National Nurses United

discharged from the hospital to be cared for by their families and home health nurses. Some patients were sent home early to reduce their potential exposure to Covid and also to free up beds for other patients. Stroud says these home health patients might spend two weeks at home but then she may have to send them back to the hos- pital because they needed 24/7 care, their condition declines, or the family is unable to care for them. Fighting for PPE when covid-19 hit the United States, home health nurses got another layer of complexity and challenge added to their work. At the start of the pandemic, many home health RNs had to fight for personal protective equipment (PPE) because management mis- takenly did not think they needed it. The assumption was that patients were safe at home and did not have Covid, completely disre- garding the reality that patients could be exposed to Covid by family members or visiting friends or exposed in the hospital, developing symptoms after discharge. Or as Carolene Hill noted, health care workers at nursing homes, the epicenters of the first Covid surges, often hold part-time home care jobs and inadvertently exposed their homebound elderly patients to Covid. Early in the pandemic, some home health RNs' deep concerns about PPE were ignored and many were told that surgical masks 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 21 Considering home health? Excellent assessment skills are indispensable for home health nurses. RNs who are interested in this area of prac- tice may want to get several years of nursing under their belt to reach the level where they are comfortable making decisions and judgment calls. "Go to the ICU, learn every- thing you can, learn CPR," advised Carolene Hill, an RN at Hines VA in Chicago, where she is part of an interdiscipli- nary team providing home-based primary care to veterans. "You need to tell the doctor everything they need to know to make their decisions." Hill, who previously worked in the ICU and ER, said she is using every bit of her clinical skills in her home care posi- tion. "I need to know what someone sounds like if they have pneumonia," said Hill. "I need to know if someone's abdomen is swollen or critical." Kathleen Longwell, who has worked for more than two decades in home health, including 13 years at Kaiser San Jose, said that nurses with the widest range of acute-care experience from different departments are a better fit for home health than nurses who have worked in only one unit. "It's harder for them to do home health because there are so many different things you have to do," noted Longwell. Mary Beth Gagne, a pediatric home health nurse in Maine suggested going on a ride-along with a home health nurse before committing to it. "It's like nothing you have ever done before," said Gagne. "People try it for three months and leave. They have no idea what it's like to be in home health. You're out there by yourself. It's a lot of pressure." Colleen Lunsford, a home health nurse with Dominican Hospital in Santa Cruz, Calif., said that RNs who are inter- ested in this work should be independent thinkers and have the motivation to learn. "When you don't know something, you must have the drive to do your own studies," said Lunsford. "You have to constantly keep up with changes." To be an efficient home health nurse takes about a year, according to Glynn Cascolan, who has been with Palomar Home Health for 27 years. When he started out, Cascolan admitted that he was charting at night when he got home. And it took him about five years to be able to do all his work in eight hours. "If you cannot organize yourself, you cannot work in home health," observed Cascolan. "It is very rewarding to be in the field and see how you can help change someone's mindset about diabetes, COPD, and CHF," said Melissa Stroud, RN with St. Joseph's Medical Center in Stockton, Calif. "I can see them make lifestyle changes and have a better quality of life with their chronic conditions. If you have the drive to make a difference in their lives, you can make a difference." —C.S. Kathleen Longwell, RN Kaiser Permanente San Jose, San Jose, Calif. 21 years in home health; 41 years as in RN; Previous experience: medical-surgical, critical care, telephone triage, travel nurse

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