By Marianna Herrera, RN, IgCN, Clinical Nurse Educator
According to the National Home Infusion Association (NHIA), there are 1,500 – 2,000 nationwide providers that can administer parenteral infusions in the comfort of a patient's home. This has provided a great opportunity for the home infusion nursing community. Being a home infusion nurse has many benefits, including decreased exposure to workplace hazards such as infectious diseases, minimized work related injuries and decreased work place related stress to mention a few.
Possible exposure to infectious diseases on a daily basis is part of life when working as a nurse in a hospital, clinical or community setting. However, if one is a home infusion nurse the daily exposure to infectious diseases such as hepatitis, HIV and tuberculosis gets minimized significantly. A patient in the home setting with a chronic illness may only be experiencing ailments from there chronic illness, but otherwise may be healthy. This in turn, decreases the exposure the nurse has to infectious diseases. If a patient is suffering from an acute illness, then the infusion may be rescheduled, relieving the nurse all together of exposure. Or, if a patient with an infectious disease must be infused, all the necessary personal protective equipment (PPE) will be provided to the nurse for safe patient contact. Unlike in a hospital, the placing and removing of PPE will be minimized because there is no entering or leaving a room, and there is also only caring for the one patient. This ultimately puts the nurse in a better environment for not contracting an infectious disease. With proper hand washing the chances of contracting an infectious disease will be slight.
"I love these Workstations On Wheels (WOWs)," said no nurse EVER!! The concept was good, but not well thought out. WOWs gave the nurse use of almost every minute they had on the floor, but pushing them from room to room, maneuvering them around corners, locking them and cleaning them after each patient, was simply not ideal. Three (3) consecutive days of pushing a WOW, lifting patients, assisting patients to chairs, etc., was extremely harsh on a nurse's back. Infusing a patient in their own home, keeps a nurse from dealing with many, if not all the previously mentioned tasks. A patient who is receiving home infusion therapy is not necessarily home bound, so doing laborious back-injuring tasks is significantly decreased. Another hazard that nurses are exposed to are the constant use of industrial strength germicides used to prevent cross-contamination between patients and equipment use. Some product labeling clearly states to use gloves and avoid use on people due to the possibility of carcinogenic effects as well as irritation of the skin, eyes, and mucous membranes or acute allergic reactions. In the home setting there is only one patient to care for. There is no need for harsh chemicals to decontaminate a chair for multiple patient use. Another hazard nurses may prevent or decrease with providing care in a home are exposure to radiation from neighboring departments and/or portable x-ray monitors that are constantly used in facilities. Again, this is a benefit for both parties if neither is in a facility providing or receiving care.
The national average nurse to patient ratio (NTP) according to the Academy of Medical Surgical Nurses (AMSN), a med-surg nurse has 1:6 NTP ratio on the day shift and 1:6 –10 NTP ratio on the night shift. This is not an issue when providing 1:1 care for a patient in their home. Imagine the decrease of stress one can achieve by providing care to a single patient. Less documentation, less tasks involved and a huge plus, many can agree, are the one-to-one conversations and connection you establish with the patient. This could never be accomplished in any facility without adding hours to the end of your shift and overlooking the care of other patients. In a home infusion setting, expertise in handling emergent situations is expected and having full understanding of the complexity of the drug is a must. This allows 1:1 NTP ratios and full autonomy in the home setting while infusing a patient. When working in any facility, you really don't get a choice of the people with whom you work and there is the chance of personnel conflict. Stress that may be encountered in a "toxic" environment is very counter-productive and it can carry home with the nurse. A nurse may encounter an unsafe or toxic environment in the home setting, which may be indicative of inappropriate for home infusion. The nurse may refer the patient's living conditions to the prescriber to discuss other options. If a toxic environment, the nurse may request a different assignment. Although home infusion has been proven to be a safe and effective alternative to infusion centers for patients, it must be also be safe and effective for nurses to provide services. The home infusion provider will go through great measures to ensure the nurse will experience a successful infusion by providing all the supplies, pumps and training materials prior to the visit. Some inquiries made by the home infusion provider may include gender preference, language preference and even presence of cats or dogs. A nurse may have a severe pet allergy and will be able to decline providing service to a patient who is a proud, happy owner of ten cats. Also, stress is decreased knowing what your schedule will look like ahead of time, and being that these patients have chronic conditions, they will be requiring services for the long run. Home infusion scheduling can be tweaked to better accommodate the patient, providing additional benefit for the nurse. The nurse may not have to work late evenings, weekends or holidays because a patient may like to enjoy the same time off and simply not ideal with infusing. Having fewer tasks to perform and having control of the environment and scheduling are a few of the many perks associated with home infusion.
It has been over 30 years since home infusion was declared as a safe and efficient alternative to infusion centers and it has provided huge opportunities for many. Not only do patients significantly benefit from this change, but so do nurses. Home infusion is a great opportunity to practice autonomously, free of stress, decreased exposure to infectious disease and will help nurses not continuing to be the #1 profession with back injuries acquired at work. In speaking to a retired home infusion nurse, she stated, "It's a great gig, when you love what you do, but don't wish to deal with all the politics [working in a facility] or being stuck in the same place day after day!