1. Mcclellan, Tammy RN

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I have been a registered nurse in the home healthcare setting since the early 1990s, and one thing that I have learned is how to improvise in difficult situations. Home healthcare is a different environment than inpatient settings such as hospitals, nursing homes, and rehab facilities. Items are not at the nurse's fingertips like they are in inpatient units. You quickly learn to carry everything in your car, because you may need it when making a home visit. As the years passed by, I learned to have a work vehicle and a leisure vehicle. It can become very burdensome to drive youngsters to school toting durable medical equipment, dressing supplies, Foley catheter kits, intravenous poles, and anything else one might need to perform a home visit.

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I can think of many humorous experiences I have had in my nursing career when either my patients or I had to improvise. I have seen everything from patients washing latex gloves and hanging them on the line for reuse to carrying multiple outlets in my car to plug in an electrocardiogram machine. From many unusual experiences, I have learned to be very specific when giving instructions to patients about their health needs. One particular patient taught me that you have to remember to teach not only what you want the patient to do, but also what not to do. This patient had a gastrostomy tube (G-tube), and I saw her weekly for maintenance and integumentary checks. She lived in a house that did not have running water inside and only a spigot on the outside. It was always dark and drafty in the house. On warm sunny days we sometimes completed our visit outside on the porch. I saw her each week, and she and her family were very familiar with me, and I with them. One day, I went to see her and in doing a skin assessment around her G-tube site, and I noticed something strange poking out of the end of her G-tube. She normally kept it plugged off because she did bolus feedings, which are intermittent rather than continuous. On further examination I realized she had a stick poking in the end of the G-tube. When I asked what had happened, she said she lost the plug so she made herself one. She had whittled a stick into a homemade plug for the G-tube! You can imagine my shock and concern about infection and general cleanliness. I quickly got her the appropriate equipment that was needed and monitored for signs and symptoms of infection and also reeducated her and her family regarding cleanliness of the skin around the G-tube as well as care of the G-tube. I made sure she knew to call the office if she ever lost supplies again.


I think we have all, in our home and professional lives, improvised at some point. In home healthcare, it is expected on a daily basis and goes with the job. However, in this case, I wish the patient had called me rather than take matters into her own hands!


Home healthcare is a job performed in the patients' homes and on their terms. You learn to love it or hate it. Fortunately for me, I love it. The creativeness and personal relationships are what made me seek a career in this field and say that I am blessed to be in this profession for more than 20 years.