Dialysis Nurse, home care nurse

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 thirteen-hour shifts three times weekly exhaust me. I have trouble recovering on my days off and feel as bad as when I used to work the night shift. I started looking for a job with daytime hours. I found a good home for my dog with a single man at church. My condo seems empty without my dog, but I enjoy visiting him some weekends at his new home in the country.

I treasure the fellowship with the believers at church and am growing in the Lord and encouraged to know God better through the Bible messages. I thank God for a good job in a poor economy and trust Him for strength to keep going.

“God is my strength and power, and He maketh my way perfect” (2 Samuel 22:33 KJV).

July 1992

“But my God shall supply all your need according to His riches in glory by Christ Jesus”(Philippians 4:19 KJV).

In December, I became a member of the Bible church I am attending and joined the choir in January. What 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.

The long hours in dialysis continued to exhaust me. I praise God for my new job in home care I started in June. I took a large pay cut, so I work a second job doing home care with a different agency two evenings a week. I love driving around the pretty green countryside and eating 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 understand why the agency requires every home care nurse to have at least one year of hospital experience. When alone with the patient, I must be confident in my assessment skills, know when he can remain at home, and when I need to call the ambulance to send him to the hospital. Most of them are kind elderly folks, so I enjoy chatting with them instead of rushing off like I did in the hospital. Many of them have wounds that I assess and then change the dressing. I do extensive teaching 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.

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, 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 send my total mileage every two weeks to payroll. 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 2019 Federal rate of reimbursement is 58 cents per mile.

It was great to be a home care nurse on sunny days, but not so much during snowstorms, freezing temperatures, or sweltering heat.  The daytime work schedule 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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