Frontline Communicators

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Intake nurses and home care staff value strong communication skills

Communication between nurse leaders and their staff is essential to good patient care. Especially with home care nurses, who spend their days in different locations from their supervisors, staying in touch is paramount.

Delores Jones, RN, intake nurse for AnMed Home Health, which serves clients in South Carolina, said, “The LPNs are the front line.” Proper communication techniques make the jobs of LPNs like Aleta “Cookie” Barnes,” a per diem home health nurse for the company, easier. Jones continued, “Communication is a big thing. Right now, we’re having a nursing shortage and a patient may see several different nurses. One of our goals is continuity of care.”

For her part as an intake nurse, Jones oversees various steps in getting the patient from referral to home care. “We get as much information as we can from the admissions nurses.” With a pilot program now underway, the nurse who primarily cared for the patient at AnMed Health Medical Center, and therefore, knows their prognosis the best, gives the home health intake nurse the intake report. Jones and other intake nurses can also go to the medical center to personally pre-admit patients to home health services before patients are discharged.

Smooth Patient Experience
Barnes assists the nurses and takes overflow cases on a given day. She is called the day before with her assignments, which can take her all over the county. When she is in the field, communication and technology remains important. Home health LPNs and nurses bring laptops into the patients’ homes. “As you ask your questions and make your checklists, the information is right in front of you,” Barnes explained. Accessing the patient’s electronic health records on-site makes a smoother care experience. Home health nursing professionals won’t forget to chart if the tools are right in front of them.

“We document everything in the computer,” noted Jones. Since a different RN or LPN could see a patient on the next visit, electronic access to notes and charts provides a semblance of continuity.

Barnes also works in home monitoring, where she hooks up monitors to phone lines for those CHF patients. The patients check their vitals each morning and the data is transmitted to a nurse at the AnMed Health offices. If something is out of a prescribed range, the nurse follows-up with a phone call to the patient.

Besides staying in touch with the office, Barnes and other home health nursing professionals communicate in different ways with their patients. “We have teaching materials we generate.” Congestive heart failure is a frequent diagnoses and Barnes will go through the disease process with patients. “They need to know about their disease-signs and symptoms, side effects. If they have something in their hand, while you’re teaching them, it helps a lot.” Home care LPNs and RNs will also demonstrate any durable medical equipment a patient may need to manage their diagnosis.

Safe at Home
AnMed is not the only home health service provider where communication is central to a smooth operation. Geri Brooks, RN, MS, GNP, vice president of geriatrics and home care at United Hebrew of New Rochelle in New York said, “The nurse is the eyes and ears for the patient to make sure they get the proper care.”

Brooks asks herself, “What are the connections I need to maintain patient safely in the home? Those lines of communication include the primary care physician and the patient’s family, who are the support system.

In terms of assigning home care nurses she said, “The most important thing is getting the right person to the right person. That matchmaking begins with clear communication. Many nurses can offer the same skills, but each nurse has their own personality. Who will be the right fit for a particular patient?

First Point of Contact
“Your intake nurses are your most important roles,” Brooks explained. They are how people first make contact with your agency. “They need to be knowledgeable and kind.”

When the referring party calls, the intake nurse assesses their needs through questions. They determine if United Hebrew has the skills to help the patient. Once the intake nurse matches the client with the healthcare provider, the home care nurse goes for her site visit.

In the home, the nurses use laptops to access EMRs and input information. Brooks said, “The speed with which we get information is quicker than ever before. If you don’t have good software packages to support your work, you can’t function.”

Communication and observation are essential to being a good home care nurse. Frontline nurses evaluate and determine what other skilled would benefit the patient. Nurses must remember patients who are cognitively intact may not accept health advice, which can be frustrating because by nature, nurses want to make things better.

Choosing the Right Nurse
At SelectCare, a small, Manhattan-based home health company, three nurse supervisors oversee the case load. “The majority of reporting given to field nurses is done by nurse supervisors and me,” explained Kelly Takemura, RM, BSN, director of nursing.

“Obviously, in-person communication is always great,” she noted. That is not always feasible with the travel requirements of the profession, so the nurse supervisors will call the home health nurse on the phone to communicate relevant patient information.

Takemura said, “Our goal is to give patients the best care possible while keeping them in their home.” She often handles the responsibilities of an intake nurse, taking the initial referral call and reviewing the patient’s health history. She assesses each patient’s particular needs and tries to find the best nurse for them.

The process is thorough. One question to consider is whether or not the client is mentally sound, in which case the person with power of attorney needs to be present at the intake appointment. Communicating with family members and getting everyone on the same page is crucial to the well-being of the patient.

On a non-medical note, Takemura must also find out if pets are in the home, as some home health nurses will not work in environments with pets. “We’re a very honest company,” she remarked. If a potential client has a need SelectCare cannot meet, they will reach out to other home care agencies to find a match. “New York City is a wonderful place to age because there are so many services available,” she said.

Patients at the Center
As an intake nurse, Takemura will email the field staff their schedules. “Email is a wonderful thing but we need to be mindful of HIPAA.” She continued, “Technology is beneficial in terms of following-up with registered nurses via text to confirm schedules etc., although information provided and received is very limited due to HIPAA.” Both clients and staff can opt into email notifications from the company. Any identifying patient information on informative emails is left blank. However, SelectCare is primarily still a paper-based company

Beyond communication with home care professionals in the field, staying in contact with other service providers is important. Takemura noted, “We have wonderful relationships with companies that provide skilled services in the home.” Such services can include visiting physicians, visiting podiatrists, speech therapy, occupational therapy and physical therapy.

“We can even get X-rays in the home,” she explained. “If there is not a major emergency, we can get it done in the house. It really makes a difference.”

The company is patient-centered. Home care nursing is not a 9-to-5 job. Home care supervisors will call patients at night and visit multiple times per day. Takemura said, “We very much enjoy what we do and that’s reflected in our work.”

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