Home health nurse takes care to where her patients live

When Sandra Pugh left hospital nursing after 20 years to practice in home health care, colleagues warned her that her nursing skills might become rusty. Just the opposite happened.

"I've learned more skills and come to the realization that I learn something new every day. It's exciting," said Pugh, RN, who has worked for Visiting Nurse/Hospice Atlanta for 15 years and is one of nine home-care specialists there. "I have more autonomy and feel very strong and confident."

That confidence comes in handy because being a home-care nurse requires self-

sufficiency. When faced with an unfamiliar IV infusion pump recently, she opened a reference manual to refresh her memory.

"When you work in a hospital, you have co-workers to help you. In home health, you use your judgment. You organize so that you can put your hands right on what you need," Pugh said.

Pugh could have contacted a team member or the pharmacy that dispensed the pump. "In an emergency, I've called 911 and knew it was the right decision," she said.

Pugh's nursing skills are tested every day. With a trend toward shorter hospital stays, her "patients are coming home sooner and sicker than ever before," she said. "They need us even more now."

For that reason, Visiting Nurse/Hospice Atlanta clinicians receive ongoing, specialized training. Finding that its nurses and therapists were treating more than 300 acute wounds a day, the company hired a wound, ostomy and continence program manager in 2006. Visiting Nurse/Hospice Atlanta also launched a multifaceted program to train all of its clinicians and to increase their competency levels in treating wounds.

"We don't have all the machines that you'd find in intensive care, but home health has become very high-tech," Pugh said.

Team members — including nurses, social workers, home-health aids; and physical, occupational and speech therapists — share case notes and assessments via laptops and cellphones.

"A nurse has to be knowledgeable and skilled," Pugh said.

Traveling to Rockdale, Newton, Walker and DeKalb counties, Pugh sees up to six patients a day. Once she gets her assignments, Pugh plans her schedule and packs supplies according to patients' needs. A fishing tackle box holds small supplies; a Rubbermaid tub holds large dressings.

Her route may take her to a ritzy condominium or to a mobile home.

"It doesn't matter about their home or economic level, because the No. 1 rule in nursing is that you love people and really care about them," she said.

Helping people manage their own care requires top-notch assessment and teaching skills.

Recently, Pugh drew from her high school Spanish when she treated the wound of a patient who spoke little English.

"We used sign language, and she was teaching me words in Spanish, so that, by the end of the visit, I was able to write out wound-care instructions for her that she could read. No day is boring," Pugh said.

Another reason that Pugh enjoys home health care is that she gets to know patients. She often cares for them from the time they leave the hospital until they return to normal activities.

"In home health, you become involved in your patients' daily lives; you have time to hear about their children and grandchildren, and you see what they're actually doing and eating," Pugh said.

It's a gift to teach clients to manage chronic illness so that they can stay out of the hospital, Pugh said.

"So much of what we do in the home environment is teaching. You get to give that personal, one-on-one touch," she said. "I love this kind of nursing."