or learning a new medication regimen and feel empowered to care for themselves at home rather than in a controlled clinical setting. In that moment, the nurse becomes more than the person who performs the visit. The nurse becomes the face of the service and often the person who helps the patient believe, “I can do this.”

The research studies in this issue offer a clearer view of that work. In the article titled “A Multi-Center Time Study of Home Infusion Nurse Services During Therapy Initiation,” nurses documented 309 tasks for anti-infective patients and 115 for monoclonal antibody patients during therapy initiation. The data show the nursing work completed before the first home visit. For anti-infective patients, Visit 0 accounted for 22% of all nursing tasks, and care coordination and telephonic communication were the most common activities during that phase. The study also found that approximately 40% of nursing patient care time occurred outside the patient’s home for both therapy groups, reflecting care coordination, documentation, telephonic communication, and other non–face-to-face activities. The findings challenge a narrow view of nursing productivity that equates value only with time spent face-to-face in the home. In home infusion, the work done outside the home often enables the in-home visit to succeed. The phone calls, documentation, care plan updates, coordination with prescribers, communication with pharmacists, and preparation before the visit are not administrative extras. They are patient care activities. They are part of the clinical infrastructure.

The article, “Onboarding Home Infusion Anti-Infective Patients: A Descriptive Study of Nurse and Pharmacist Time,” reinforces this point. Patient onboarding was defined as the professional time spent prior to treatment starts, and onboarding home infusion anti-infective patients required substantial time from nurses and pharmacists before therapy was fully initiated. Nurse activities were concentrated in care coordination, communication, assessment, and patient education, while pharmacist activities centered on drug preparation, compounding, patient assessment, documentation, and care coordination. Combined patient onboarding time exceeded 5 hours of professional time before or during therapy initiation. The study also notes that providers may invest professional onboarding time before payment begins and that a proportion of referred patients may never ultimately receive billable home infusion services.

This is an important reimbursement and sustainability issue. If the goal is successful therapy initiation, fewer avoidable complications, better adherence, and a positive patient experience, the work required to achieve those outcomes must be recognized. Home infusion providers cannot safely deliver complex care if they are reimbursed only for the most visible portion of the service. The tasks that build trust, establish readiness, prevent delays, and support continuity require real time. Real time has real cost.

The third article, “Home Infusion Nurse Time for Intravenous Immune Globulin: Findings From a Multicenter Observational Time Study,” adds another layer by showing how therapy-specific complexity affects nurse workload. IVIG required more nursing time than anti-infective or monoclonal antibody therapies, with Visit 1 requiring approximately 5.90 hours. Drug administration was the primary driver, but the study also described substantial nurse responsibilities across clinical, educational, documentation, coordination, and travel-related activities.

Together, these studies point to a broader conclusion: home infusion nursing cannot be understood by a single task, visit, or billable unit. It is a coordinated professional service that varies by therapy, patient need, care environment, administration method, monitoring requirements, and transition complexity. Some therapies are task intensive. Others are time intensive. Many are both. In all cases, nursing work is essential to turning a prescription into safe, sustainable treatment at home.

This issue of Infusion Journal invites us to rethink the home itself as a site of care. In a hospital or infusion center, safety is supported by proximity: nearby clinicians, supply rooms, or emergency response systems. In home infusion, safety is supported by preparation, education, coordination, and relationships. The nurse brings clinical expertise into the home environment and adapts individualized care plans to the patient’s reality. That work requires judgment, flexibility, communication, and trust.

As home infusion continues to grow, the profession needs data that make this work visible. We need staffing models that account for coordination and documentation. We need productivity expectations that reflect travel and non-patient-facing care. We need reimbursement discussions that acknowledge the front-loaded nature of therapy initiation. And we need ongoing research that links nurse time and tasks to outcomes that matter. Patients find home infusion personal and reassuring. That is the goal. But behind that experience lies a complex system of professional work, much of it performed by nurses before, during, and after the home visit. It is essential to sustaining the model of care that patients increasingly prefer and the health care system increasingly relies on.

Home infusion succeeds when patients feel safe at home. Home infusion nurses are a major reason they do.