It’s been a rough couple of weeks for the nation’s registered professional nurses. First the ladies on the popular television show The View disparaged the country’s nurses by critiquing a Miss America contestant, a professional registered nurse, who dressed as a nurse and carried one of the tools of her trade, her stethoscope. Many of the country’s 3.2 million professional nurses, quickly took to social media to correct the negative impressions the ladies of The View held about nurses. Apologies followed.
Then in an October 15th New York Times op-ed page, Dr. Sandeep Jauhar came up with what he thought was a novel idea that physicians return to making house calls to help patients recuperate after hospitalization, and in the process totally ignored a large group of the professional nurse workforce: community home health nurses. Jauhar’s interest in physician house calls came about through a chance encounter with a patient whom he visited in his home. Jauhar was shocked to find that the conditions under which the patient lived were less than ideal for adequate recovery. He found dirty dishes in the sink and little food in the refrigerator among other issues. He feared that the patients deplorable living conditions would lead to repeat visits to the hospital. In Jauhar’s words, “Neither doctors nor hospitals have tried very hard to tackle the problem.” His erasure of the nurse’s role in combating the readmission problem is troubling to say the least.
Dr, Jauhar’s sincerity in addressing the problem of patient readmission to hospitals due to a home environment appears sincere but misses an important point: there is already a large contingent of health care professionals doing exactly what Jauhar suggests each and every day. Nurses, in particular, go into patients homes, some under very arduous conditions and deliver care, making sure the home environment is safe, monitoring the patient’s status, arranging for necessary care, tests, and treatments and ensuring that patients have a person to turn to if trouble strikes which it often does.
Nurses providing home care has been historically widespread for quite some time. For example, Historian Karen Buhler-Wilkerson chronicled home nursing programs in her book No Place Like Home. Buhler-Wilkerson gave an extensive overview of nurses role in shaping care, from Lillian Wald’s founding of the Henry Street Settlement House which eventually became the Visiting Nurse Society to contemporary community nurse agencies. Quite simply, the burden of delivering care to home-bound patients and the hard work of preventing hospital readmittance has always fallen on nurses shoulders. Given the long history of community home health nursing, it is surprising Jauhar was unaware of its presence in the healthcare field, although Dr. Jauhar has a history of minimizing nurses role in health care.
In order to educate Dr. Jauhar on nursing’s role in home health care, I suggest the following. First of all, he should go to the nearest hospital and track down one of the discharge planning nurses. They are usually pretty busy so he may have to run hard to catch up with them so comfortable shoes are advised. I suggest Dr. Jauhar observes what has to be done to discharge any patient from the hospital today and see if he can identify the patients whose discharges are especially complicated. This shouldn’t be a difficult task. Next, I think he should spend a day with a community health nurse following him or her as they make their rounds, observing the environments in which patients live and the challenges they face as they try to manage their health. I can assure Dr. Jauhar as a former visiting nurse, that dirty dishes in the sink would be the least of most patient’s problems. He might also want to do some homework on reimbursement for home care services which could help to answer his question as to why some patients are sent home with very little to no support.
Rather than sending in the doctors on their white horses to save the day for patients under their care it would be more constructive for Dr. Jauhar to inform himself on the services already available. Maybe then he would understand why the system does not work for everyone. Community home health nurses are doing the day-to-day work of caring for the sick public, and they are doing a commendable job. The current system of home health care would work much better with greater funding for home visits, but that does not mean that we should completely dismantle existing infrastructures by placing doctors in the primary role, which would only lead to further economic hardships. Furthermore, any overhauls of current home health systems that diminish a nurse’s role would be a disaster waiting to happen. Nurses are the experts skilled at keeping patients out of hospitals and if Dr. Jauhar believes he can send in the doctors for a housecall without the help of a nurse, then he is sadly mistaken once again.