Amy loves her job as a home care nurse practitioner for several reasons-flexibility, variety, and ability to make great connections with her patients, to name a few. Amy's ability to diagnose, treat, and make timely referrals for her patients keeps her excited to start the day. She is an early bird, waking at 5:00 a.m. to plan her day while sipping her favorite ginger tea. She resides in a suburban setting; however, she typically treats older adult patients in urban settings of Evansville, Indiana.

The violent crime rate in Evansville (including rape, murder, armed robbery, and aggravated assault) is one of the highest in the nation. One's chance of becoming a victim of either violent or property crime is 1 in 17. Amy has been a home health nurse practitioner for 1.5 years and has felt unsafe at two home visits. She would like to share those incidents so other home care clinicians have better insight into potentially unforeseen incidents.

First Incident

It's 4:30 p.m. in early December and already getting dark. Amy heads to see her last patient for the day. As per the patient's instruction, she parks her car at the back entrance and rings the doorbell. A fragile 87-year-old woman opens the door. She follows the woman into the house and starts with her usual introduction. Suddenly, a middle-aged man appeared in the room. He seems to be angry and drunk. He paces the room shouting: "Who are you? Why are you here? Show me your identification." Amy politely responds to his questions, but he seems unsatisfied and threatening. He is controlling the patient and does not let her intervene. The situation escalates. Amy becomes fearful, so she tells the man she forgot her identification in the car and manages to escape the house. He follows her outside and takes pictures of her car with his cell phone. Amy quickly drives off and reports the incident to her manager who makes plans for an escort to accompany clinicians on future visits.

Second Incident

It's 2:00 p.m. in mid-June and it is hot. Amy heads to see her 67-year-old patient who is paraplegic and blind. She rings the doorbell and the patient opens the door. Amy steps into a dark hallway. The patient says: "You may turn the lights on if you want, for me it hardly matters." As she turns on the lights, Amy hears a growling sound and sees a Pitbull dog sitting unchained next to the patient's wheelchair. The dog bares his teeth menacingly. Amy, terrified, sprints out the door. The patient hollers "don't worry, this dog only attacks, if I ask him to." Amy doesn't find this to be reassuring. She requests that the patient transfers the dog to a different room, but the patient disagrees. Amy learned the hard way as a child not to trust protective animals, so she apologizes to the patient and leaves. Once again, her supervisor will make plans for future visits.

Amy absolutely loves her job and embraces it wholeheartedly. For her, visiting patients' homes is an honor and privilege. In today's world, there are no crime-proof places. Safety must be of the utmost priority and involves common sense, listening to instincts, and employing good judgment. Amy urges home care clinicians to carefully read the patient's face sheet, call, and connect with patients the day before visits; ask in advance that all animals be secured in another room; be aware of surroundings; take a moment when entering before walking further into the home; and finally, and perhaps most importantly, pay very close attention and trust your instincts.