1. Szulecki, Diane


Chicago NP Dwayne Dobschuetz makes house calls-often on bike-to improve his patients' health and well-being.


Article Content

Fifty years ago, Dwayne Dobschuetz earned his BSN from the University of Wisconsin in Madison, just a few years after the school opened its nursing program to men. But his path to nursing took a few detours, and he didn't join the profession until 19 years later.

Figure. Dwayne Dobsc... - Click to enlarge in new windowFigure. Dwayne Dobschuetz, MSN, RN, APN, AGPCNP-BC. Photo courtesy of Northwestern Medicine.

After spending the first decade after college working for a student Christian organization on campus, Dobschuetz began to look for work as a nurse but found it wouldn't support his family. "By that time, I had kids, and nursing was paying about $5 an hour," he recalls. He went into medical sales instead, representing a product used for patients with spinal cord injuries.


Dobschuetz excelled at his sales job but was laid off after several years. Shortly afterward, he ran into the director of the hospital he'd worked with most closely, Northwestern Memorial Hospital in Chicago, who jokingly asked him if he wanted a nursing job. The two laughed about it, but a few days later, Dobschuetz called him with a question: "If you were serious, what would I need to do?" Within a few weeks, he was Northwestern's newest nurse.



Dobschuetz's transition to nursing was eased by his familiarity with Northwestern staff from his time as a sales representative. "They all knew me, and they very gently reintroduced me to all the things I needed to do. One night, two of the nurses rolled up their sleeves and let me do IV practice on them," he says. "Within a year, I realized that I really loved nursing and didn't want to do anything else." He went on to work in the ICU and later became an ED nurse, earning a master's degree along the way and taking jobs at various hospitals, though he eventually returned to Northwestern.


In 2013, the Centers for Medicare and Medicaid Services awarded Northwestern a grant to fund a Geriatric Emergency Department Initiative (GEDI), a new program aimed at preventing unnecessary senior admissions. Dobschuetz-then 20 years in emergency nursing-was invited to participate in the program, in which specially trained "GEDI nurses" assessed older ED patients to ensure they were able to meet their health needs at home, thereby helping them avoid hospitalization and subsequent readmissions. Intensive follow-up is part of the program: GEDI nurses call patients after discharge to confirm they're taking their medications and making their medical appointments. (Northwestern's GEDI program continues today; a 2018 study in the Journal of the American Geriatrics Society found that since its implementation, GEDI has reduced unnecessary hospital admissions by 33%.)


For Dobschuetz, working as a GEDI nurse prompted yet another unexpected career change. He found that he enjoyed the camaraderie with his older patients and the challenge of identifying and solving their problems. "But I realized there was more I could do for them if I knew how," he says. He decided-at age 65-to go back to school to become a geriatric NP. "I didn't think that anything would make me want to leave the ED but working with seniors did the trick."



When making follow-up calls to his GEDI patients, Dobschuetz was concerned when he couldn't reach some of them despite multiple attempts. It occurred to him to check in on those patients at home. "I would look up their addresses-many lived between my home and the hospital," he says, explaining that as a bike commuter, it was easy for him to ride over and knock on their door. He found that the patients he visited at home often had issues that required attention, whether small (like a wheelchair adjustment) or large (like being unable to care for themselves). "Sometimes they needed real help in the home that we weren't addressing."


Dobschuetz's efforts to reach his patients didn't go unnoticed. After he completed his NP certification, Northwestern's geriatrics department created a new role for him in its expanding home care program: making primary care visits to seniors. Now in the role for three years, Dobschuetz receives referrals from physicians and other clinicians either while patients are hospitalized-in anticipation of needing medical follow-up after discharge-or because they've missed physician appointments. He visits patients anywhere from every two weeks to every few months. "I tell patients I went from being the oldest staff nurse in the ED to the young guy who comes to see them at home," he jokes.


One major perk of home visits for Dobschuetz, and for his patients, is that he doesn't need to rush. "A 30-minute appointment is short for me," he says. "Many times, it's an hour, because we cover physical, emotional, equipment, and caregiver needs," plus medication reconciliation and general safety. This thorough level of assessment and problem-solving can make a big difference to the patients' well-being, especially for those who have difficulty leaving their home or who rely on a caregiver. In fact, working closely with caregivers is a key part of Dobschuetz's job; he frequently provides them with both education and emotional support.


Dobschuetz also notes that successfully meeting his patients' needs requires partnership with their physicians and "constant continuity." He describes, for example, the case of one of his first home care patients. She was referred to him by a physician because she had missed several appointments in a row. By working with the patient in her home and keeping in regular contact with the physician, Dobschuetz helped see to it that the patient never had to return to the hospital; the following year he helped her transition to hospice care, where she died.



Beyond attending to their immediate circumstances and needs, getting to know his patients as individuals is important to Dobschuetz. He enjoys listening to patients' stories and tries his best to find out what their lives were like in earlier years. "My only regret is that many times, I come in at a late point in their life when they're no longer able to relate that to me," he says.


Given the population Dobschuetz cares for, aspects of palliative care often factor into his work. He estimates that at least 30% of the patients he's visited in the last three years have passed away. "Part of my role is helping them transition to palliative care, to hospice," he says. "I have a palliative care approach when I see people at home because I'm supporting their desires, and I try to use palliative hospice language to clarify their goals of care as they transition, age, decline-so that whatever we're doing is consistent with their wishes."


Often, it's at memorial services for his patients, when family members express their thanks for his visits, that Dobschuetz realizes what his work means to families. "You wouldn't believe how I'm welcomed in those situations-you would think I was family, the way I'm greeted," he says. "I'm overwhelmed by how people respond to me and how grateful they are for having had that contact in the home."


Dobschuetz is passionate about his job and, at 72 years of age, doesn't plan to retire anytime soon. However, he's determined to help younger clinicians and students, who sometimes accompany him on home visits, understand the issues seniors face-and discover the value of working with them. "There's going to come a time where I need to turn the reins over to somebody else," he says. "I realize that I have a responsibility to train the next generation of geriatric advocates in what I'm doing, whether it's in the clinic or at home."-Diane Szulecki, editor