The nurse practitioner’s house call: a new spin on an old-fashioned practice

Nurse Practitioner (NP) Jennifer Honey’s Rapid Response outreach service for frail home-bound seniors on the North Shore is a blast from the past for her patients.  As a long-time NP, and with more than five years experience with VCH, Jennifer works in collaboration with North Shore family physicians, specialists and hospital services to improve access to care for one of our most at-risk and rapidly growing populations.

“Seniors are living longer, more productive lives. They volunteer, they help their families,” says Jennifer. “They have such a wealth of experience to offer. The Nurse Practitioner practice is a perfect fit for our elder population. ”

As an RN, Jennifer used to feel as she was half a step behind: “I felt like I was always chasing a problem – dressing a wound, giving a medication, teaching about managing a disease.”

It was only in an expanded role living in Behchokǫ̀ in the rural Northwest Territories for several years that she began to consider broadening her scope to become a Nurse Practitioner, and in 2008 she branched out to do just that. “Now I am in a more innovative place in health care delivery. I still do a lot of those things, but I feel more empowered.”

Jennifer recalls one of her more memorable cases. A 101-year-old woman accidentally put bathroom cleaning cream on her face instead of face cream. She quickly developed a burn and then a serious infection.

“At her age, infections become more complicated by frailty,” explains Jennifer. “However, with home visiting assessment and treatment, she was able to avoid the hospital and complications. She was referred to appropriate services on-going to prevent further mishaps and lived until she was 104.”

Visiting seniors in their home to provide care

Referrals to Jennifer’s program are also low-barrier and come from a variety of sources: Lions Gate Hospital high-risk discharges, Home and Community Care clients, and even local GPs request her collaboration.  All of Jennifer’s patients are too unwell to leave their home to visit their usual provider, and are at risk of developing complications if they do not receive the primary care they urgently need.  Home visiting also provides a context for the unique assessment of frail seniors; it provides insight about how people live in their own space – something that might not be evident when a patient is seen in a clinic or office.

The Home and Community team: interdisciplinary and collaborative

The value-add of having a Nurse Practitioner on the Home and Community Care team was evident early on: allied health staff value the clinical leadership and fast response time that full scope Nurse Practitioner practice provides.  Instead of visiting the emergency department because they feel too unwell to navigate their stairs, or if their usual provider is unable to accommodate them in a timely manner, Jennifer will make a home visit to provide primary care, and then returns regularly until they are either better, or re-connected with their GP.

It means a great deal to Jennifer to help seniors get back to good health – and she believes in putting people first.  Almost every time, Jennifer can respond to urgent visit requests on the same day. The Home and Community Care interdisciplinary team share their expertise to support seniors health and wellness.

“I am privileged to be embedded in such a talented group of professionals,” she says.

Seniors provide a wealth of experience and stories

Jennifer never thought she would end up in geriatric practice. “I always figured I would do something fast-paced, and gory and glamorous.” But she is happy where she has landed.

“Once, on one day, I had three patients who were 103, 105, and 108 years old – all living in their own homes. That’s 316 years of life experience and stories,” says Jennifer. “Sometimes the 90 year old gets a kick out of being my youngest patient of the day.”

Workshop: seniors and community care settings

Jennifer will be speaking at a panel discussion entitled “Seniors living at risk in community care settings.” This talk is hosted by the VCH Coastal Ethics Committee and the VCH Community Engagement team.

Thursday Oct 30, 2017. 12:00 pm-1:00 pm
West Vancouver Community Centre (Multi-purpose Garden Room)

For more information, open the PDF for the workshop Seniors Living at Risk in Community Care – Panel Discussion.

Facts about Nurse Practitioners (NPs)

  • NPs prescribe medications including controlled ones like morphine and Suboxone ®
  • NPs practice in both primary and acute care settings
  • NPs are autonomous practitioners (do not require physician supervision)
  • NPs work shifts including evenings, weekends and on-call groups

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