Thursday, December 1, 2011

Cupcake Walking?

"...and they asked her how she liked doing Home Care and she said, 'It's a cupcake walk!'"  The Super shook her head and asked me,  "Now that you've been out there for awhile, do you agree with her?  Is Home Care a 'cupcake walk'?"

I cast my mind back over dozens of visits, the parade of faces passing in review; Mr Train Wreck, Kitty Man, Lung Lady, the Edema Twins, and their kind, concerned, families and friends.  "A cupcake walk?" I said, "Not hardly!  I don't know where or how she was practicing, but is sure wasn't here and now."

Home Health is nursing for sole proprietors-at-heart, requiring a sort of entrepreneurial spirit and a love of the open road coupled with nerves of steel and a head for infinite detail.  Add to that tolerance for reams of government paperwork and scheduling.  Bring with you a fondness for human quirks and a self-assurance that you know your patients, nursing-wise, better than anyone but God.  There you have a Home Health Nurse.

Personally, Home Health Nursing puts a smile on my face that I seldom had in Hospital Nursing.  Just being able to talk with my patients, to establish a relationship with some of them, help solve their problems, figure out where their learning deficits are and teach to the gaps in medical information, nurtures me in return.  Hospital Nursing is far more high-tech and treatment oriented, because they see medically unstable patients.  No one pays for a patient to lie in hospital unless something pretty technical is being done for him.  So, hospital nurses spend their time executing orders for Medication and Treatment in a timely manner; review plan of care, meds, labs, and imaging; manage acute problems, and chart it all accurately.   Add to that at least one patient to be admitted or discharged (another blizzard of orders) per shift, and you're lucky to get a lunch.   There is less time to talk and teach in a hospital setting.  Sometimes it's difficult even to get a bathroom break.  Maybe the Hospital Nurse of the Year is able to accomplish both technical care and talking/teaching, but the rest of us are only human.

Do not imagine--for one moment--that Home Health Nursing goes at a slower, healthier pace; it does not.  Home Health Nurses do everything Hospital Nurses do, only their patients are (at least somewhat) stable and scattered across the community.  My bulky bag is the modern equivalent of the one carried by fictional character Sue Barton, who remarked on the weight of the heavy black bag on her arm marking her as a nurse among the Henry Street patients.  My car has become my supply room.  I chart with government requirements always at the back of my mind.  I set up and change the visit schedule as necessary.   Whatever the patient needs, if I don't do it/ask for it/order it, the patient goes without.

As friend Little Mary says, "God is in the details."  If you enjoy independence, glory in nature, and have a desire to walk with patients/families through difficult times, you're going to do just fine.  That's the beauty of Home Health.

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