In case you are wondering what I do all day….
Today I drove into work at 8 am and got my assignment for the day. I spent half an hour calling patients and scheduling visits. I left the office around 9 am and drove to my first patient’s home (over 30 miles, an hour drive). This lady has chronic heart and lung disease, had a stroke a few years ago, is oxygen-dependent, and is a diabetic. She still smokes and is trying to quit. Her husband smokes too, and they will try to quit together. They have both done this before, and they told me at one point they had successfully quit for 7 years and then started smoking again. I tell them that quitting smoking is very hard, and I recommend they call the tobacco quitline for tips. I try to encourage them, knowing that it’s going to be an uphill battle.
Drove 5 miles to my second patient’s home. He just got out of the hospital with a GI bleed. He also has chronic heart and lung disease. He is now on 7 liters of oxygen continuously and is very weak. He has a lump in his arm that appears to be a phlebitis from an IV infusion while hospitalized. He has lost 3 pounds while in the hospital and he is starting to look more like a hospice patient. He is constipated (of course–there’s always a constipated patient, every day). I call his physician to report on his status and get orders for medications. I leave thinking that this man is pretty fragile, and may end up back in the hospital soon.
I get a call at the end of my second visit that my schedule has changed. I was supposed to see a patient who is coming home from the hospital on a new IV medication. The company supplying the medicine won’t be able to get it to her until late today, so she is going to an outpatient infusion center for today’s dose, and I will go to see her tomorrow instead, to teach her caregivers how to do it in the home setting. Instead, I am headed to see a patient with dementia who lives in a boarding home and who was just discharged from the hospital after an admission for abdominal pain, a bowel infection, dehydration and renal failure. I arrive at the home and find that the patient has very advanced dementia and she won’t let me touch her. She doesn’t understand why I’m there and she just sits there and shakes her head “no” at me. I call her son, who is half an hour away. He says he’s coming, and to wait. I sit and wait with her, and review the paperwork from the hospital. The boarding home staff tell me she refuses to eat fairly often, and is also refusing personal care. When the son arrives, I tell him that home health is not going to be successful with his mother due to her dementia, and that forcing her to do it will just make her more agitated. I tell him, gently, that maybe he needs to consider palliative/comfort/hospice care, if he wants to prevent his mother from going to the hospital all the time with dehydration. He is calm when I tell him this but seems uncertain what to do. I call the patient’s doctor’s office to let them know about my visit today.
In the middle of the day I get a call on my cell phone from the police department (!–not a usual part of my day). They have been called to a patient’s home due to a domestic disturbance, and the patient told the police to call me, his home health nurse. This patient has mental health issues, and is a diabetic, and is still living independently. I had to make a referral to Adult Protective Services two weeks ago because his home environment is unsafe and he can’t manage his own care. Today the patient is asking to go to the ER (he goes to the ER multiple times per week). I call APS again, and talk to his case worker, and beg him to please prioritize this case, as this man is escalating and needs help, fast. The patient tells me he is finally ready to move to assisted living and I am glad to hear this–he really, really needs more help than he is getting right now. The APS caseworker says he will go visit the home later today and see if he can fast-track getting the patient into an assisted living home.
I get to my last patient of the day, a woman who is home from the hospital following a heart attack. When I arrive at the home, her husband tells me they have applied for low-income housing. They live in a mobile home and are both in poor health and he says he wants to move to a place where he doesn’t have to shovel snow. He tells me that low-income housing still means they have to pay $500-$600 per month, and they can’t afford that. His wife tells me they go to the food pantry weekly and she has just applied for food stamps. I offer them the assistance of our social worker, to see if she can help them with resources. I call the doctor to request an order for a social work evaluation.
End of the day, back to the office. I have traveled about 100 miles today and worked 8.5 hours. I did get a short lunch break which was nice. I realize that my day has been more social work than nursing, really, but that’s home health for you. I get a test call at 4:15 pm reminding me that I’m on call tonight. I will keep my cell phone close from 5 pm to 8 am. There is a possibility I’ll be called in the middle of the night for a death visit–we have a hospice patient very close to dying. Tomorrow is another day…