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Home Health Nursing: Interview with Shirley Irby, RN, MSN, MFT

By Mariah Williams
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Home Health NursingWORKING NURSE MAGAZINE: How did you first get into nursing?

SHIRLEY IRBY, RN, MSN, MFT: I started an LVN program at Golden West College one month out of high school. I continued on through the local programs, getting my RN and BSN. I began my home health career in 1981 after receiving my MSN from UCLA. A few years later, I earned a Masters Degree in Counseling and became licensed as a Marriage & Family therapist (MFT), working with families with drug-involved teenagers for six years. Eventually, I decided to return to nursing because I enjoyed the process, particularly teaching and patient care.

What is your current nursing specialty?

I am a home health nurse for the St. Joseph Health System Home Health Network in Orange, CA. I have specialized in infusion, oncology and palliative care nursing for the past seven years. Because of the nature of oncology nursing, we encounter many patients who are entering into the last phase of life. My MFT experience and expertise in family dynamics has proven helpful in this area.

An important part of our nursing role is patient education of high tech infusion care. We teach families how to operate infusion pumps and administer medications. We also see a wide variety of patients from orthopedic infections to end stage cancer, and this provides a nice balance. However, it is the palliative care patients and their families that leave lasting memories and gives this job special meaning for me.

Tell me about the team you work with palliative care.

The team is led by our Palliative Care Medical Director, who is a neurologist, pain specialist, and a physician on the palliative care team at St. Joseph Hospital. The rest of the team consists of the palliative care program coordinator, a social worker, hospice clinical manager, pharmacist, and the home health clinical team members who provide care to the patients. The patients and family members may participate in the conference by phone. Our palliative care consultation team provides a high level of expertise in pain and symptom management that helps to guide clinical practice to ensure patient’s needs are met. Hospice participation in the conference helps smooth the transition to hospice when appropriate as the patient is ready. However, it is the core team of nurses that help carry me through the daily emotions.

Please describe a typical day in this specialty.

We often schedule patients the night before, which may take 30 to 60 minutes. Our patients are scheduled according to timed infusions and the location of their home. I can see between four to six patients, depending on the length of the visits. Palliative, new patients and longer infusions determine the number of patients seen. I like the variety of patients—many have an oncology diagnosis, and run the spectrum of newly diagnosed, receiving chemotherapy or end of life patients. Then some of my patients are wound care and IV antibiotics.

What I appreciate most is the honest emotions expressed between patients and nurses when providing supportive end of life care. Everything feels a little raw, my senses are more acute, the air smells fresher and the sunsets seem brighter after those intense moments.

Do you have a story you can share with the readers along those lines that illustrates what you like best about this type of nursing?
I do. One such patient and her family stole my heart a month ago when I watched her 24-year-old son carry her in his arms from his car to the house, cradled like a baby. I had arranged to meet them at their home so I could immediately start the IV pain medication upon her arrival from the hospital. Her family was bringing her home to die. She had battled her illness with severe pain for four years. Her loving husband, son, and daughter had stayed by her side day and night, in her hospital room, and continued their dedicated care at home.

On this visit, her pain had worsened and she was semi-comatose. When I attempted to turn her to assess her skin, she began to cry. We decided to allow her to rest, so I gave her a dose of Fentynal, and she fell asleep. I educated the family about the option of stopping the TPN and hydration, and comfort measures to ease her suffering. Her husband verbalized his fear that her pain would worsen. I assured him that we could work to manage her pain and honor their goal to keep her at home. This required terminal sedation with daily nursing visits for frequent medication adjustments to manage her complex pain management needs.

The primary care nurse, my teammate, was a true advocate for this patient and worked diligently to ensure optimal pain control. She requested that she see this patient for all scheduled visits to maintain continuity of care. However, my teammate became ill and developed a high fever, so she reluctantly took to her bed and called others to take over the patient’s care. I called to update her and provide reassurance that I would take good care of this dear lady. “God willing, she'll be in heaven before your fever breaks,” I said. “Call me anytime, please,” she begged. She was so disappointed she would not be able to be there for this patient during her last few days of life.

I have discovered that working with our team of dedicated nurses is as rewarding as serving our patients. We have become close friends and colleagues. I have learned so much from our collaborative team efforts and I greatly admire and respect my colleagues. When we cover days off for each other, there is a natural flow of like minds and hearts, as we communicate well and step in sync. The patients always appreciate the personal relationships we have on our team and it shows in our approach to their care.

Do you have any additional advice for nurses in home health or looking to enter the field?
I once read that if you love what you do, you will never have to work a day in your life. My advice to nurses interested in this specialty is to make sure it suits your personality. You must be open and willing to feel and share from your heart. Remember to reach out to your teammates for support and do not try to do it all on your own.

This article is from workingnurse.com.

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