When I first applied to a home health care agency as an RN, I thought it was going to be a “gravy job”. It seemed home health and I were going to be a good fit. The job fostered independence (I was going to be doing home visits alone), I could see one patient at a time, and when I was done I could cuddle up with my computer at home and do my charting.
Once I had my foot in the door and my training was over it was a different story all together. Let me tell you about a patient that I encountered. She was my first visit of the morning.
I was greeted at the door by a relative at approximately 9 AM with a cigarette in one hand and a mixed drink in the other. I entered the living room and noticed two large German Shepard dogs seated on the coach. “I hope we are all friends here,” I thought to myself.
I was escorted downstairs to the basement to do wound care on my patient’s leg. She had just recently been discharged from the hospital. I was very surprised when I unwrapped the bandage and saw an infected looking wound. It was so deep that I could see her tendon showing.
I learned also that the paramedics had been called for this patient earlier in the morning for a blood sugar of 47. Apparently they inserted an IV and gave her some dextrose right there in the basement. Due to the condition of the wound, I paged the doctor and got an order for a wound culture . Once cultured, the specimen was driven, by me, to the lab at the hospital. The patient was notified of the results.
There were several things that concerned me about the scenario. First of all, it didn’t appear to me that she should have been sent home with a wound in that severe condition. I was also concerned that her blood sugar was treated by the paramedics but there was seemingly no follow up. Something else that concerned me was the fact that while I was doing the dressing change she was smoking a cigarette. The smoke was blowing right in my face.
I was beginning to see, that as a home health RN, there were many more elements to contend with when you are in the patient’s environment at home. After a few visits more, it was decided by her physician, to send my patient to a subacute facility where she could be treated with IV antibiotics and get the medical treatment that she needed. In my opinion, she should have been sent there in the first place.
Another difficult experience was treating an HIV positive patient at home. It was a hot August morning. My patient was at the end stages of the disease process and was dying with wasting syndrome. The apartment he was living in was hot, no air conditioning.
He had a large coccyx wound for which I did wound care. He had a g-tube for tube feedings, which I started, and I had to draw labs from his PICC line. There was a black cat in the apartment. He kept jumping on the bed while I was trying to do the dressing change.
And again, there was cigarette smoking going on. Other things about the apartment were challenging as well. Several friends were in the kitchen playing cards, the supplies were all kept in the crowded bathroom.
For me, all of the combined circumstances were overwhelming, even nauseating. I have taken care of many HIV patients in the hospital without difficulty, but I think it was the combined details , once again, of being in someone’s home or apartment in the conditions in which they lived which made there care difficult and challenging for me.
My last story is about a young man with a gun shot wound to the head. I was going there to do dressing changes. I was also watching his diet as his jaw was wired shut due to a jaw injury. When I first arrived at his residence he told me I should not wear my leather jacket there anymore, as people were killing for those in his neighborhood.
That did not make me feel very comfortable, and I stopped wearing the jacket. He had friends visiting in the home while I was there doing the dressings and it overall was not a very safe feeling. There was another RN during this same time frame that was on a home visit. She actually had to drop down to the ground because of a potential shooting in the area.
In addition to varied home environments, safety concerns, supply issues, and smoking (to name a few), the home health RN is also subject to all kinds of weather. If it’s raining, he or she is on the road. If it’s snowing, windy and blowing – it’s still out to see patients.
All of these things, combined with meticulous charting and multiple corrections, having to drive all lab work and specimens to the lab (on top of all the other driving), waiting for physicians to return calls, sometimes unsafe work environments and doing all of this alone, certainly changed my mind about how I fit with home health care. I know there are many RNs out there that love it and wouldn’t trade it for anything. But for me? Well, I found too many challenges on too many levels for me to operate in my best capacity.
I don’t regret trying it though, because now I know.