NEW YORK NURSE: June 2008
The New York State Area Health Education Center (AHEC) Statewide System recently announced the winners of its statewide Nursing Essay Contest. Two of the three winning RNs are members of NYSNA. All of the essays can be read at the AHEC website (www.ahec.buffalo.edu).
Rose H. Stiles, a home care nurse for the Cortland County Health Department, won the top prize. Second honorable mention went to Phyl McKinney, who works at Samaritan Medical Center in Watertown.
Carol Brewer, director of nursing for AHEC, said, “One of the common threads in these nursing essays is the human compassion, caring, and creativity that nurses bring to their job every day…the pride we have in our profession is exemplified in the wonderful images written by these nurses.”
by Rose Harrington Stiles
The most difficult aspect of being a home care nurse is also the most rewarding. It is entering a person’s home and treating them within the context of their family and community. It is caring for the entire person, and the relationships that form when you do.
Dora had voted in the 1924 election, the first year that women were allowed to vote. She took pride in having cast a ballot in every election since. Now, at 92, she was no longer able leave her home. I met her as her public health nurse following a hospitalization, prior to which she had been quite independent. She was an ideal patient, always compliant, wanting to know about her medications, diet, and how to take care of herself. Her father had been the physician in this rural community. She remembered going out with him in the horse drawn buggy to make house calls. She still had his medical bag filled with vials and surgical tools.
When it became evident she was near the end of her life, she made two requests. She wanted to vote in the upcoming election and she wanted to die in her home, where she had been born and had lived her whole life. The first request was easy. I helped her with a mail-in ballot. The second request was more difficult. She had no family, other than a niece, Arla, who stated that she would help as much as she could. There was no hospice care available.
I worked with Dora and Arla to prepare them for what to expect as death approached. Arla provided supportive care, but became increasingly uncomfortable with the impending death. I visited daily to review expectations and to reassure them both. One day, Dora was in and out of consciousness. I knew it wouldn’t be long. Before I left, I held her hand and told her I would return in the morning. When I arrived the next morning, Arla was seated in the kitchen. “I check on her every half hour, but I can’t bear to stay in the room,” she said. I went into the bedroom, sat by the bed, took Dora’s hand, and told her I was there. She nodded slightly. She died five minutes later. She had waited for my return so her niece would not be alone.
Care at home is delivered according to the patient’s priorities. You enter the sanctuary of their home, meet the family, the dog, and you take your shoes off at the door sometimes.
When patients are in their own homes, they want and need to have more control than when in a hospital bed and gown. The home care nurse teaches them to (or learns to let them) take charge. Shelly was 14 and quite modest. She had a port that needed to be accessed and flushed weekly. She would allow me to supervise, but she did the entire procedure. We figured a way that she could wear a half slip pulled up over her chest to preserve her modesty. Not even her mother was allowed in the room until everything was set up.
Sometimes it isn’t all so rosy. Not everyone has a clean, or even warm, home. One time I cross-country skied to get to a home. A teammate set up a sterile field to do an abdominal wound packing on a patient while, in the same bed, a mother cat was birthing kittens. One of my patients lived in a converted rabbit hutch. He had a wood stove, a cold water tap, and an electric light. No other indoor amenities. He was confined to a wheelchair. He challenged my creativity when it came to figuring out how to keep him safe and healing in this home he insisted on staying in.
Home care nursing is different than any other specialty. You will be frustrated, challenged, touched, embraced, and rejected, but you will never be bored. You need to know all the resources in your community and how to make things happen when there is no resource. You learn to schedule your visits around The Price is Right. You will be recognized in the grocery store and introduced as “my nurse.” You will strive to be HIPAA-compliant in a small town or a city neighborhood where everyone can identify your car. Home care nursing is not for the faint of heart, but it will cause your heart to be full.
by Phyl McKinney
My husband once said to me
“It’s not like what you do requires a lot of skill.”
With a glance at my expression he quickly changed tack to
“Well, OK…maybe it does.”
It was then that I decided:
It is impossible to understand what it is to be a nurse,
unless you are one.
How could it possibly be put into words?
How do you explain what it’s like:
To be patient advocate or doctor representative,
depending on whether you’re walking into or out of a room.
To hug a grown man while he weeps for his dying mother,
then walk into the next room and “high-five”
the 80-year-old man that gets to go home today.
To be needed for knowledge
and depended upon for kindness.
To be compassionate, understanding, empathetic
and objective simultaneously.
To realize it never gets easier to watch someone die.
To follow someone else’s orders
while prioritizing, organizing and delegating your own.
To take pride in exemplifying team work,
and be humble enough to ask for help.
To feel like you’ve reached your breaking point,
only to be saved by a simple, sincere
whispered when least expected.
To look back at the last 12 hours
with a crooked smile and the thought:
“Nursing: No Skill Required!”