Home Health Nursing: Interview with Elisabeth Franklin, RN
Lillian Wald and the Visiting Nurse Service
Please tell us your job title and where you work.
I am an RN Case Manager in the Redlands Community Hospital Home Health Department .
Tell us a little about the history of your nursing career.
I wanted to be a nurse since I was a child in the first grade. I started to take nursing prerequisites fresh out of high school, but then had to stop for financial reasons. I became a CNA and then a medical assistant, earning my RN in 2005. Until four years ago, I worked mostly in ICU, including cardiac, trauma and med-surg. Trauma ICU was my favorite of those various units. I’ve also worked in the ER and was floated to various units over the course of my career. Home health nursing has been my focus for four years now.
What brought you to home care nursing?
My daughter wanted me to be home more and the 12-hour ICU shifts were actually 14 hours if you counted my commuting time. So, I did it for her, but I’m glad I made the switch. I absolutely love home health, hands down. My husband says I have an old soul and that’s why I click with the elderly.
Do you see changes in the importance of home health nursing as the population of the United States ages?
Yes, I think home health is exploding right now. So many doctors didn’t know we existed a few years ago. I think it’s a wonderful thing because the doctors trust us more and are constantly sending us referrals. Quality home health nursing minimizes readmissions and potential complications, especially for fragile elderly patients.
In your experience, how has home health itself changed over the years?
Our patients are being discharged from the hospital much sicker and more acutely in need of care than ever before. The docs know we’re here and we basically consider ourselves “med-surg on wheels” due to the general acuity of our patients.
Physicians now have a greater comfort level referring their most complex patients to us. Some doctors have been set in their ways, but we’ve changed their minds by demonstrating the excellence of our care.
With more acutely ill patients coming home so quickly from the hospital, we administer complicated IV antibiotic regimens and provide equally complex wound care. We spend a great deal of our time educating patients in order to keep them from being readmitted. If we can keep patients in their homes and out of the hospital, everyone benefits, especially the patients.
How have electronic medical records and other technologies impacted home health?
We’ve had various difficulties with our systems, especially with our wireless communication. Our I.S. department is working on improving it and they are now accompanying us into the field to learn about the challenges we face. The benefit of the wireless systems is the ability to electronically submit and receive orders, documents and information directly from the field.
What feeds your spirit at work? What keeps you coming back day after day?
My work is so rewarding! I go into patients’ homes and I’m a guest whom they generally welcome with open arms. I’m there to educate them and keep them healthy and out of the hospital. I can even get through to some of the older patients who are more set in their ways and hard to “crack.”
Some relationships with patients can feel like friendships — although we always maintain appropriate professional boundaries. These elderly patients’ stories are amazing if you take the time to listen. It fills my heart with warmth.
What was the transition like from ICU to home health?
ICU is so highly structured. You know exactly what you’re doing most of the time: titrating drugs and checking various machines and monitors. Home health is different. Things don’t happen in home care the way you think they will and it took some getting used to the variations and unexpected changes that can occur every day.
The constant driving also makes for a very different type of flow in terms of the workday.
What can you say about the nurse autonomy inherent in home health?
The level of autonomy also took some getting used to. You’re out there on your own, but you have a team leader available by phone for help or advice. I enjoy setting my own schedule and having control of my day.
Was that level of autonomy scary at first?
Yes, a little bit, but I had great training and I asked a lot of questions. I probably drove my team leader crazy with my questions when I was first starting out!
What personal qualities do you look for in a home health nurse?
Compassion and friendliness are very important. You need to smile. You’re going into patients’ homes and you need to not appear like you’re in a hurry. Home health nurses need to be warm and open, recognizing that they are guests in their patients’ homes.
You also need to remember that you are there to educate the patients, not to change their lives. Elderly people don’t want to change, but you can still influence them positively. Some nurses try to force new ideas onto their patients, but that approach doesn’t really work. If you ask the right questions, listen well and are laid back, you have much better results.
If a home health nurse is patient, skilled at providing education, a good communicator and listener and knowledgeable about many disease processes, he or she will do a great job.
If a nurse was interested in home care, what would you advise them to do?
I see a lot of turnover in home care because people don’t realize what they’re getting into before they begin. I recommend talking to other nurses in home health and doing a “ride-along” and an informational interview before you take a position. It’s a completely different arena from the hospital and not everyone likes the level of autonomy. It can also feel lonely out there if you’re used to being surrounded by colleagues all day. For myself, I held onto my ICU position for a while until I was sure I really liked home care.
Are there any certifications or trainings that are commonly pursued by home care nurses?
A lot of the nurses we hire are not educated in wound care, diabetes education and disease processes that require intensive teaching. You don’t get to do all of that regularly enough on the med-surg floor, especially since the wound specialists often handle the complicated wounds when patients are in the hospital.
In our agency, we receive frequent education on diabetes, CHF [congestive heart failure] management and also wound care. Many home health nurses pursue various trainings so that they become more expert in these areas.
Do you have a wound care nurse to lean on?
Aside from our frequent educational opportunities, we have a wound clinic at the hospital where we can ask questions and get advice. We also have an LVN on staff who has a wound care certificate.
What are your future career plans?
I’d like to pursue my geriatric nursing certificate, but first I’m going to pursue an RN-to-BSN program. I’d also like to earn a master’s degree in gerontology. Now that my daughter is in high school, I have more freedom to pursue my dreams.
Lillian Wald and the Visiting Nurse Service
by Elizabeth Hanink
Photo right: “The whole world is my neighborhood,” Lillian Wald said. Her portrait, painted by William Valentine Schevill (1864–1951), now hangs in the National Portrait Gallery in Washington, D.C.
Ever since Florence Nightingale first attempted to codify what nursing is, there has been tension between caring for the sick and fostering personal responsibility. Lillian Wald (1867–1940) learned to live with those conflicts and through her Henry Street Settlement House became the first nurse in this country to lead in the field of public health.
The Henry Street Settlement
After graduating from New York Hospital Training School for Nurses in 1891, Wald worked briefly in institutional nursing, but left to study medicine. While taking classes, she was invited to offer a home nursing course on the Lower East Side of Manhattan.
Wald’s exposure to poor immigrant populations quickly stirred in her a feeling of responsibility to bring affordable care to everyone. Soon, she was offering a visiting nurses service and, with the help of friends, established in 1895 what she originally named the Nurses Settlement.
As her understanding grew of the interaction of social and economic factors with disease and prevention, Wald eventually changed the name of the Nurses Settlement to the Henry Street Settlement House, which still exists today.
Advocate for Children’s Health
Wald’s influence as an advocate for all forms of public health service led New York City to establish the first American public school nursing program in 1902. By 1905, settlement nurses worked in 18 different districts and had a caseload of 4,500 patients.
Wald’s efforts also prompted New York City to establish the world’s first public health nursing system. In fact, she actually coined the term “public health nursing.”
In 1912, at Wald’s urging, President William Howard Taft established the Children’s Bureau, which is now part of the U.S. Department of Health and Human Services. It took a grassroots effort and 11 bills over a period of six years to give birth to this first national effort to protect children, which continues to advocate for children and families, promoting their safety, permanency and well-being. The bureau’s first research effort addressing infant mortality revealed a vast difference in mortality rates based on socioeconomic factors and the bureau’s efforts to register births, encourage prenatal care and end child labor have done much to improve the lives of American children.
If that weren’t enough, Wald was one of the founders of the Columbia University School of Nursing, which is now one of the premier nursing schools in the U.S.
Wald’s legacy is lasting: Today, the Henry Street Settlement remains in the same three original buildings where it began, offering a wide range of assistance and serving over 50,000 clients each year.
The Visiting Nurse section of the Henry Street Settlement became independent in 1944. Today, it is the largest nonprofit home health agency in the U.S., employing 2,445 nurses and offering services in 50 different languages. In 2012, the agency made over 2 million visits to 150,000 patients in the New York metro area and offered $26 million in care to uninsured and underinsured New Yorkers. The agency has now been a part of New York longer than the Yankees and the subway.
This article is from workingnurse.com.