My day in the community

Last week I  had the opportunity to spend a day with a community health nurse. It was an experience I didn't expect to like that much. Instead, I found that I "clicked" with it in a completely unexpected way. We visited 6 patients, 3 of whom my nurse had been seeing for a long time. There are a lot of complicated rules governing when and how often a person can be seen by a home nurse that I'm not going to get into here.

I think patients interact with nurses differently in their homes than in a hospital room. They seem more relaxed, more receptive. I also really liked that you got 5 minutes to just talk to people. I learned more about people in a 45 minute home visit that I learned about people I took care of for 4 + days in the hospital. I also learned a lot about how doctor's orders get carried out (or not carried out) in homes. I liked that the nurse practices really independently in the community. She draws labs, makes assessments and recommendations to doctors, who write orders based on those recommendations.  She makes the decisions about how to best structure the visit and what the priorities are for that individual situation. I also liked the case-manager-ness of it all. My nurse was on the phone to pharmacies, doctor's offices, home health aide services, and caregivers. She made referrals, tracked down orders, and went out of her way to ensure that the patient had things in motion before she left the house.

While I enjoyed the people I met, I don't know if that particular population is the one I would want to work with. Mothers and babies? Oh my yes. I know there are some agencies that offer mother and baby visits, especially for at-risk patients. What I don't understand is why a visit from a nurse isn't a requirement after a mother has a child (especially a first child). It should be part of the package.

Have a baby? Here's your nurse! I know I could have used an experienced maternity nurse showing up on my doorstep around day 3.

Breastfeeding not going well? Let me help.
Not sure if they're getting enough to eat? Let me explain.
Concerned about that spot/rash/cough/bleeding/pain? Let's take a look.

Research shows that community nurses keep patients out of the hospital. They keep patients from getting hospital-acquired infections. They keep patients taking medications correctly. They allow them to go home earlier. Why community nursing isn't ubiquitous is truly a mystery to me.