Sunday, March 3, 2013
TING AND I, Home Nursing Care, I
How did a nurse from a village in South America make it to us? We needed people who were not afraid of the responsibility of a ventilator-dependent patient. The second nurse I hired (August 2004) was an intelligent, warm, attractive mother of two, originally from British Guiana. A minister’s wife, she was an LPN who had no ventilator-dependent case experience. She was willing to learn, however, and I was able to train her easily. [Perhaps half of the nurses we hired subsequently needed such on-the-job training.]
For a year and a half, her family lived within a dozen miles and she commuted daily. Her husband’s ministerial career then took them to Long Island, so for another two years she came Monday mornings, worked during the week, sleeping at our house, and returning home Friday evening. When this got to be too much for her and her family, we regretfully waved goodbye (November 2007). She was inspired to continue her education toward her RN license.
Another early hire (November 2004) was a local RN who has been with us since then, for more than six years, serving effectively as our head nurse and my personal nurse. Her high intelligence, broad experience, and almost obsessive attention to detail, along with great personal warmth, and a great sense of humor, have made her an invaluable asset. Although we did inherit from the agency a variety of forms with which to track medicines and treatments daily, she improved them, developed new management tools, and provided insightful advice on a wide variety of nursing and management issues. Now semi-retired, she still comes to nurse, to organize, and to write the semi-annual reports we need to submit to our insurers, United Healthcare.
Some say the problem with public transportation is the public. Nurses will tell you that the problem with home care is the home. They can do their jobs under a variety of conditions, but the nature of the home can make the job pleasant or unpleasant. We tried to keep that in mind. Tina is a patient patient and a gracious and grateful one. I am appreciative, too, though businesslike in manner. I praise in public and criticize in private and try to be clear in communications. We have not only detailed shift record forms to be filled out each shift by each nurse, but also a communications notebook for information that is less technical but needs to be shared.
One goal is to make the job a place the staff looks forward to coming to.
We try to live up to our motto, “Tina comes first, but everybody counts.”
On the refrigerator in the nurses’ kitchen, I post two or three months of shift schedules. Each row is a date, and the columns are for three or four shifts, typically 4 to 10 hours each, during that date, indicating which nurse (her initials) is to be on duty. I started by giving each nurse pretty much which shifts she preferred, and then I negotiated to fill the less-popular hours. I required the nurses doing 16 hours or more a week to serve some week-end time. The 10-hour shifts were almost always overnight, from 10:00 p.m. to 8:00 a.m. If a nurse needed to take some time off, she gave up hours temporarily to another nurse or traded with other nurses. They marked up the schedule to show the revision, with my approval. If a nurse did the same shift for a month or two, she “owned” it. There was a “use it or lose it” factor. New nurses were hired to fill particular gaps, then later tended to get more hours as the occasional vacancy developed. With the help of my nursing business manager, Barbara George, we almost never had a period without nursing coverage.
In the home care situation, we have almost no privacy. The baby monitor connecting Tina’s bedroom to the nurses’ kitchen/headquarters is almost always on. Whatever one does or says is likely to be known. The nurses, too, have little privacy, as they may readily be overheard or observed. One gets used to it, and we make some effort to back off and provide each other a bit of privacy, at times.
Of course, when you are not doing something you shouldn’t, the need for privacy is less. Once or twice during the week, Tina and I lock her bedroom door, use the dimmer to turn down the lights, turn off the baby monitor, and turn on some romantic music. It’s a good opportunity for each to tell the other, “I love you, every cell, every second; every molecule every moment; all ways, always.”