National Nurses United

car, too, leaving her coat behind, and rushes to the patient's door as quickly as possible to reduce her time outside in the bone-chill- ing weather. If she is visiting an apartment, she will leave her winter coat outside the door in the hallway and don her PPE before she enters the unit. On her way out she removes the PPE in the hall, puts it in a trash bag for the family to throw away, and slips on her coat. Another Covid challenge home health nurses face is that their patients—or the people who live with them—may not be masked. The RNs ask them to mask, but not all of them comply. For Carolene Hill, working for the VA meant that a policy about asking patients to mask was extremely slow to be adopted. She said RNs could not ask patients to mask for nearly two years into the pandemic because management told them, "You can't tell someone what to do in their own home." It was only in December 2021 that home health RNs were given permission to ask VA patients to wear a mask. And now wearing a mask is a condition of the veterans continued participa- tion in the voluntary home care program. Obviously, home health RNs need to be vigilant about screening patients and their families before appointments. When Mary Beth Gagne does screenings prior to her visit, some people will tell her not to come because they are sick or have had an exposure. Her patient population includes parents and babies with Covid. When parents can't take the baby to the doctor's office, they are assigned a home health RN. Gagne tries to avoid seeing non-Covid and Covid patients on the same day. But if that does happen, she aims to see the cancer patients in the morning and the Covid patients in the afternoon. Cascolan does what he can to limit his own exposure because he wants to avoid bringing Covid home to his family. He wears an N95 whenever he sees a patient for the first time and asks questions about their vaccination status and whether they have any symptoms. He tells other people to leave the room. Some patients prefer to see him outside. The weather is fairly temperate in North County San Diego so that has been a welcome option. Fulfilling work "we're the eyes and ears for the doctors who may not have the time to get all the details," said Melissa Stroud, who noted that home health has expanded her skill set tremendously. "We see the whole picture. If we have good collaboration, we can keep the patient out of the hospital." Being in home health means that you sometimes work closely with a team—physical therapy, occupational therapy, speech ther- apy, and social worker—to come up with the best plan for the patient. Mary Beth Gagne loves being part of what she describes as a very strong and supportive pediatric team. "We support and learn from each other," noted Gagne, who worked in the neonatal ICU at two large hospitals and then an obstetrics/gynecologist's office before she began her home health career. "We're all working together to create better outcomes for the patient." Gagne enjoys the diversity of home care, doing everything from immunizations and chemotherapy to weighing babies and manag- ing central lines as well as seeing prenatal and post-partum patients. "I am a person who doesn't like chronic care," admitted Gagne. "I don't want to do the same thing every day." Home health nurses have a lot of autonomy, which is what Kath- leen Longwell, a home health RN with Kaiser Permanente San Jose, likes most about her job. "I'm able to work independently," said Longwell. "I wanted to be a country doctor and I get to do that as a home health nurse." "I love what I do," said Stroud, who has been a home health RN for 11 years. "I can give back to the community I grew up in and pro- vide service to my own county." "I like the interactions with patients, being able to help people and make a difference," said Colleen Lunsford, who worked as a psy- chiatric nurse for 10 years in a closed unit as well as ER and trauma at other facilities before transferring to home health a decade ago. "I like the intimacy of seeing one patient at a time. I'm not distracted or constantly feeling guilty because I felt like I didn't do enough." "It is very rewarding to see people who weren't taking good care of themselves, do well and recover," said Kathleen Longwell. "I run into family members all the time who say, 'Mom does everything you taught her.' Home health can be the most rewarding nursing job you will ever have." Chuleenan Svetvilas is a communications specialist at National Nurses United. 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 23 Carolene Hill, RN Hines Veterans Health Administration, Chicago, Ill. Home-based primary care 3 years; 32 years as an RN; Previous experience: ICU, emergency room, recovery room, 10 years in home health "It is very rewarding to see people who weren't taking good care of themselves, do well and recover. I run into family members all the time who say, 'Mom does everything you taught her.' Home health can be the most rewarding nursing job you will ever have."

• Cover