By Frank Otto and Alex Gardner
The image of the American “cowboy” evokes someone who is unapologetically free, unpredictable, and calm under pressure as he wanders across the shooting range. But to succeed, cowboys needed practicality and pragmatism.
When a Penn Medicine home health nurse talks about how she handles her job while she’s on the road, she sounds a bit like that mythical “cowboy.”
“You have to know a little bit of everything, and we see everything: orthopedic patients, surgeries, a lot of heart problems, sometimes dementia,” said Carolyn Coladonato, BSN, RN, a nurse from Penn Medicine At Home. “One day it will be heart failure and all the devices people have to manage that, and the next day it will focus on cancer and IVs and drips.”
Coladonato said this late on a recent Tuesday afternoon, sitting in her sedan, the “horse” she rides from job to job. When the cowboy suggestion came up, she laughed, but then took a second to think about it.
“There is a certain autonomy in what we do,” she muses. “We’re basically nurse case managers, so we have a lot of responsibility. And we have to trust our feelings: if something seems abnormal or wrong, you have to investigate.
Coladonato is early in her career as a registered nurse, but she is a home health nurse thanks to a recent initiative by Penn Medicine at Home, the home health care arm of the University of Pennsylvania Health System. At the end of 2020, in the context of the continuing COVID-19 pandemic and its accompany and support push for more care to be provided at home, Penn Medicine launched the Nurse Residency At-Home program. Typically, residency programs (month-long training periods for recent nursing school graduates) place nurses in hospitals or clinics. Only after these nurses gain experience in traditional settings are they considered for home care jobs, and this often takes years. But for those participating in the new program, the first day puts them on track to caring for patients at home.
Creative Recruitment and retention
Recruitment of nurses for home care And in hospitals, has been a difficult proposition lately, even before the COVID-19 pandemic put a strain on health care workers. In light of this, Penn Medicine has targeted new ways to onboard early-career nurses, including invest in the new ASPIRE pipeline program which supports local high school and college students interested in the profession.
But when it comes to home nursing specifically, early-career nurses represent an untapped talent pool, according to Danielle Flynn, MSNdirector of Penn Medicine Home Health and a nurse herself.
“We believed that if we built a residency program the right way, we could help these early-career nurses transition into home care and do it safely for everyone involved,” said Flynn.
Three years ago, the program’s first cohort consisted of four nurses. Since then, more than two dozen people have signed up, and Flynn said there is room — and demand — for growth.
“This program aims to recruit new nurses into a specialized area of practice traditionally reserved for nurses at the end of their career. We needed to get creative to adapt to growing demands for home care and respond to a national trend of an aging workforce,” Flynn said. “But it is also about supporting new graduates and ensuring that we meet their needs and retain them in a specialized and growing field.
Articulating a unique path at Penn Medicine
Nurses in this residency program work in partnership with an experienced home health nurse, called a preceptor in this program, for several months. They learn and master specific types of home nursing skills like wound care, phlebotomy, perfusion, chronic disease management, etc. For many early-career nurses, it’s a giant step toward what they hoped to do for the rest of their career and a chance to learn the trade on the road.
Coladonato said she is especially happy with all the support she receives through the program, ranging from her preceptor, Marie Morrison, BSN, RNto his manager Jessica Michielli, MSN, RN, and his resident educator, Jill Rachild, MSN, RN.
“I know this type of support is not available in programs elsewhere,” Coladonato said.
Important training for residents includes clinical management, which is an important aspect of home health and a place where home health nurses have the opportunity to take the lead in managing their patients’ care.
“When you’re in a patient’s home, you’re privy to information that other providers don’t know,” Flynn said. “You see what’s in your patients’ cabinets, where they sleep. You can better assess their overall condition and determine what interventions would help them and be easily added to their lives.
After about six months, resident nurses have more independence and can make house calls without their preceptors. They also complete a residency project approximately nine months into the program to explore and display their knowledge of specific aspects of their work. Participants continue their learning in the field and through training for an additional nine months, then “graduate” from the program after approximately 18 months.
Open ing the door
Coladonato has been in residence for over a year. She is happy.
“I’m so happy to finally be able to do this, go from patient to patient,” she said. “You get to know them really well, in a way that you might not get to know on a hospital floor. »
When Coladonato decided to leave her initial career in teaching, she became a certified home health nursing assistant. This often involved spending 8 to 12 hours a day with the same patient, and there wasn’t much variety; the position usually only encompassed care of the elderly.
So Coladonato went to nursing school in San Diego hoping to go straight into home care. She discovered that she probably wouldn’t be able to pursue this side of nursing right away. But after graduating and moving to the Philadelphia area with her husband, she discovered the Penn Medicine At Home residency program.
“I thought it was a perfect fit for me,” she said.
Coladonato was hired in May 2022 and now covers a range that spans between Chester and Delaware counties. In October, she will complete her residency. But this will not mark the end of his learning or his professional advancement. At first, Coladonato thought she wanted to become a home hospice nurse, but she has since realized it might not be for her. What is?
“I love treating wounds,” Coladonato said. “It’s so funny to me because a while ago, someone from my program said they wanted to do this, and I was like, ‘Why?’”
Now that the wound care portion of her residency is behind her, Coladonato considers it an engaging and important job. She plans to receive her wound care nursing certification later at Penn.
Home nursing care in the future
As the United States entered the 20th century, the American cowboy almost disappeared, because of livestock mechanization.
The opposite is true for home health nurses. In the world created by COVID-19, healthcare has welcomed technological advancements, such as telemedicine and connected devices such as digital blood pressure monitors and pulse oximeters. This technological leap appears ready to more and more push more care outside of a traditional clinical environment. This bodes well for home care nurses and the training they have received to adapt and make their own decisions.
“Home health care is expected to grow at a breathtaking rate over the next decade,” Flynn said.
“According to the US Bureau of Labor Statistics, employment in the sector will increase by 25 percent, creating around 700,000 jobs on average each year. The average growth rate for the sector is just 7 per cent, so you can see why we hope to be at the forefront when it comes to recruiting and supporting these nurses.
Hospitals and the armies of clinicians who run them and their specialized departments will likely never go the way of the mythical Wild West. But in the future, care seems destined to look much more like what Coladonato and her fellow resident nurses provide: rolling from house to house, jack of all trades.
“It’s just fascinating here,” Coladonato said. “You definitely get to know your patients, to see them as a whole person. And I’m so happy to do this now, to have this independence and take care of people the way I do.
