The life of a home care nurse
The following is an acceptance speech given by Eliza Petrovits, recipient of the prestigious Nursing Practice Award, which she gave at the MNA Awards Banquet held at the World Trade Center in Boston on Nov. 8, 2000. The speech describes, in moving and poignant detail, what a home care nurses’ practice is like.

Thank you. I am very grateful and honored to be the recipient of the MNA Nursing Practice Award for the year 2000. I thank my dear colleagues of the VNA of Cape Cod for nominating me and for their extremely generous praise and consideration. I would especially thank Debra Caruso, our bargaining unit chairperson, and Bernice Rice, both extraordinary nurses and role models. I accept this award only with the understanding that it belongs to each and every registered nurse of the VNA of Cape Cod. 

I look back with amazement on 27 years in nursing. I would like to say I followed a calling, but the truth is my parents got tired of me driving around Cape Cod in my father’s Olds and convinced me I did not have a career as one of the Jerry Garcia Band, (later known as the Grateful Dead). So they packed me off to nursing school. It was the 70’s and as I learned my profession I learned to be verbal about my values and beliefs.

 I have followed my profession in different directions: general med surg., critical care: ICU/CCU and the ER. I have worked in various areas of long-term care, worked as an office nurse for a cardiologist, done private consulting for skilled nursing facilities and have also worked in management in several capacities. I was a director of nursing at two different skilled nursing facilities, but found that my management style was the inverse of the pyramid style of management accepted at the time. In other words, I saw my position as being at the base in order to support those at the top: the nurses, aides, supportive staff, etc. So, you can imagine that I did not last very long in that capacity.

I went into homecare in 1991, and have remained there ever since. I love homecare nursing, and so, perhaps, I have found my calling after all. 

About one year ago, I was having trouble sleeping. I was stressed by a number of things. I felt overwhelmed and overworked, fearful that I could never meet the expectations of my ever expanding job description. I went to see a renowned neuro-psychologist. She is, in fact, on the faculty of a Cambridge University here in town. I told her my symptoms. She said to me in a gorgeous old world accent, “My Dear. Here is what you must do. When you visit your patients you must take a little nap; at each visit a little 20-minute nap. And your patient must take one also. It will be good for you. It will be good for your patient.”

After I blinked and recoiled and took several deep breaths because I could not believe what I had just heard from a person eminent in her medical field, I said, trying not to scream , “Doctor. I do not think you understand what I do. I am a homecare nurse. A visiting nurse. And this is the 20th century” (it was 1999 at this time) 

And then I informed her, in fewer words than I will follow with now, just what that means. I will be more expansive because I do not think many of you know exactly what it means to be a professional registered nurse involved in home care working eight-to-12 hour days, five days a week.
 

• We do home chemotherapy: 5 FU, Vinblastin, Adriomycin and more.

• We are plumbers and electricians with mix and match IV equipment. We diagnose fulminating CHF and push IV lasix and hang dobutamine all with the high tech support of a blood pressure cuff, a stethescope and a scale.

• We care for wounds beyond description; of great awfulness.

• We bargain with supply companies for timely deliveries of tape and gauze.

• We are teachers and philosophers and students.

• We question everything that stands in the way of our patient’s wellness…

• We take battle from pay phones with HMO’s and case managers and often with our own agency. Our pagers are a cacophony demanding reply.

• We care for the mortally ill as they slip back to their maker; for the mentally ill in Section 8 housing and cluttered rooms: the asthmatics and COPD’ers in chilly, moldy, damp homes with cats and fleas, while they smoke next to oxygen tanks.

• We care for the frail caregivers; for the elders with dementia and their overwhelmed loved ones. We teach new moms to breastfeed their infants and to bathe them without drowning them.

• We are kissed and kicked and slapped and hugged by patients who never forget us on Valentine’s Day and Christmas.

• We work in a zoo. I have had pigs running around my feet while giving a lovenox injection. This in a living room. 

• We have been bitten and scratched by assorted creatures; dive bombed by parrots whose feathers floated down into an open belly wound; shrieked at by monkeys; strained to hear breath sounds over the howling-barking-yapping racket of canines.

• We are emergency nurses, twisting tourniquets above blown arterial wounds; performing one-person CPR frightened out of our minds that rescue will be too late.

• We do it all. We see it all. We are generally alone with our patients, and, if they are lucky enough not to be alone, we are with their families also.

• We are essentially autonomous. Our cars are mini-clinics. Some of us drive over 100 miles a day in all kinds of weather, on a sandbar 60 miles long with one hospital in the center.

• We trudge into homes burdened like mules with the tools of our profession and with our laptops. And when our patient visits are over we work hours at home to complete our documentation on paper and in the computer.

• Our families have learned to wait.

Recently, we, the negotiating team for the bargaining unit nurses of the VNA of Cape Cod, with the guidance of our wonderful MNA representative Stephanie Craig-Francis, negotiated our new contract with management. While we had a number of issues our main focus was mandatory overtime. We labored for a year to bargain an agreement that sets realistic limits to the amount of work expected by management of a nurse in a 7½ hour work day. It was a battle, but in the end we achieved wonderful language that should stop the egregious and fatiguing overtime sustained daily by registered nurses in our agency working in the field as I have described. It will not stop all of the overtime work but it should allow some reprieve so that we can find time for ourselves and for our families; to allow us again to see ourselves as highly skilled nurses and not highly skilled slaves. It should allow us some peace of mind so that our sleep can be peaceful and restful.

I very much doubt this resolution would ever have happened in a non-bargaining setting. It would never have occurred without our MNA support. I am proud to be a member of the Massachusetts Nurses Association. I thank you all.