Charting a New Course: the Home and Community Care Nurse

There’s a familiar saying in health care that the only constant is change. Health care is always evolving and Home and Community Care has been changing right along with it!

Home and Community Care (HCC) Nursing is a community-based service that provides health care to clients outside the institutional setting – in both clients’ homes and community clinics. It has seen some dramatic changes – even in the last decade.

Community Health nursing roles have been evolving to meet the needs of the population. The length of a hospital stay is getting shorter; patients are discharged to their homes much earlier than ever before. People want to be home sooner and hospital facilities want more efficient use of beds.

The result? The types of clients that are being seen are becoming more and more acute.

In the past 10 years, the numbers of people cared for in OR surgical suites, day surgeries and acute care beds numbers have all gone up. And all of these clients require follow up by Community Health Nurses. With the growing number of client referrals, it was recognized that the way we delivered services must also evolve.

The community nursing done now is not like it was years ago. The clients are more acute today and nurses can find themselves flushing ‘port-a-caths,’ administering an IV, or providing negative pressure wound therapy.

Gina Butt, RN/BN, with Home and Community Care, Clarenville

Gina Butt, RN/BN, with Home and Community Care, Clarenville

Gina Butt, an RN/BN from Clarenville agrees: “I remember when we rarely even did a urinary catheter!”

Traditionally, community nursing was provided only in the home setting. During that time, a nurse might visit 10 clients daily in the home and could ‘paper chart’ from home to home. Charting was done completely by paper; there were no computers on each desk. Referrals were received by mail; there were no faxes or email scans.

In fact, when computers were brought in, some nurses didn’t want to hear tell of them! They wanted to stick with paper as it was all they’d ever used and thought it worked fine.

“Gone are the days where we would see 10 home visits and chart in the car along the way,” says Shona Stoyles, an RN/BN from Clarenville.

As time moved on, so did the acceptance that the computers and electronic charting were here to stay. It’s hard to imagine the program without faxes, emails, and computer scans now. The advent of technology has increased communication, which is really important for nurses working in the community. Getting information to remote locations is faster and more effective. The technology will soon allow nurses to chart electronically during home visits.

In addition to the changes to nursing care at home, about 10-12 years ago nurses began providing services in a community clinic setting. With ambulatory clients coming to the nurse, many more clients receive service; a positive change that nevertheless took some convincing!

“It was just assumed by people that we would home visit,” adds Shona. “Getting people to start coming to clinic was hard at first. Now it’s becoming more known that we have ambulatory clinics.”

In 2014, a typical day for a community nurse could include home visits to clients with health needs ranging from post-operative care for hip replacement, flu vaccination for a home-bound elderly client, the administration of an IV antibiotic and a stop at a nursing clinic to access a ‘port-a-cath’ for routine flushing.

Today, Home and Community Care nursing requires a great deal of professional independence and a broad base of nursing knowledge in a variety of areas, including:

  • health protection/prevention,
  • maintenance,
  • restoration to health,
  • palliative care and,
  • health promotion.

The nursing workforce in Home and Community Care has also grown in the past decade to include Licensed Practical Nurses.

In the past, LPN duties consisted mainly of personal care of patients or residents and assistance with feeding in an acute or long-term care setting. Today, their roles have expanded considerably – especially in home and community care – and include the administration of medications.

Rowan Faulkner, LPN, with Home and Community Care, Bonavista

Take Rowena Faulkner, an LPN with Home and Community Care in Bonavista. She’s been an LPN for 22 years and witnessed many changes. But she says the biggest have been the name change from Registered Nursing Assistant to Licensed Practical Nurse – and the introduction of the LPN in the community programs.

“We can embrace opportunities for change and prepare for them or we fall behind,’ says Rowena.

“My current role was practically non-existent 10 years ago, and now here I am, working to my full scope of practice alongside registered nurses to provide quality care to clients in ambulatory clinic and in their own homes.”

Rowena and her LPN colleagues provide a wide variety of community and public health services, such as school immunizations and the management of allergic reactions to vaccines, and vision and hearing screenings for school-aged children. They do home visits and work in ambulatory care clinics, administer IVs and participate in health promotion.

Krista Stagg works in the greater St. John’s area, one of the first LPNs to be hired by the Public Health program in 2011. “I feel this change has been welcomed with open arms by Eastern Health,” says Krista. “I hope this is only the beginning for the profession, and that LPNs will continue to make their mark within community programs across our province.”

Kimberley Buckle, LPN with Home and Community Care, Conception Bay South

Kimberley Buckle, LPN with Home and Community Care, Conception Bay South

Kimberley Buckle agrees. An LPN with the Home and Community Care program in Conception Bay South, Kim says she’s able to work to her full scope of practice, alongside RNs, using a team approach. “We work well together, depending on one another to get the job done,” she adds. “LPNs are being recognized for our skills and being utilized properly. I’m excited to see how the program continues to evolve over the next few years!”

In 2007, post-hospital care was further strengthened by the launch of the Community Antibiotic IV Program in Harbour Grace and Bay Roberts. For the first time, nurses were able to administer IV medications in a home or community setting, eliminating the need for clients to go to a hospital. The program expanded to Heart’s Delight, Whitbourne and Holyrood in 2012.

All of this growth aligns well with Eastern Health’s strategic priorities of increased access to our services, the highest possible quality care and the promotion of healthier populations.

With the new age of technology and higher acuity of clients, also comes an ever-growing awareness of safety, privacy and accountability. Once, filling out a chart would take five minutes in someone’s driveway – now charting and related tasks can take more time than the actual nursing care. Accountability and accurate charting is of utmost importance and need to include everything that’s required.

More focus on the safety of the nurse has brought forward the Safe Working Alone Practices, whereby nurses need to check in and out. They must carry a “working alone” cell phone while out of the office and complete a Client Risk Assessment prior to any visit.

Shawna Vokey, RN with Home and Community Care, Clarenville

Shawna Vokey, Nurse with Home and Community Care, Clarenville

Shawna Vokey, a Home and Community Care nurse based in Clarenville, says community nurses are faced with challenges that others don’t even consider. “You are not surprised if a cat drags your dressing tray off the coffee table! You manage to survive the woodstove heat as we change a urinary catheter on a couch. You understand why a nurse might use a ‘sterile field’ to kneel on,” she adds.

“We all have stories of ‘a day in the life’ of doing nursing home visits!”

Although a lot of what Home and Community Care nurses do has changed, a lot hasn’t. They still strive to provide the best nursing care possible in the face of ever-changing roles – in an ever-changing health care system.

Some of the old ways may be gone, but the dedication to high level of care remains the same – as nurses navigate woodstoves and charts, pets and port-a-caths to ensure the clients get the right level of care – where and when they need it! ■

For more information on the Home and Community Care Program and clinic locations, click here.

This story was written by Shawna Vokey, a Community Health nurse, based in Clarenville and Wendy Maloney, Manager of Public Health – Peninsulas.

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