by Joelle Moran
Heather Steele, RN, is enjoying her role as nurse preceptor at Centura Health at Home (CHAH). It’s where it seems she was destined to be.
She gets to combine her love of teaching - both patients and new nurses - with her passion for nursing. Steele was instrumental in helping develop CHAH’s preceptor program. She spent 75 percent of her time the past year as a nurse preceptor and has been in her official role for about three months.
When a new nurse is hired, Steele partners with them for eight to 12 weeks, making joint nursing visits to patients, showing them how to complete the large amount of paperwork, and guiding them as they adjust to the home health care world.
“I enjoy the aspect of taking these nurses that haven’t done (home health care) and sharing my love of home care and teaching them how to be successful with it so they have a good experience with it,”
Steele said. “I love the teaching aspect and bringing that to them.”
The first year in any nursing position is the hardest. CHAH was looking for ways to increase nurse retention rates. So overhauling the preceptor program was logical. Before the changes, new nurses would work with various nurses in the field following a bare bones orientation.
“Since we moved it to the direct partnership with one person, it gives us good chance to be consistent and to get a lot of good feedback from the same person,” Steele said.
Ellery Aiken, clinical manager at CHAH, said Steele’s contributions have been invaluable.
“Heather has been instrumental in improving our preceptor program for our new nurses. She takes extra time to share her expertise and ensures the nurses feel comfortable in their new role,” Aiken said. “Heather is a true star and an incredible asset at Centura Health at Home.”
Steele said home nursing care is something people truly feel a passion for, as she discovered early in her career. After earning her associate’s degree from Calhoun Community College in Athens, Ala., in 1995, Steele worked on a post-surgical floor at Hunstville (Ala.) Hospital for three years. That was enough time for her to realize that the hospital wasn’t where she wanted to be. She started working for a home health care agency where she spent seven years before moving to Colorado and joining Centura in 2006.
“In home health care I really enjoy the opportunity to know my patients on a personal level,” she said. “When you see them three times a week for a month, or once a week for a year, you develop a different relationship.”
With the slower pace, Steele said, she has time to sit down and provide education to her patients, which helps with their overall health. In a hospital, she said it is procedures-driven and she never felt she had time to educate patients about their medicine or diet.
On home health care visits, she can look in patient’s pantries, teach them how to read nutrition labels and show them how these things affect their health.
The majority of CHAH’s patients are 65 and older, and their needs range from chronic illnesses such as diabetes and congestive heart failure to patients that need assessment and education following hospitalizations. The majority of the cases are referrals from Centura hospitals, but physicians refer patients as well.
One of the qualifications for receiving home care it that patients generally have to be homebound, Steele said. Home care is often a critical transition after hospitalization.
“As hospital stays are getting shorter, it gives patients a bridge to have someone come and check on them and communicate with the doctors,” Steele said. This care and educational training also help reduce the re-hospitalization rate.
Centura’s 40 home health nurses manage about 20 to 30 cases at a time, with full-time nurses seeing about 25 patients a week. The Denver-metro area is divided into three different geographical areas, so nurses aren’t driving too far.
In home health care, Steele said the way nurses fill out paperwork is critical. Much of it is required for Medicare, and making sure it is done correctly drives everything as far as patient satisfaction and outcomes.
Because of the paperwork - from all things regulatory to tracking doctors appointments and matching visit orders on more than 20 patients - keeping organized is the biggest challenge for a home health care nurse, she said.
Home health care nurses also have to be flexible, Steele said, because patient needs come first and you often have to find ways to squeeze in one more patient into a day. Communication skills are essential, too, as home care nurses are constantly on the phone with doctors.
Aside from the challenges, the benefits to patients make it a rewarding experience.
“For the patients, it’s such a relief when you’re just out of the hospital to not have to get up and go to the doctor’s office and lab and physical therapy center,” Steele said. “They also always have the same nurse; someone that knows them.”
For nurses, home care can be a nice change of pace, Steele said. “You get an opportunity to work with patients one on one, rather than trying to manage four, six or eight patients at one time; it’s not such a juggling act.”
It was a personal home health care experience that led Steele to a career in nursing. Right as she finished high school in Alabama, her grandmother in Ohio was diagnosed with terminal cancer. Steele offered to go to Ohio and stay with her grandma during the day.
“She was receiving home care services and eventually moved into hospice and had nurses coming in regularly,” Steele said. “I got to spend some wonderful time with my grandmother that last month of her life. At that point in her life, Steele was not sure what career path to pursue - teaching or nursing.
“Now I’m combining the two, I’m teaching nurses and patients,” she said. “It seems like it was meant to be.”