Job-shadowing program spotlights home care

Nursing students receive real-life credits

Hospitals Home Health Care in Fulton, NY, and the Crouse Hospital School of Nursing in Syracuse both took a look at the present state of nursing, and they reached the same conclusion about its future: Career opportunities will abound in home health.

In the hope of recruiting more nurses into the field, the hospital-affiliated agency and the school joined forces about six months ago to start a job-shadowing program, which permits senior nursing students to spend one eight-hour day making home visits under the supervision of a registered nurse. The students earn degree credits for their experience, and the provider gets to observe future recruits at work.

Realizing that home care is the fastest-growing segment of health care, Crouse Hospital School of Nursing faculty member Jean Irwin, MSRN, began developing the Community Experience Program about a year and a half ago to give students "opportunities to enhance their studies in nonacute care." Included in the curriculum, the program exposes nursing students to three main areas of nursing:

• home care;

• long-term care;

• miscellaneous, which includes oncology patients, dialysis patients, adult day care, hospice, and rehab centers.

Once her program was established, Irwin began calling area providers to sell them on the idea of giving nursing students practical experience. The Visiting Nurses Association (VNA) and Olsten Kimberly Quality Care in Syracuse volunteered for the program first, followed by Hospitals Home Health Care.

Irwin’s contact at Hospitals Home Health turned out to be Public Service Coordinator Kathleen Paolini, RN, a Crouse alumna, whose agency was experiencing rapid growth in both number of visits and staff. Hospitals Home Health Care had been founded in 1991 by Lee Memorial Hospital in Fulton and nearby Oswego Hospital with the expectation that demand for home care would soon exceed supply, says Lee Memorial’s administrator Dennis Casey. This has proved to be true, chiefly because of how managed care forces patients out of hospitals quicker and sicker. At Lee Memorial in Fulton, the average stay fell from 8.4 days in 1994 to 7 days in 1996. At nearby Oswego Hospital, the average length of stay dropped from 10.5 days in 1992 to 5.9 days last year.

Hospitals Home Health Care’s staff has mushroomed since then, growing from 35 to more than 100. Home visits have increased from about 10,000 in 1995 to more than 25,000 in 1996, according to Paolini, who says Hospitals Home Health Care has openings now for "two to four registered nurses" to handle its 200-225 patients, who are mostly rural residents. The school program came at the right time.

"We have a great relationship with Crouse," Paolini says. "We approached it as providing a mutual benefit, and it’s worked out extremely well."

In just about six months, Hospitals Home Health Care has taken five nursing students under its wing, and each one has expressed "very definite interest in home health nursing," says Paolini. The catch, of course, is new graduates lack experience. Paolini acknowledges this, but adds that "we would hire somebody who went through the program within a short period of time, a year perhaps, after they get more experience. They need to get the hands-on nursing first."

That’s exactly what Irwin hopes to do with the Community Experience Program. Crouse, which graduates 40 to 60 nurses a year, has recently begun offering the program to first-semester students, so it now is threaded throughout the school’s two-year nursing curriculum. Irwin’s plans are to give students even more experience by attracting more nursing specialties, especially home care.

"Home care is where it’s at, job-wise," Irwin says. "The problem is home care requires new graduates to have one year of experience. We’re working on the problem; we’re looking at how to prepare fresh graduates for home care, and we have to look at the curriculum."

Following in the teacher’s footsteps

Currently, students in their second year of nursing must choose three nonacute nursing specialties to explore. "I insisted on home care and long-term care," Irwin says, "because those are the two big areas. For the third, I gave them a choice. Each site evaluates the student and the student evaluates the site."

The three components of the Community Experience Program are:

• course objectives;

• course requirements;

• evaluation process.

For home care objectives, Irwin says, "we wanted students to describe the role of a community health nurse, to identify services available to people with complex medical problems, and to explain how community health nursing differs from other specialties within nursing."

Each student is required to accompany a nurse on visits, says Irwin. "We had students work with nurses doing assessments. The students also did assessments; then, when they left the home, they compared their assessment with the regular nurse’s."

Students also were required to read articles about home care, complete a clinical worksheet on communicable diseases, and become familiar with rural health prevention issues, case management, how visits are documented, and what community services are available to the elderly, Irwin says.

"Then they had to keep a journal about what they learned from the experience and share it with me," she says.

What some of them learned was almost "culture shock," Irwin says. Though many of the students had worked as home health aides, some had never been exposed to home care. "Students truly learned. They actually see that patients are going home now with IVs, tube feedings, dialysis machines, and they appreciate the complexity of care at home," Irwin says. "The experience helps them develop critical thinking skills because they have to be more independent in the home care setting, more reliant on their basic knowledge. I think they gain a better appreciation of how some people have to live."

For their part, the agency’s nurses told the school they would have preferred to have students longer than one day, Irwin says, "because there was so much for them to learn, they couldn’t teach it all. But the nurses enjoyed the teaching."

Hospitals Home Health Care nurses make about five visits a day and drive an average of between 100 and 150 miles in the process, says Paolini. "The students have been very receptive to community health. They realize you have to adjust to things in the home and it’s different from the hospital setting."

Perhaps the biggest surprise for students, Paolini says, is the amount of responsibility home care nurses have and the extent to which patients’ families are involved. "The nurse is a role model," she explains. "Students have a much better understanding of what’s going on. It gives the nursing profession a much better understanding of what home care is. It’s the wave of the future."