Metamorphosis: Becoming an infusion butterfly

By Ann Williams, RN, CRNI

Infusion Nurse Educator

Deaconess Home Services

Evansville, IN

I have been fortunate to witness, as well as participate in, the metamorphosis of home care nurses into home care infusion nurses. It was a slow process, but much like the unfolding of fresh new butterfly wings, it was a thing of beauty and a process all can be proud of.

In 1995, I was hired as the infusion nurse of the newly formed, hospital-based Deaconess Home Medical Equipment and Infusion. I had been the IV coordinator at the same hospital for six years previous and an SICU nurse for 15 years prior to that. My job in the beginning was to be one of creating the P&Ps for the new department, writing the patient teaching manuals, educating on-call RNs and teaching the patients requiring home infusions, as well as placing lines, troubleshooting, line tracking, QI, etc.

Change is inevitable

As with any new developing process, change occurs often. As a nurse for 25 years, I have learned to tolerate, and often accept, change. If we didn’t at least try to adjust to change in today’s world, I think we would go nuts! Change soon came along as business picked up and I got a part time nurse to help me with the patient care. Then the next change was when we began to make our process a more seamless one. Rather than HME trying to maintain on-call nursing, we blended with our home care department that was already doing the follow-up visits after I had taught the patients.

I attained my CRNI in September 1997, and my job title and responsibilities changed in November 1998. I became the infusion educator, and now I was responsible for teaching the home care nurses to also do the patient education. I also needed to continue working with them, building their skills, and mostly their confidence in their abilities.

This process is where I witnessed the greatest change! The nurses, some having done home care for 15 years, were not thrilled about this new experience of starting IVs and all that goes with an IV patient. It was a new world to them. I tried to work with them patiently (one must always remember that every one of us was new once). I gave them classes, demos, one-on-one conversations, I listened when they had questions, I involved them on teams to correct or perfect a process. I bragged on their skills. At the start of this process, I once said they were like cats being drug by their tails — clawing all the way, trying not to go there! But soon, I saw a change. They were making appropriate decisions, they were actually enjoying doing an infusion set-up. No more fighting the change. METAMORPHOSIS!

End result: Excellent team

Today, we have an excellent home care staff capable of providing excellent infusion nursing. We provide all therapies from hydration, antibiotics, TPN, PCA, IVIG, chemo, inotropics, etc. I continue to provide frequent inservicing to refresh their skills and bring them up to date on new procedures. We work together on teams to get input from their perspective when solving problems. The team approach is what makes this difference. I even had a contest for IV Nurses Day, giving away T-shirts as prizes, just letting them know that they are a part of the team.

If you are struggling with developing your staff into infusion or any new process, here are my suggestions to aid that process. First, be patient. Listen to them complain, then work together to get to a workable, realistic solution. Then, reinforce their abilities over and over and over again. I found they were most frightened about "teaching" the patients to do this themselves. I had taught this for so long, that it came second nature. I tried to instill in them the ideas that they are nurses who know how to give this med themselves and know how to teach patients. Put that all together and teach them on the patient’s level how to do what the nurse would do if she were administering the drug.

I also provide them with the patient teaching manuals; this can serve not just as a tool for the patient, but more or less an outline for the nurse, assuring her that she doesn’t leave anything out. Anything you can provide them that they can have at their fingertips is very much appreciated. These nurses see a lot of patients during the day, so anything we can do to simplify their jobs, thus increasing their productivity and relieving their stress is very much appreciated.

We have weekly care conferences on the IV patients in which the pharmacist is present so they can ask any questions of either of us. They also know where we can be found every day.

Treat them with respect and encouragement and you will soon find that you too have a willing team of excellent infusion nurses!