Community nurses are important members of the health care team. They are involved with all members of the community and see patients first hand. They are involved in education, assessments, care coordination, care management, support and follow up with individuals. Community health nurses can be involved in schools, correctional facilities, hospice and palliative care, and help in disaster areas. Community health nurses can be occupational nurses, travel or visiting nurses with agencies, work in telehealth or they may work in numerous other areas.
The following is from interviews with two registered nurses with ommunity health nursing backgrounds. A comparison of the similarities and differences in the roles of hospice nurses, nurse educators and hospital nurses will be discussed. Introduction of Community Nurses First Community Nurse Barbara Hughes (personal communication, November 22, 2016) has been a registered nurse since February 2004. She received her Associates of Science at Polk Community College, which is now Polk State College and became certified in hospice and palliative care in 2011.
Barbara has worked at the Lakeland Regional Health Center (LRH), in the cardiac unit and is currently mployed at LRH on the Palliative care unit and works with Good Shepherd Hospice as a pool case management nurse. The two roles as a hospice and palliative nurse are similar and also have some differences. Second Community Nurse Laura Jordan (personal communication, November 23, 2016) has been a registered nurse since July 2010. She studied at Polk State College and Keiser University in Tampa, Florida and received her Associates of Science, Bachelors of Science and her Master’s degree at Keiser.
She worked at LRH as a floor nurse and a relief charge nurse on the Palliative care floor. She has orked as a hospital educator for Florida Hospital in Sebring and continues to help with special education projects for educating staff and patients. She is presently working as a professor at the Keiser University as a nursing instructor and as the simulation coordinator. She is responsible for making sure the next generation of nurses is well prepared and competent members of the nursing profession.
Summary of Roles First Community Nurse Barbara’s role as a hospice and palliative case management nurse is one that can be stressful and very rewarding at the same time. She works in multiple environments including the ospital, nursing homes, assisted living, hospice house and personal homes. She coordinates the care with many other health care workers and must see the patient every other day. She reports her findings to the Doctor or the Nurse Practitioner and recommends things that may need to be amended. She directs the care plan for each patient based on individual needs.
She has expert interpersonal skills as well as being a kind, caring, nurturing, compassionate individual. She has impeccable skills in critical thinking and assessments. She is able to care for patients who may not be able to verbally communicate. She is able to read cues from the patients like a furrowed brow or sounds the patient may make. These assessment skills help her provide for pain management or other distressing symptom management. Barbara is responsible for the education and well-being of the caretakers and support members of her patients (B. Hughes, personal communication, November 22, 2016).
She must provide for the compassionate, competent, coordinated care that everyone involved with end of life care deserves. She is the driving force in providing the best quality end of life care for each of her patients. Second Community Nurse Laura’s role as an educator is multidimensional and vital to the nursing field. She is responsible for the planning and teaching curriculum of future nurses at Keiser. It is extremely important to Laura that the new nurses understand what impact they have on teaching patients, family and community members (L. Jordan, personal communication, November 23, 2016).
Instilling critical think is important for all nurses. Prompting discussions among the students is one way Laura is able to help implement critical thinking skills with the students. Laura oversees the students’ while they are working in the lab and clinical areas. She serves as a mentor to her students on an academic and career level. The role of the nurse educator is an ideal role for Laura. She has expert communication skills is very organized and enjoys sharing her skills and expertise with others.
Similarities of Roles First Community Nurse The role of the hospice and palliative care nurse in the hospice setting can be similar to the role of a hospital nurse. The compassion, assessment skills and working with interdisciplinary team members can be the same. Symptomatic treatment should be done in both settings by the nurse. Treating everyone with dignity and providing individualized care ith respect for human needs and values without prejudice is an essential element for all nurses. Working in the hospital or for Good Shepherd Hospice the nurse will have procedures and protocols to follow as well as a chain of command.
The levels of care may be different from the hospital compared to non- hospital care settings. Second Community Nurse The similarities between the nursing roles as an instructor of a university and the hospital setting include the expectation to keep up to date with evidence based practice and equipment. Hospital employees and the instructors of Keiser frequently hold n-services and attend professional development opportunities to enhance their knowledge. Laura states she is “constantly reviewing equipment while in the clinical setting and often attends hospital new nurse orientations” (personal interview November 23, 2016).
Instructors and nurses have certain policy and procedures that they must follow to be compliant with accreditations. Similar challenges include developing time management skills. Laura stated “we have so many hours to effectively prepare nursing students for the National Council Licensure Examination-Registered Nurse (NCLEX-RN) and to egin as nurses on the floor” (personal interview November 23, 2016). The instructors are so inundated with constant information and have to be sure to emphasize those things the students must not forget.
As a relief charge Laura had to find coverage for the next shift, nurses would call out and she would try desperately to fill those slots. Education has similar challenges dealing with vacancies of educators. Some professors will leave mid semester with only two weeks’ notice. This results in faculty scrambling to cover these openings. Laura realizes the importance of educational consistency in schooling, is much like atient care continuity in the hospital. Both being high priorities, must be attended to in a timely manner. This can be very challenging for everyone involved.
Differences of Roles First Community Nurse One difference for the hospital nurse and the hospice nurse is having to travel to different locations. Being able to find the location of some of the homes can be difficult and the area may be a bit scary for visiting hospice and home health nurses. Hospital nurses have hands on care with patients and family members at the hospital. They do not have an insight to the home environment like the visiting nurses. The environment is one thing that the visiting nurse is able to assess and they can range from immaculately clean homes to roach infested homes.
Safety is always a concern for hospital and visiting nurses. The family dynamics play into the safety aspect of Barbara’s role and she has to be aware of her surroundings at all times. One of the hurdles for Barbara is that she has to be able to problem solve and utilize what resources are available at the location she is in, whether it is a facility or personal home (B. Hughes, personal communication, November 22, 2016). One of the difficulties Barbara faces is not just being responsible to the patient for care; she is responsible for the care of the patient’s family and support systems.
The stress of having a loved one dying is very hard on family members. Barbara has to be able to provide for the emotional and mental support of each person. She is able to contact other team members such as the pastor of Good Shepherd who can provide more spiritual support for everyone. The interdisciplinary members of Good Shepherd are available, but may take some time to get to the patient or family member in need. At the hospital, she has numerous resources available o her from Respiratory Therapist, on call Doctors or Nurse Practitioners, Patient Care Attendants, cleaning crews, technical support and security guards to mention a few.
The members of the hospital team are able to get to her aide much quicker. Time management is much more stringent in the hospital than in the field with Good Shepherd hospice. Charting the visit must be completed within two hours of the visit per protocol. The hospital would like everything to be charted in real time as you are caring for the patient. The nurse in the hospice setting will not be focused on curative measures like a hospital setting urse. One of the responsibilities of the hospice nurse is to prevent hospitalization for symptoms related to the diagnosis.
This can be trying with the support group of the patient doing hands on care. Sometimes the caregivers will call 911 in stressful times instead of the hospice nurse. This results in the patient being admitted to the hospital and lifesaving measures being implemented. There are three levels of hospice care for agencies. First is continuous care for unmanaged symptoms, or teaching family members how to care for a patient. This is when a staff member is in the home at all times. Second is respite care or family members where someone comes in for a short amount of time.
This allows the caretaker to have time to take a break from the continuous care. The third level is general inpatient care, whether in the hospital or hospice house is covered care because of the need for a higher level of care than can be provided in the home. Hospice patients can be hospitalized, but if it is for the management of what their diagnosis is for hospice the hospice center has to pay for the hospitalization. If the hospice patient had a fall and broke their leg that would be covered by Medicaid or Medicare if they have it instead of the hospice agency.
Second Community Nurse The role of the nurse educator is a bit broader than with the role of the hospital nurse. Nurse educators are expected to maintain skill proficiency as well as an understanding of the workings of the hospital floor. In the classroom nurse educators must be able to establish a way to express their in-depth knowledge in a way that students can understand, learn from and retain the information. There are broad variations in students as far as knowledge base, age, and personalities which can be dynamic and diverse.
Laura stated “it is often like orchestrating a musical with different musicians” (L. Jordan, personal communication, November 23, 2016). Some students have knowledge and experience while others are fresh out of high school with little nursing knowledge. Creating an atmosphere that is conducive for all to learn is an expectation of her role as an educator” (L. Jordan, personal communication, November 23, 2016). Conclusion Community health nursing incorporates concepts of healthy living, prevention of disease and treatment of disease as well as rehabilitation.
Community health nurses are involved in research to better the quality and outcomes of patients and community health and wellness. They may be involved in the education of individuals in direct or indirect care. The roles of the hospice nurse, nurse educator and hospital nurse can be varied with similarities as well as differences. All of these nurses will be involved in patient care and education at some point. They will all be involved with interdisciplinary team members to collaborate the patient care and patient experience. Differences in the stressors for each group will be different.
Hospital nurses will be more stressed with work overload and the ratios of patient to nurse. The hospice nurse will have more stress with death and dying and how the family copes with the process. The nurse educator will have stress making sure they have provided the proper guidance to get the students to pass the NCLEX-RN exam. There are so many fields of nursing that are available that each nurse will find at least one area that they love and will excel in. All nurses are involved in community health nursing and providing for the best outcomes of each person and community.