Home Health Nursing: Interview with Eileen Tondreau, RN, BSN, PHN, OCN, COS-C
Providing focused care with the patient at home
Where do you work and what is your role?
I am the director of the Home Health Department at Simi Valley Hospital.
What would you like to share about the trajectory of your nursing career up to now?
I feel like I’ve done almost everything in the field of nursing! I worked for more than 30 years in hospital-based positions such as director of med/surg and administrative director for post-acute services, which included rehab therapies. I’ve also worked in surgery, pediatrics, NICU and other areas.
What brought you to home health nursing?
As my career progressed, I found myself gravitating toward the care of the elderly. That’s a niche that really clicked for me, so my passion as a healthcare provider lies in that area of nursing. I also arrived at a point in my career where I wanted to take on a role outside of the inpatient setting.
About 10 years ago, I discovered that Simi Valley Hospital had its own home health service. Thinking that would enable me to make an easy transition, I began working in the Home Health Department as a clinician. After six years, the director position opened up, so I interviewed and was subsequently hired. My responsibilities include both the business and clinical functions of the department.
Do you see changes in the importance of home health nursing as the population ages?
Yes, definitely. In the years ahead, as more and more Americans live longer than ever before, the need for home care will rise exponentially. One major reason is that hospital care is very expensive and providers are always looking for ways to keep patients out of the hospital. Home health is a service that can prevent hospitalizations and readmissions.
If a physician gets home health involved before the patient becomes acutely ill, our team can prevent that patient from being re-hospitalized. For example, if a physician orders the services of a home health nurse to treat a minor wound or a small pressure sore, such early intervention can prevent the wound from becoming infected. That in turn can prevent sepsis, sparing the patient a preventable hospitalization. That’s a win-win situation for both the provider and the patient.
How has home health changed during your time in this area?
First, we’re seeing patients who are more ill than in the past. Sicker patients require more complex care, such as IV antibiotics and electronic monitoring. Second, the rise of medical technology — such as telehealth and electronic medical records — is having a major impact on our field.
How have electronic medical records and other technologies had an impact?
The way we practice has been greatly changed by technology. When you’re in a patient’s home, you don’t have the support system you have within a hospital. Before new technologies were developed, we could call the physician or a colleague, but that was about it.
Thanks to the growth of technology, we’re able to do things in the home that we wouldn’t have been able to do even a few years ago. For example, if we have a patient with a worsening surgical wound, we can now send the physician a photo of the wound, which eliminates the need for the patient to make a trip to the doctor. Often, the physician can prescribe treatment based on that image.
Technology also enables us to have remote, face-to-face conversations with physicians, which is a big help for our team and more convenient for the physician.
If a patient of ours had been hospitalized at Simi Valley Hospital, we have access to his or her hospital medical record. Even if the patient was hospitalized elsewhere, we have our own medical record that we can consult. This is very important because patients often don’t know what questions to ask until after their discharge. When they ask our team members questions, we can use information from their medical record to provide the best answers.
Another form of technology that really makes a difference is our telehealth system, which enables patients to take their blood pressure, pulse oximetry, blood glucose and weight and automatically transmit that information to us via the Internet.
If we have concerns about any of those measures, we can immediately alert the patient’s physician instead of waiting to discover this information during our next home visit. Adjustments to treatment or medications can be made right away, which further helps to avoid re-hospitalization.
Hospital nurses say they have less time to do direct patient care. Does this apply at all to home health?
It’s actually the opposite! Our patients will often tell us, “This is the first time I’ve spent an hour with a nurse.” The reality is that the nurse who took care of them in the hospital may have also spent an hour or more with them, but it was broken up into brief episodes as the nurse took care of other patients and duties on the floor.
Our nurses and other caregivers provide focused, one-on-one care for patients. We can take our time teaching the patient, providing care and answering questions without interruptions — other than an occasional friendly pet that needs a little attention!
With which kinds of illnesses and conditions do your patients present?
Most of our patients have infections and chronic diseases — respiratory conditions such as COPD or heart conditions such as congestive heart failure. These conditions cause patients to become debilitated; the primary problems are decreased exercise tolerance and endurance.
Studies have shown that readmissions are often caused by a patient’s debilitation, so we not only provide nursing care for the disease, but also physical and occupational therapy to assist with rehabilitation.
Another issue we see in recently discharged patients is malnutrition. When patients are in the hospital, they often don’t eat well. Their appetite may be low, they may not like the food or they may have to fast before a test or surgery. Following surgery, patients may also be on a liquid diet for a period of time. As a result, patients often leave the hospital at a lower weight than when they were admitted.
We have an early nutritional intervention program to address that issue with our home health patients.
What feeds your spirit at work and keeps you coming back day after day?
The great thing about home care is that we have the opportunity to see our patients get better. Hospital-based nurses and therapists see their patients for only a brief period of time before the patient is discharged. In that situation, clinicians never know their patients’ ultimate outcomes.
In home health, we don’t discharge our patients until they’re healed, so we get to see the whole picture. We may follow patients for weeks, months or even years, so we watch patients who couldn’t get out of bed begin to walk again or see a patient’s deep wound completely heal. That is very fulfilling.
I am also blessed to be part of a very tight-knit, deeply committed team of nurses, physical therapists, occupational therapists, social workers, bath aides and office support staff who all work in harmony to help our patients get better. We all realize that it’s not just a single person effecting this positive change in our patients — it’s our entire team.
What can you say about nurse autonomy in the context of home health?
Nurses have a very high level of autonomy in home health. The nurse must function independently in the home, be creative and have the ability to think outside the box. When I discuss this with my staff, I use the term “mindfulness”: looking at the situation and seeing all the different possibilities.
I have noticed that the type of people who don’t make it in home health are those who desire step-by-step instructions and close supervision — people who are not comfortable making their own decisions.
Although the physician is the supervisor of patient care, our nurses are right there with the patient, so the nurses often find themselves advising the physician about what the patient needs. As a result, our nurses build strong bonds of collaboration and trust with the physicians, acting as their eyes and ears on behalf of patients.
What personal qualities do you look for in your colleagues?
Three that come to mind immediately are teamwork, passion and a sense of humor. Everyone here has passion for providing excellent patient care, but they’re also passionate about being team players.
A sense of humor is important because there can be drama involved in working with a patient in his or her home. It helps our caregivers to keep things in perspective when they approach their work with a sense of humor.
In addition to these three attributes, I also look for creativity. Every patient and home visit is different, so it’s important for our caregivers to be able to solve problems in each unique situation they encounter.
What advice would you give to nurses interested in home health?
From a practical standpoint, they generally need at least one year of experience in an acute care setting. In particular, working on a med/surg unit or in a skilled nursing facility provides a solid foundation, enabling nurses to hone their assessment skills in a wide variety of circumstances.
In addition, since physical therapy and occupational therapy are so key to what we do, it’s important for aspiring home health nurses to develop knowledge about those two disciplines.
I guess it goes without saying that in today’s world of nursing, computer skills are also critical.
Are there any certifications or specific trainings that are pursued by home care nurses?
The most common are wound care certifications: either WCC (wound care certified) or WOCN (wound ostomy care nurse). OCN (oncology certified nurse) is another that can be helpful. In terms of infusion therapy, infusion certification (CRNI) is helpful in enabling a home care nurse to develop expertise in starting IVs and managing PICC lines, central lines and porta-caths.
What are your future career plans?
I plan to stay in home health. As director, I will continue to grow the department. In the five years I have been here, the department has grown approximately 80 percent in terms of patient admissions, which works in tandem with the hospital’s goals.
The facility is working hard to attract patients from the catchment area and preventing patients from migrating to other facilities and agencies. We share the same goal.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students.
This article is from workingnurse.com.