by michele sprague
w r i t e s t y l i n g s
Faces of Nursing
Nurses today have a wide range of options available to them as they seek their career niche. From home health care to critical care to family care settings, the career paths chosen by nurses are challenging and unique. This issue of “Connection” explores the many faces of nursing that are visible throughout all affiliates of McLaren Health Care Corporation.
Debbie Allen VNA
When Debbie Allen, R.N., worked at a hospital she remembers thinking, if only I had more time to spend with patients we could work through some of their problems. As a nurse with the Visiting Nurse Association (VNA,) Allen has freedom to take extra time and loves it.
“There are so many things about this job that are positive, and it’s all because we see things achieved–goals met,” she said. “Sometimes in the hospital you see people get better, but you still know there are a lot of unresolved problems.”
The VNA nurses see six patients a day in their homes. They provide total case management, which means they coordinate all the home health needs their patients’ doctors ordered–physical therapy, occupational therapy, speech therapy, medical social work, mental health and rehabilitation.
Their primary goal is to help patients become self-sufficient. That means teaching patients and/or their families about their illnesses or injuries and how to care for themselves. This may involve wound care, learning how to adapt their diets, using IVs and much more.
And if you want your patients to be successful, you must teach them how to operate within their lifestyle. Allen said it’s challenging adapting special diets to satisfy some of her ethnic patients’ tastes, but she does it to help them be successful.
“This is where health care is being pushed. We’re going to become responsible to take care of our families and loved ones,” she said.
Allen has been with the VNA for approximately two years. In April she was promoted from senior staff nurse to education coordinator. “I want to teach nurses to look at the whole patient–not just a dressing change or IV therapy,” she said. “Home care nurses get that opportunity, which I find very satisfying.”
Community Health Services
When Joy Burns was seven years old she laid in a hospital bed with her leg in traction. She remembers meal trays kept out of arms reach and doesn’t remember nurses checking her often. “It doesn’t take a whole lot to be helpful, and a little help really means a lot to people who need it,” Burns said. She left the hospital determined to become a nurse and help people.
Today Burns is an R.N. with 26 years of experience, who works at Community Health Services, which offers private home care by nurse aides, companions and nurses.
“We are a bridge between hospitalized clients and their needs for assistance before they recover,” Burns said, explaining that patients are released from hospitals sooner today and need help for recovery.
“When we admit someone who has been discharged from the hospital we continue the teaching that we know the nurses started in the hospital,” she said, explaining that many times patients forget instructions because of anxiety or the excitement of going home.
Among the things she teaches her patients–how to give insulin, special diet needs and wound care, to name a few.
“I see empowering and educating as important things that I do in my line of work because when I leave things are better than they were before I came,” she said. “And often times loved ones are able to do things for their family member that they never thought they could do because a nurse took the time to say, ‘you can do it.’”
Burns sees from three-to-five patients a day, and makes monthly visits to each of the agency’s patients to make assessments. In addition to nursing, she coordinates the patients’ care which can include light housekeeping and meal preparation from nurse aides and companies.
“I can’t imagine not being a nurse,” Burns said. “Even when I’m off duty I’m a nurse–I think like a nurse, talk like a nurse and help like a nurse.”
And that she does. Tossed in the back seat of her red car, which she calls her “medical mobile,” are two maps and the City of Flint directory. Her trunk is stocked with sponges, rubber gloves, alcohol swabs and anything she thinks will come in handy.
And on Wednesday she volunteers her nursing services to the congregation of Our Risen Lord Lutheran Church in Burton.
When Barbara Caldwell started working at Kith Haven in 1983 as a nurse aide, she wasn’t prepared for the emotions that followed. The first day I thought, “No way, it’s too hard,” Caldwell said. The nurse aides are assigned a case load of eight patients and do a variety of things–bathing, feeding and lifting patients; taking their vitals; and anything else the nurse assigns them.
Initially Caldwell was not comfortable bathing patients. And it didn’t take long to learn the importance of managing her time. But something else happened–the patients and staff won her heart.
“I fell in love with the people. It wasn’t just one person; it was all of them,” Caldwell said explaining that it’s the patients and staff alike. “Everyone here loves the people, and we work together to take care of the total person–psychologically, socially, physically and mentally.”
Caldwell continued working as a nurse aide, attended Mott Community College and became a L.P.N.
Now she sees 28-32 patients a day and said her days are busier than she imagined they would be. She remembers working as a nurse aide and having her makeup evaporate into thin air. I looked at the nurses, who had makeup on at the end of the day, and thought their jobs we easier. Now she knows it’s not.
Caldwell supervises three nurse aides, distributes medications to patients and does daily patient assessments. Also, she takes doctors’ orders and contacts them if patients need them. And she writes monthly summary reports on all the patients. Basically, Caldwell does anything it takes to ensure her patients get the care they need.
What’s her favorite part of the job?–the patients. “I see each patient at least four to five times a day,” she said. “I talk to them, bring smiles to their faces–just get them laughing and smiling. I just love that part,” she said with a warm smile and tender face. Caldwell is continuing her education to become a registered nurse and plans to earn a bachelor’s degree from the University of Michigan-Flint. And she plans to continue working at Kith Haven. These people need me, she said, explaining that they’re not living in homes surrounded by families.
“I’m going to stay in this field, no doubt about it. I chose this field because it’s a loving field. It's the hands on that I love.”
Marcia Cheff, VNA
We take care of our clients' health through teaching, said Marcia Cheff, R.N. and education coordinator at Visiting Nurse Association (VNA).
Whether patients have been released from the hospital before they’re ready to function by themselves, have progressing diseases, changing therapies, wounds that require regular care, or need help adjusting their diets for medical reasons–VNA nurses help.
The bulk of their clients have been hospitalized and need continued nursing before they can become self-sufficient. VNA nurses go to their clients homes and teach them about their illness and how to manage on their own.
“Patients get well quicker when they participate in their care, understand what the disease is and how they can prevent it from getting worse,” Cheff said. “As soon as they start participating we see them blossom, and they heal faster.” Clients may need help for a couple of days to a year – depending on the nature of their illness, its progression and changing therapies prescribed by their doctors.
Cheff said one of the advantages of home care is that nurses have time to help patients emotionally, as well as physically. Sometimes they see family dynamics that create stress for the patient and hinder recovery progress. “Then we can bring in a social worker or mental health worker,” she said.
Cheff has been with VNA for two years. She began by balancing a patient case load with educating new nurses. Now, she concentrates on educating nurses and sees about five patients a week when doing on-the-job training with nurse orientees. And she keeps up-to-date on the latest changes in the home care field and schedules monthly in-services.
“Being an educator and a nurse gives me the best of both worlds,” said Cheff, adding that she has 7.5 years’ experience. “This is the first time since I graduated that I am in a job I feel I can work at until I retire. There’s enough growth and opportunity within to keep me challenged.”
Community Health Services
All the nurses at Community Health Services can’t be out in the field practicing nursing. Someone must answer emergency calls from nurse aides and clients, get medical information about new admissions and take calls from insurance companies. And someone should visit hospital patients who express interest in home care. That someone is Joanne Crandall, a R.N. with 18 years nursing experience.
“I’m practicing my nursing skills even though I’m in the office because I’m using my mind,” Crandall said. “I’m just not using my hands.”
When she gets emergency calls, she guides the caller’s actions, calls an ambulance and the doctor, if needed, and notifies loved ones of the situation. And when clients seek admission, it’s Crandall’s medical training that helps her ask the right questions about their medical needs.
In addition to private nursing, Community Health Services offers help with housekeeping, meal preparation, running errands and transportation. Therefore, Crandall will find out if clients need nurse aides and companions to help with those services too. People who can afford private home care are fortunate, she said, explaining that they can stay home in comfortable, familiar surroundings instead of going to nursing homes. But don’t stereotype Community Health Services as only being available for senior citizens. Their patients range from infants to over 100 years old. Some need services for a couple of days; others need them for years.
Although the bulk of Crandall’s responsibility falls in the office, she usually sees patients two to three times a week–when she’s the only nurse available. And she loves it. “Most of them are a joy to visit,” she said. “You smile, you sit and talk, and it’s more like a visit than acting like a nurse. Yet you’re doing your job at the same time.”
Lapeer Area Hospice
It’s not uncommon for Joyce Lee’s telephone to ring at two o’clock in the morning. And it’s not uncommon for Lee to report to work after spending a sleepless night with a patient and the patient’s family. It happens at least once a week when the registered nurse is on call for Lapeer Area Hospice.
Whether the patient needs to talk, the family is alarmed because the patient’s condition suddenly changed, or the patient is nauseated or in pain, Lee goes to the patient’s home as quickly as possible.
“We don’t want patients to wait until morning to call us,” she stressed. “We want them to call us as soon as they have a problem.”
The hospice’s patients have a life expectancy of six months or less, and the nurses at Lapeer Area Hospice are dedicated to making their last days comfortable. They accomplish this through pain and symptom control.
“Being comfortable means so much to a family. I think they can accept death more than they can accept their loved ones suffering,” Lee said. The medications we provide relieve pain, thus enabling patients to enjoy the days they have left, Lee said. And that’s what she finds most satisfying–extending their quality of life in their homes surrounded with their loves ones.
“Working as a hospice nurse is nursing at its utmost,” Lee said. “I want to be able to spend time with patients, anticipate their needs, and be there for them, as well as for their families.”
But it’s inevitable that her patients die, and she gets those calls too. Again, she quickly goes to the patient’s home to help the family. She notifies the funeral home and the doctor.
“It’s a stressful time for a family, and we try to make it as easy for everyone as possible–listening to them and then validating everybody’s feelings.
Lapeer Area Hospice
When Cheryl McCreedy, R.N., joined the Lapeer Area Hospice, people told her she would be burned out within two years. Seven years later she’s wondering when and if the burn out will come.
Her nursing days are spent dealing with physical and emotional pain, terminal illness and death. They’re also spent listening, supporting and educating patients and their families. And some of her nights are spent helping people when their loved ones are dying, or making arrangements when they pass away.
“I get tired, you know, physically tired. And sometimes I get emotionally exhausted. But I love this job,” McCreedy said with her voice softening and her face glowing with compassion.
What she finds most rewarding is that under the guidance of the medical director she makes it possible for her patients to live without pain. “Our focus is pain and symptom control,” McCreedy said, explaining that the agency’s goal is pain control within 24 hours.
“We hear about people who have suffered for months and months. And all of a sudden we provide some medicine and the pain is gone in 24 hours–sometimes even four hours,” she said.
The hospice nurses work with primary care givers in the family, and teach them how to monitor and control the patient’s pain. The prescribed medications relieve pain and don’t induce drowsiness, McCreedy said, adding that drowsiness results from the progressing disease.
Another thing that brings her satisfaction is making it possible for patients to go home and live their last days without pain, surrounded by their loves ones.
“It’s like going on this dangerous journey. It can be terrible between now and then. Or it can be as good as it can be. The doctor and I work as a team to make all those obstacles go away,” she added.
Remember when your parents told you to respect your elders? Dave Ostrander, L.P.N. at Kith Haven, does more than that. He made it his life’s mission to care for the elderly.
“A lot of these people actually paved the way for us,” he said. “I may not know them, but they opened doors for a lot of people. And now it’s time for me to take care of them.”
Ostrander’s eight-year nursing career has been spent in nursing homes, with the last four and a half at Kith Haven.
“There really isn’t much that I don’t do here that I wouldn’t be able to do at a hospital,” Ostrander said, emphasizing that it’s a busy job which is a must to keep this former Arizona policeman satisfied.
He cares for approximately 30 patients and follows the doctors’ orders with each one, including giving peritoneal dialysis, and maintaining and monitoring IV therapy. His job responsibilities vary. You will see him admit new patients, administer medications and treatments, and make daily patient assessments. But no matter how hectic things get, this easy going nurse takes things in stride.
Many times he works 12-16 hours a day and considers his patients his family way from home.
Like many nurses, he says it’s the patients that make his job satisfying. “They need someone to care for them, to help them laugh and enjoy their life,” he said. And that’s what he plans to do. His most memorable moment is when a dying patient thanked him for caring.
“I never would have thought I’d want to continue working in nursing homes,” he said. “But once I started working in them, I can’t imagine working anywhere else.”
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