Each Job, Every Day: Home Care and Hospice Nurses

To many people, driving across the metro alone to spend an hour in a stranger’s home is the definition of “awkward.”

But to a home care or hospice nurse, that’s all part of the fun.

“One minute, I can be on Lake Minnetonka in a million-dollar home and, within the hour, I’m in a government building watching out for bedbugs—but I think that’s awesome,” says Angie Oujiri, RN with Fairview Home Care. “We’re invited into peoples’ most intimate and sacred places and really make a powerful impact on their health care journey.”

The nature of a home care or hospice nurses’ work demands that they be skilled at making personal connections and building trust. Fortunately, they are a clever bunch.

“Talk about their dog,” says Hannah Arbogast, Fairview Home Care RN. “If you can remember that dog’s name and address it every time you visit, that patient will trust you and like you. One of the most important things we have to do is build that trust from the beginning— I don’t know that we could do our jobs without that.”

What they do

There are many misconceptions about the role of home care and hospice RN, even within the medical community.

“I think a lot of people come from hospitals or rehab centers and think, ‘Oh, you get to go to people’s houses and talk with them; it’s more relaxed and slower-paced,’ and it’s nothing like that,” Hannah says.

Hannah in her "Office".

Hannah in her “Office”.

Though their roles are different, home care nurses and hospice nurses have similarly structured days. In the mornings, they usually check their voicemail and email and respond to any pressing needs. Then, it’s off to patient visits: nurses are assigned to a geographical area and see between five and eight patients each day, with each visit lasting between 30 and 60 minutes. Hospice nurses manage 13 to 15 patients at a time, while home care nurses manage about 25 patients.

Home care nurses check vital signs, weight, wounds, etc. Some patients also need hands-on skilled care, such as a catheter changed or lab specimens drawn. A significant portion of each visit is spent teaching patients and family members about things like medications, warning signs to report to a physician and how to best manage their illnesses.

Between visits, nurses make follow-up calls to the patients’ doctors to update them on a change in stats, finish charting, respond to other patients who have called during the day, make condolence calls (in the case of hospice nurses) and clean up odds and ends—all from the driver’s seat.

An army of one

Because home care and hospice nurses visit patients solo, they have an immense amount of control over each patient’s care.

For example, hospice nurses have “standing orders,” meaning they can start certain routine medications and treatments without contacting a physician beforehand.

Hannah listening to a patient's heartbeat.

Hannah listening to a patient’s heartbeat.

“I almost feel like a nurse practitioner, because I have so much freedom and I’m so trusted,” says Jody Kriese, hospice RN. “We can have drugs couriered to a house within an hour. We can have a wound nurse come out; we can request a physical therapist or occupational therapist come for a one-time assessment; we can get equipment quickly. We’re given a ton of power and a ton of trust.”

However, with great power comes great responsibility, which Angie says can be daunting.

“At the end of the day, you are the only one out there. You don’t have that immediate support of your colleagues to back you up. We do have interdisciplinary teams to come together, but it’s not as convenient as in the hospital. This job affords you a huge amount of autonomy, which is awesome.”

Why they do it

“I love that Fairview is really trying to create a health care continuum, and home care is a big part of that,” Hannah says. “In the hospital, nurses and doctors do an awesome job in preparing patients for discharge but, with everything that just happened– lack of sleep, new medications, coping with a diagnosis they just got – when patients get home, none of that has stuck with them. Home Care is so necessary to keep those people from bouncing back into the hospital.”

Those in the field agree that the best part of their role is the opportunity to help patients on a personal level.

Hannah checking a patient's blood.

Hannah checking a patient’s blood.

“We have the luxury of spending more time with patients, which allows us to be a very powerful force in their ability to take care of themselves,” Angie says.

And those patients (and families) teach the nurses, too.

“The best part of my job is empowering families in ways they never realized they could have,” she says. “That’s incredibly rewarding. We see so many cruddy things in the world, but I get to see families come together, even if they don’t get along. I find it amazing what people will do for other people.”