At this point you may say, “Well she finally lost it after all those years of nursing!” However, I want the younger nurses to start thinking about a career in the field of home health care. YOU can make a difference in the lives of so many by making the right calls at the right time. You can teach, protect and foresee on a first hand basis what is happening in your patient’s life.
Working as a home care nurse is not like any other job you will have in the setting of a hospital, clinic or doctor’s office. You must leave the comfort of knowing that someone is at your elbow to help access a vein for lab work and to know that there is no one but a family member to help you do a transfer from the bed to a wheelchair.
The home care nurse is usually a seasoned veteran of the craft who has had many experiences and acquired much knowledge along the way. They know the ropes and take a situation and fall back on what they have learned to make the right decision based on their assessment. She or he can recognize these situations that may be going sour and alert the patient’s physician to what they feel, see, smell and know. Being the “doctor’s eyes” and right there in the patient’s home, t
hey can make recommendations. Without a doubt, they are the unsung heroes of nursing. I would like younger nurses to read this article and start to think if you are up to the task as you grow in your experiences and knowledge and consider becoming a home health nurse. The rewards of watching a patient’s face light up when you come through the door and show them a procedure that they themselves or a family member have not been able to master is worth a thousand hugs and so rewarding. You will, however, have the occasional patient and situation that can be not so pristine and not so sterile. Let me give you an example, but remember this is not the norm.
Now, this really happened to me so I know it to be true. For this example, though, we will pretend that you have been assigned an elderly patient in her 80’s whose name is Martha. Martha’s health has been declining but she keeps getting frequent infections and the doctor is at a loss of why this keeps occurring. You…..yes YOU…..arrive at the patient’s home. This was a great day because the directions were not complicated, and you found the house right away and all was great with the world because you didn’t get lost!!! You exit the car in front of the patient’s home with bag in hand.
As soon as you scrape your foot across the hot July pavement to climb the concrete steps, you notice a distinct aroma that just about “knocks you flat.” Oh my God, that smells like cat urine!!! The closer you get to the door the odor increases and your head is swimming with thoughts of what is on the other side of the door. You knock. You listen to the sounds of someone approaching the door and then crack it just a bit to look out. You explain why you are there, and the door opens wide. Your first thought is, “dear Lord” but the little face looking up at you is one that is frail, solemn and kind. “Come in dear,” she says as the screen door opens. Quickly you look around the room and decide on a plain wooden chair with no covering or padding. Seems like a safe choice; and your patient, with tiny shuffles, sits down in her chair.
While doing her vitals you glance around the living room which opens to the kitchen. You notice your patient has decorated in “early litter box style!” There are at least 6 or 7 in the living room and several in the kitchen. You observe the ones that you can see, and they look like they should have been changed a month ago. My patient must have noticed me observing the decor and told me that her son, who lived with her, liked cats and had moved in with her a month ago when he lost his job. She explained, “I don’t know why we have so many now, they just seem to be multiplying.” As I did her assessment I asked if her son was at home and she dialed his number on the house phone and asked him to come down the stairs.
I am on the computer logging in my notes when a very disheveled younger man comes down the steps. “For God’s sake mother what is it now?” he asks. “The nurse wants to talk to you for a few minutes,” she answers. He plops down in a chair and stares at me waiting on me to question him. At this point I have had a fly doing a three point landing on my computer every three seconds. Yes, it was so bad that I was counting the seconds! Not only must there have been hundreds of flies in the home but also in a rough estimate I counted about 30 cats that I actually could see. Martha was actually wearing enough short hairs on her clothing that she easily could have made a cat out of all that hair.
“You know,” I said “your mother is living in an environment that is not at all healthy for her, and she has been having infection after infection. I am looking around your home and I see way too many cats for one household, and these are just the ones that I can see. The flies are literally dining off of the filthy litter boxes, and the cats who use the litter boxes are climbing on the kitchen counters. If something is not done by my next visit, I am afraid I am going to have to report the situation for your mother’s sake.” He looked around the living room as if seeing it for the first time. As I rose to leave, my nursing uniform literally peeled slowly from the wooden chair. He heard it and looked me in the eye and said, “It will be cleaned up before you come next week.” I almost volunteered to help him for her sake–it was that horrendous!
The following week I revisited my patient. At the steps, the odor was not so overpowering. When the door opened, I didn’t need to hold my breath. My little patient had a wide smile on her face. Gone were the litter boxes, the cat population had diminished greatly and the aroma now smelled of Lysol/cat urine. Not one fly landed on my computer, and my patient looked into my face beaming. “After you talked to my son he really got busy and cleaned up the place!” It was all very worth the shock and awe of that dreadful day just one week earlier to see the delight on her face now!