Issue link: https://nnumagazine.uberflip.com/i/1474200
dressing on a wound VAC, handling PICC lines for antibiotics, administering infusions to a cancer patient, the list goes on. When home health RNs walk through the door of a patient's residence, they never know what to expect. The dwelling could be a spotless apartment, a cockroach-infested mobile home, a multimillion-dollar mansion on the beach, or a frigid house being heated solely by an open oven in the dead of winter. The patient could be recovering well and ready for discharge or in the throes of an unexpected crisis requiring CPR or an urgent call to 911. "You're going into an unknown every time," observed Mary Beth Gagne, who has worked for 30 years in pediatric home health at Maine Healthcare at Home in Portland, Maine. "You have to work well autonomously and not be afraid of going into all kinds of differ- ent homes. People can have guns. People can be on drugs. It's not like working in a hospital where you go into a room." If a home health nurse does feel unsafe, she can leave. "If we feel threatened during a visit due to a patient being inappropriate or ver- bally abusive toward us, we are encouraged to leave that patient's home immediately," explained Colleen Lunsford, a home health RN with Dominican Hospital in Santa Cruz, Calif. Clearly, home health nurses need to be ready for anything and everything. They see it all: Patients with menacing dogs. Family members with Covid. Teens with cell phones ready to post videos of you and their recovering grandparent on TikTok. Moreover, these fearless RNs are often the only nurse seeing the patient. "You don't have another nurse right next to you to run some- thing by," noted Melissa Stroud, the wound ostomy nurse (WON) in the home health department at St. Joseph's Medical Center in Stockton, Calif. "You can't call a code blue. If you don't think something is right, you send them back to the hospital or call 911." Kathleen Longwell, RN at Kaiser Perma- nente San Jose in California, agreed. "It can be stressful because there is no one behind me to check the patient," said Longwell, who has more than 20 years of experience in home health. "So you can't miss anything. There is no day shift or night shift nurse to follow up." Additionally, home health nurses may be doing something for the very first time, especially when they are first starting out in the field. "If you don't know what you're doing, you better figure it out and learn how to do it before you see the patient," said Gagne who notes that a hospital might have an IV team, but home health nurses do it all. And even if you do know how to do some- thing, patients will question you, observes Palomar Home Health RN Glynn Cascolan: Have you done this before? How long have you been a nurse? "Patients will know if you are not in control," said Cascolan, who has been a home health nurse for 27 years in Escondido, a city 30 miles northeast of San Diego. "Sometimes it's not the patient but the family member who is in your face. You have to be firm and tell them, 'This is what the doctor says.'" Depending on acuity, these intrepid nurses see their patients anywhere from one to three times a week to once a month over a few weeks, several months, or even years for catheter patients. Regardless of the dura- tion of their patients' care, the RNs get to know their patients intimately and can detect when something is wrong and when they need to call the doctor or an ambulance. "You become a family member in this chapter of their life and then you move on," said Stroud, who previously worked in post-operative care for open heart surgery. "It's very rewarding. I get to see the wound, make an assess- ment, and see it heal. Sometimes you see them get worse and they pass, but it's still rewarding because you're there to help the family." Carolene Hill, an RN with Hines Veterans Health Administra- tion (VA) in Chicago, is a key part of an interdisciplinary team caring for veterans participating in a voluntary program offering home-based primary care. The other team members include a phys- ician, pharmacist, dietician, social worker, and if needed, a psychologist or psychiatrist (or both). She has been part of the VA home care program for three years but some of her geriatric patients have been participants since its inception a dozen years ago. They are long-term patients whom she sees once a month for their A P R I L | M AY | J U N E 2 0 2 2 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 19 Colleen Lunsford, RN Dominican Hospital; Santa Cruz, Calif. 10 years in home health; 25 years as an RN; Previous experience: psychia- tric, telemetry, ER, trauma