NEW YORK NURSE: November 2009
by Randi Hoffman
Judy O’Donnell is a home care nurse with the Visiting Nurse Association of Staten Island.
She enters the homes of six or seven patients a day, driving her car from assignment to assignment. She has a caseload of 30 to 40 patients at any given time. For more than two decades, this has been her job for five days a week and one weekend a month.
“The acuity of the patients has changed drastically over that time,” said O’Donnell. “When I started, I was working with 65- to 75-year-olds with adult onset illness. Now the patients are a generation older. People who used to be kept in the hospital for three weeks after heart bypass surgery are now released after five days. There’s a greater risk for instability and the nurse really needs to be in touch with the physician.”
“You see people in their environment and their whole family dynamic,” O’Donnell continued. “You always have to keep your antenna up for elder abuse. Over the years I’ve had to call adult protective services and I’ve had to call child protective services. I called the ASPCA when a family took a duck out of Willowbrook Park and kept it in a crate under the kitchen table. I was afraid it was going to be dinner.”
Home care nurses must constantly use their assessment skills with relatively little backup. This assessment goes beyond the client; it includes the family and the living environment.
“It’s a very holistic form of nursing,” O’Donnell explained. “Your judgment can be life-altering. You may detect underlying mental health issues or diabetes and refer clients to support groups or adult day care. You may see a grandchild with a developmental delay and call in an early intervention for evaluation and referral.”
After more than 25 years in the community, O’Donnell has seen the fourth generation in some families. “I’ll have taken care of the grandmother, and now the granddaughter has a premature baby that needs nursing care,” she said.
O’Donnell has also witnessed changes in the homes she visits. “I’ve seen houses turn over and I notice how the new people redecorate,” she said. “I’ll tell them I like what they’ve done with the kitchen.”
There is a team spirit among the 60 RNs working at the Staten Island VNA. “Everyone brings something different to the table,” said O’Donnell. “Jen Masiello is younger. She’s good with technology and administering IVs.”
Jennifer Masiello has been a visiting nurse for six years. She worked previously in a hospital and then in a nursing home.
“The first six months were a huge adjustment, but Judy taught me the proper way to manage a home care patient and the other nurses offered a lot of support,” she said. “The autonomy of the job can be scary at first. But now I like the autonomy. I like the freedom. There aren’t ten people pulling at you at once. I feel like this is right for my personality. It’s extremely interesting. It changes every single day.”
O’Donnell agrees. “I’ve definitely found my niche. I’m not going anywhere. There’s a challenge and a mystery behind every door.”