From Dialysis to Home Care

November, 1991

I have now worked in the new dialysis center in the suburbs for about three months. It is going fairly well, although the 13 hour shifts three times weekly are so long and exhausting. I’m having trouble recovering on my days off and am feeling about as badly as when I used to work night shift. I started looking for a job with daytime hours. I was able to find a good home for my dog, Sandy, with a single man at church who has his own business and takes Sandy with him in his van. My condo seems rather empty without Sandy, but I enjoy visiting him some weekends at his new home in the country. He just about wags his tail off when I visit, but he seems to enjoy his new owner.

The fellowship with the believers at church has been very precious and refreshing. I feel like I’m growing in the Lord and being encouraged to know God better through the Bible messages. I thank God for a good job in a poor economy and trust in Him for strength to keep going.

God is my strength and power; and He maketh my way perfect. II Samuel 22:33

July, 1992

But my God shall supply ALL your need according to His riches in glory by Christ Jesus.  Philippians 4:19

The Lord has been marvelous to me and continues to teach me so much about how wonderful He is! In December, I became a member of the Bible church I am attending,  and joined the choir in January. It has been such a blessing to sing with a group again, and lift up my heart to praise God. I was also able to play my violin with an ensemble at a children’s program.

I was thrilled to go cross country skiing three times in the mountains of Vermont and New Hampshire! I also spent a long weekend in Washington DC with a couple ladies from church. In June, the Career Group from church had fun touring the quirky Gillette Castle overlooking the Connecticut River. Quite different from the castles in Europe!

Skiing in Vermont 1992

Skiing in Vermont 1992

Skied at the Balsams grand resort in New Hampshire 1992

Skied at the Balsams Grand Resort in New Hampshire – 1992

Toured the White House in DC with some ladies from church 1992

Toured the White House in DC with some ladies from church – 1992

Quirky Gillette Castle overlooks the Connecticut River

Quirky Gillette Castle overlooks the Connecticut River

The 1880 colonial home God let me buy in 1992.

The 1880 colonial home God let me buy in 1992.

The long hours in dialysis continued to be a trial. Praise God that He gave me a new job in home care last month! I took quite a pay cut, so I have a second job doing home care with a different agency two evenings a week. I love driving around the pretty green countryside and being able to eat my sack lunch at a different place daily. I discovered the town library and town hall have clean restrooms, as well as most fast food restaurants.

A favorite library, lake, and orchards in my district

A favorite library, lake, and orchards in my district for lunch stops.

Lake Beseck 3 Lymans view 3

I feel like I am using my brain again to autonomously solve the problems of my patients. I can understand why the agency requires every home care nurse to have at least one year of hospital experience. When I am all alone with the patient, I must be confident in my assessment skills, know when the patient can remain at home, and when I need to call the ambulance to send the person to the hospital. Most of my patients are elderly and very kind, so it is nice to have time to chat with them instead of rushing off like I did in the hospital. Many of my patients have wounds that I assess and then change the dressing. I do extensive teaching with each patient on how to manage his condition, and when he needs to call the doctor or the nurse after hours.

The most difficult part of the job is finding the patient’s house the first time. The admission nurse writes directions in the chart, and then I study my maps every morning before I leave the office to try and remember the route visually. I usually can locate the home, but I have trouble finding my way back to the main road. I also have trouble backing out of long driveways, so sometimes I just park at the end and walk to the house. Perhaps I have poor depth perception?

I write the name, address, and phone of each patient on an index card and then place the cards in order of my visits on my desk at work. If my supervisor needs to contact me, she calls each patient until she locates me. Occasionally, I have to make an urgent visit or see a patient a day earlier than I had planned. After I finish my visits, I return to my home to finish charting so I only go into the office in the morning, which is conveniently located one mile from my new home.

My car trunk is full of chart file boxes, extra supplies, and my large nursing bag. I write down my mileage every day and turn in my total mileage every two weeks to pay roll. They reimburse me 28 cents for each mile I put on my personal car to cover the gas and maintenance.

Reflection

With the invention of  GPS and cell phones, it is much easier for a home care nurse to find her patients and for her supervisor to find her in the field. Unfortunately, the volumes of charting in home care have increased over the years even though it is done electronically now on laptops. The pressure has increased to see more patients each day and bring more income to the agency since the reimbursement rates from Medicare and insurance companies have decreased. By the way, the 2016 Federal rate of reimbursement is 54 cents per mile!

It was great to be a home care nurse on days when the weather was gorgeous, but not so much during snow storms, freezing temperatures, or sweltering heat.  I enjoyed the daytime work schedule which allowed me to participate in evening activities at church. I only had to work one weekend a month and could sit in the balcony for a portion of the morning worship during my lunch break since the church was within my territory. There are pros and cons to every type of nursing!

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