Nursing Blog

So You’re Thinking About Home Care…..

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Home Care…. Sounds as though it may be easy for any of you hospital kids that may be looking for something different, right?  Maybe you’re looking for a change or are just so incredibly tired of the insanity of it all, and who can blame you?  Hospital nurses work long hours. Then you’re stuck in a poorly ventilated building with patients who are getting sicker, heavier and crazier by the day.  You have all of the staffing issues and your working holidays, and weekend/night rotations.  You’re killing yourself.  You go above and beyond to cover being so short staffed.  And let’s not forget the endless charting.  But you couldn’t forget that if you tried.  Your hands are slowly starting to turn into claws from the repetitive pressing of the keyboard.  Your temples pulsate and your head feels like it is in a vice.  It’s worsening by the minute from all of the straining your eyes are doing while staring at a screen charting… charting… charting!

Eureka!  Maybe home care is the answer.  It would be such a nice change of pace, wouldn’t it?  Driving around all day, you can stop and get a coffee or pop into the bank, maybe run an errand or two.  You can even pick up your dry cleaning!  You won’t miss another school play and can maybe make all the parent teacher conferences, not feeling like a bad parent for once.  Your children may actually see you every day…… Sounds perfect, right?

Well, yes… these are the advantages and home care does offer these things.  You do have autonomy.  You can schedule your day usually in a way where you can do all the above mentioned.  These definitely are the perks, and it is something to consider.  Home care works well for people especially those with small children.  I have found that management in home care is very understanding of family obligations as most of their staff are mothers.  I did not have that same experience in the hospital I must say.  So, home care may be for you…


But…… don’t forget that everything has a but…..  And before you make that career changing decision, maybe we should take a little looksee at what home care may also be like at times…  Here are just a few of the many challenges……. Buckle up.


Challenge #1:  No More Sterile Environment.  This is Their Turf on Their Terms
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Ding Dong……”It’s the visiting nurse,” you say, and enter the patient’s home after being invited in.  Of course, the word home is a relative word and could mean different things to different people.   For various reasons, consider that home for your patient may be one of the following, however, not limited to: a hotel room, shelter, half-way house, porch, sofa on a porch, mattress on a porch, mattress on a side walk, a shed, a car and even a school bus.  Just to name a few.  Interesting, right?

Let’s also not forget that not everyone lives the way that you do.  But if you are a hoarder, recluse, with a love of collecting cats, then you may be slightly prepared for some of the more challenging households in this field.  Better still…..  If you are a hoarder, recluse with a cat collection, flea infestation and a love for putting doll heads in mason jars then you are even more prepared for this gig.

Now, these are the worst-case scenarios but they are very, very real.  You will not be in your nice sterile hospital environment.  You’ve been a little spoiled in this regard.  You are in their environment.  And that environment may be one filled with doll heads in mason jars.  So, this comes with some interesting challenges.  For example, you cannot go into someone’s home and tell them they cannot smoke.  It’s their home. and they will be sure to let you know it.  They can do what they want and live how they want within reason.  My how the tables have turned on us.


Challenge #2:  Getting to the patient’s home should be easy, right?


You also need directions to the home.  Sometimes this may be as easy as go up two streets and take a left and it’s the big green house on the corner.  Your GPS will effortlessly take you right to the door.  Easy peasy right?  Or, you may get something sounding like this:

“Go up the alley and then up the two flights of stairs over to the left after taking two rights.  Watch out for the pit bull, he is vicious.  Then, and if my neighbor comes out screaming, just ignore him as he is crazy.  Next.. climb the fence and leap over the hedges.  Don’t mess up my hedges!  Also, sorry we didn’t shovel and by the way, we will never shovel.  We can’t shovel and do not own a shovel.  Shoveling is not an option for us.  Now wade through the snow drifts and be careful of the two-inch thick unsalted ice covering the rotting stairs to the front door.  Hopefully, you can find the stairs.  If there is a woman at the end of the stairs hanging around, provide her with a secret hand shake (you are then instructed how to give the hand shake).  Next, it is very, very important that you MAKE SURE that you call first, please!  If no one answers call back ten times and let it ring.  We will pick up after ten times.  Be there right at 10 am as Wheel of Fortune is on at 11 and Days of our Lives comes on after that, so do not be late!  Make sure to knock three times at the door as the doorbell doesn’t work and we will never fix it as fixing it is not an option for us.”


Reading the directions and two panic attacks later about the directions…..

You follow everything said to the letter.  You are there right at 10 am.  They know that you are coming, RIGHT AT 10, as they requested, RIGHT AT 10.  You called to confirm this and then called again as you were walking up the alley calling the ten times as instructed and letting it ring.  Your patient answers and you tell her you will be right there as you huff and puff while trudging through the snow drifts then faking out the pit bull with the bone that you stopped and bought, throwing it as far as you can while making a break for it and sprinting up the icy stairs.  You feel a crunch under your boot and lose your footing, then fall and seemingly sprain your ankle after getting it caught in a hole in the rotting wood.  Wearily, you start to get up and you now notice that the house which you hadn’t paid much attention to is clearly a haunted house of horrors, making your day that much better.  You consider the possibility that you may never make it out alive.  You think about turning back, but you’ve come so far!  You drag your throbbing limb up the last few steps and reach for what is obviously a giant gargoyle door knocker.  You tap three times on the door trying to catch your breath and are ready to give the secret handshake just in case there is a woman inside who asks for it, as she was not at the bottom of the stairs as stated, in the instructions; although she surely could have drowned and frozen to death in the ten feet of snow which had drifted there.  No one answers the door.  You are a thousand percent sure Pat and Vanna aren’t on yet because you can hear Maury Povich saying “You are not the father,” so loud coming from inside the house of terror that whoever was in their wouldn’t hear you if you bulldozed the house down around them.  You look at your watch. Ugh!  It’s 10:05.  You knock again and again.  No answer….  You call again and this time, of course, no one picks up, and you are on the 11th try.

 

Challenge #3:  People are not Always Reliable or Sane and Kind of do Whatever the Heck They Want to do Sometimes….

Alrighty then….. Recap:  Your patient isn’t answering the phone or the door and you are one step away from a total mental collapse.  You next call the emergency contact listed in the record.  They say hello and then begin to scream at you in alien they then start hysterically crying and hang up.  But you persevere….  You call the patient 15 more times and knock again.  Sometimes I picture that the patient is inside peeking out an upstairs window laughing at me as I am calling and knocking and looking at the time, about to have a nervous breakdown and mumbling gibberish to myself.  I mean they must be right?  Or, I think that I am on an episode of Candid Camera as this stuff doesn’t happen in life, right?  Wrong!

You have no other option but to now call EMS per protocol and wait because maybe the patient has fallen inside the home or something worse, although you look in the window and notice through the cob webs and dead flies, what appears to be some white hair slightly overflowing the top of a ripped old recliner in front of a screaming Maury Povich on a giant TV screen.  You assume this white hair is attached to a head but would not be shocked at this point about anything.  You wonder if the patient is ok, or is it that she just cannot hear you.  You know for certain that she cannot hear you over Maury.  Nothing of this planet could hear you over Maury right now.  You sit and wait, rubbing your now swollen, throbbing ankle.  EMS arrives and you exhaustingly say hello while trying to explain the situation.  One of the crew angrily shushes you saying, “We know!”  He looks as if he wants to choke the life out of you as apparently, you are told, that they are at the haunted house of horrors daily.  I would want to choke me too.  Just then it becomes eerily quiet. The door slowly opens as the EMTs are going to attempt to get through and there is the patient.  She looks around at all of you and then proceeds to yell at everyone.  She shakes her cane and goes on to say, “No one was to come when the wheel is on!  I have been waiting for an hour!”  She next slams the door in everyone’s face and of course, the gargoyle door knocker falls on your other foot because, why wouldn’t it?   You start to then rethink all your life decisions that got you to this point, as somewhere along the line you realize that you made a very big mistake.  Now defeated and horrified at the possibility of coming back here tomorrow, panic sets in as you remember that you stupidly only brought one bone for the pit bull on the way in, forgetting that you need to also not die on the way out.  Home Care Rookie Mistake……  You start to cry to the EMS guys and thankfully they take pity on you, as one of them shakes a bag of milk bones and says the best sentence that you have heard all day, “Let’s get the hell out of here.”  You are relieved and happy that you won’t die yet today and follow them closely back through hell.

Home care like any job has its benefits and its challenges.  It’s all about what works for you.  I would not have been a proud home care nurse for as long as I had without loving many aspects of the job.  I just want you to have all the facts friends.  And, I know it may seem that I am exaggerating for effect, as I have been known to embellish from time to time….  And, well, yes…..  I can honestly say that I am.  But just a tinsey winsey bit, as the EMS folks are generally always pleasant…..

 

 

Stay tuned…. More to come.

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