It’s 6:00 am and Daisy rushes out the door to see her first patient of the morning. Short in stature, yet never shy in her approach, her energy is limitless. A typical day for Daisy will involve seeing a variety of patients from the elderly gentleman recovering from major gastrointestinal surgery to a woman battling cancer and entering the palliative stage of care. With bright eyes and a warm smile, she treats each individual as if they were family.

During the COVID-19 pandemic, nurses working in hospitals have garnered tremendous support and attention. But there are other unrecognized heroes out there continuing their critical work to ensure that their patients are staying safe. Home health nurses are one example of those who are making a difference in the fight against COVID-19.

I had an opportunity to speak with my friend and fellow nurse, Daisy Gonzalez, MSN, RN who recently went back to work part-time in home health.

1. Daisy, can you tell me a little bit about your background and why you decided to go into nursing?
 
I always had a nurturing personality and enjoyed taking care of others. I have a deep sense of empathy and a desire to help. Nursing manifests that part of me. I grew up in Philadelphia and recall seeing a commercial depicting a home health nurse driving through a severe storm to see her patient. It was at that moment I decided I wanted to be a nurse just like her. After graduating from nursing school in 2000, I went on to become board-certified as a Family Nurse Practitioner in 2006. My husband’s work moved us to Denver, Colorado where we settled and continued to grow our family. I resumed work in an acute care setting until I decided to take a leave to care for my young children.
 
2. What led you down the Home Health Nursing path?
 
Almost 2 years ago, I was driving and saw a sign for BAYADA Home Health Care, the same agency that advertised the “nurse in the storm” many years ago. I said to myself, "Could that really be the same company?" I had been wanting to get back into nursing, and after taking ten years off, it was time. I had no idea what the world of home health would be like as all my previous work had been in the hospital setting. A friend encouraged me to “take a leap and all will fall into place.” I took a chance and interviewed for a position. A few days later I had a job! Working in home health is extremely flexible which was very important for me. I cannot express how meaningful and purposeful my time in home health and our patient population has been.
 
3. Can you describe a typical day as a home health nurse?
 
Nurses who work full-time in home health can see between six and eight patients each day. I’m currently working a PRN schedule and can see between three and five patients a day when the census is high. These visits are located throughout the metro area. My days have had to be a bit more flexible due to my children’s schedules and I am able to scatter my visits to accommodate for that as a PRN nurse. I may see a patient newly discharged from the hospital and will spend a great deal of time completing the history and physical exam as well as medication reconciliation. Another patient may experience an emergency at home and I will need to manage that as best I can. Working in the field, you never know what to expect. It’s not a controlled, sterile environment… rather unpredictable. And patients are being discharged from the hospital earlier, with higher acuity and complexity. While the work we do is by no means easy, and at times exhausting with all of the added pressures, it has the enormous potential to make a positive difference to everyone we encounter. We are entering their lives in the most vulnerable of times…the amount of humanity there is beyond measure. 
 
4. Can you describe the range of diseases and diagnoses you encounter?
 
I see a wide range of patients, many of which are elderly with several comorbidities including heart failure, diabetes and renal failure. I’ll take care of patients recovering from surgery, actively fighting cancer, and managing chronic conditions such as multiple sclerosis and Parkinson’s. I will assist patients transitioning to palliative care, enhancing their quality of life, advocating for them and helping to provide the resources needed to make decisions.
  


5. How has the COVID-19 pandemic affected your work?
 
I feel an even bigger commitment to my profession during this time. Our patients need us more than ever as they will likely have less access to their primary care providers. Our goal really is to avoid non-emergent hospital encounters and readmissions. I worry about the potential exposure my patients may have to COVID-19. Who is entering their home and are family members visiting them? I am fearful for how I am being exposed. For my family especially, the fear is compounded as both my husband and I are in direct contact with patients every day. However, I have never once thought I would stop. And my patients are fearful as well. They worry about me coming into their home, if I have been exposed to the virus, how many patients I have seen that day. I try to be as diligent as possible to keep myself, my family and patients safe. We have very specific protocols for sanitizing everything between patient visits, vigilant hand hygiene practice, glove and mask use. Home healthcare providers are well-versed in infection control procedures and we have routines for each task to minimize contamination and the spread of coronavirus. I know personal protective equipment (PPE) has been an issue for many frontline workers and so far, we have had the PPE we need to properly and safely take care of our patients. As more people recover from COVID-19 and are discharged from the hospital, we will begin to see more of these patients at home as they will likely still require frequent assessments and a variety of therapies for their deconditioned states.
 
6. What specific skills are needed to work in home health?
 
First of all, you need strong assessment skills. You are the “eyes and ears” for the multidisciplinary team. Collaboration, communication, and teamwork are key. You need strong time management and organizational skills. You are also providing so much teaching on disease processes, on how to help these clients manage their own care all while maintaining a holistic approach to each individuals’ needs. In addition to the direct patient care, much of what I do involves case management, following up with patients, families, or their providers, coordinating resources, identifying barriers and constantly managing every aspect of care. I believe you also need an overall sense of “humanity” and people skills. Your patients are vulnerable, they need to trust you as you are entering their personal space. You need to make strong connections. For me, I establish really close bonds with my patients, they become like family and it is hard to pull myself away at times.
 
7. What do you enjoy most about your job?
 
I love that my job is purposeful, I’m doing something for others that is beautiful and rewarding. I have to say that I get as much out of it as my patients do. Patients tell me I’m meaningful to them and they allow me to enter their lives. I enjoy the “human connection.” I also really enjoy being part of a team. I work closely with a wonderful group of people – fellow nurses, physical, occupational, and speech therapists, social workers and our amazing home health aides. Ordinary tasks that we often take for granted can be obstacles for many patients. We have to work together and “think outside of the box.” It is a wonderful feeling seeing your patients recover and progress – whether it’s helping them take their first steps or helping them take their first shower in days, weeks, or months, every moment is special and important. Being able to “restore a sense of dignity” to my patients is incredible.
 
8. What are the biggest challenges that you face? 
 
Documentation is a big challenge. I feel that we are spending more time these days documenting rather than with our patients. After seeing patients and now having to home-school my children, I often spend several hours at night, carefully documenting the care I provided. For many nurses working full-time, this is really the most time-consuming part of their day.
 
9. Do you have any words of advice for nurses interested in home healthcare?
 
I would say “try it!” It is one of the most rewarding specialties. For new graduate nurses, hospital experience is likely necessary to help strengthen your assessment skills first. But after gaining some experience, home health puts it all together; everything you learned throughout your nursing education about holistic care of a patient is applied here. You assess every aspect of a patient’s life, their home environment, their family dynamics, the whole picture.
 
One of Daisy’s patients stated “… your compassion and professionalism are top notch. You are wonderful and mean so much to me and my recovery.” Daisy has been honored with BAYADA’s Hero Award for the first quarter of 2020. I want to thank Daisy and all the visiting nurses across the country who put aside their personal safety to ensure their patients continue to receive quality care in their homes. They are truly on the front line of the pandemic. I can’t wait for the day when I can give Daisy a big hug once again.