A day in the life... of a Community Hepatitis Nurse

1 July 2013

Kerry Kennedy's day starts with her dog demanding a walk. Her working day starts at her home desk inputting yesterday's notes before hitting the road to visiting hepatitis patients needing regular blood tests because of the risk of liver disease.

NAME | Kerry Kennedy

JOB TITLE | Community Hepatitis Nurse for The Hepatitis Foundation of  New Zealand   

LOCATION | Based from home; covering South Auckland from Meremere to Mangere.

5.30 AM: WAKE

My dog wakes me every morning at 5.30am. He sits by my bed grunting until I get up. If I send him back to his bed, I may get another ten minutes, but it’s not worth the effort. I feed the pets and make lunches for everyone. I know they could do it themselves; I also know they won’t. It’s a mum thing. The dog and I stretch our legs on a half hour walk. It’s getting dark and cold in the mornings but it is good planning time for the day ahead.

8.00AM: COMPUTER AND PHONE TIME

When I’m not on the road, I work from home. I start the day at my computer, inputting notes for yesterday’s patients. It is vital patients with chronic hepatitis B get a blood test every six months to identify early characteristics of liver cancer and cirrhosis. It’s my job to do the blood tests for those who are late in getting their tests done. I also trace contacts of patients to check their hepatitis status and provide education for new patients and their families. My appointments for the day are already made as every Sunday evening I spend three hours scheduling the week ahead. While I’m on the phone to a general practice, the dog has brought his lead and all his toys to me. I can take a hint … and a break! Later, I have a coffee and load the car for a busy day ahead.

11.30 AM: ON THE ROAD

My first appointment today is with a translator to provide education for a newly referred patient. He is an older Chinese man with limited English. His wife and eldest son are present. As well as education, we confirm there is no history of liver cancer in the family (if this was the case, he may need regular liver ultrasound scans). It’s important the rest of his family is tested. His wife is unsure if this has happened, so I ring the GP to enquire. I do a blood test for the wife and son. There are three others in the family who I will test on Thursday evening.

12.30PM: BACK ON THE ROAD

My next appointment is not till one o’clock, so I visit a patient I have not been able to contact. The house appears empty. The neighbours are outside and have seen me arrive. They tell me the family moved to Perth three weeks ago. I ring the practice. They confirm this and inform me the patient has taken their notes. I’m relieved as this increases the chance they will get good follow-up care.

1.00PM: A NO SHOW and COLD CALLING

My one o’clock appointment is not at home, and I get no response to cell phone calls or texts. I will call him again tonight. This gives me more time for cold calling. No one is home at the next house. In a sealed envelope I leave my card asking them to text or ring me. If no response, I will ring the general practice tomorrow to check contact details and when the patient was last seen. I can also check HealthLink and the phone book. My role: part nurse, part detective.

I now visit a patient I saw six months ago. We discuss alcohol and THC use, as these are toxic to the liver. After discussing her previous results and taking her blood, I remind her that her next blood test is in November and the hours of the nearest lab. She walks me to the car. Her parting words are: “see you in six months”.

Just down the road, I call in on an elderly visually-impaired man who lives in a tiny one bedroom flat. He seems distressed and asks me to read an official looking letter that has arrived for him. I tell him not to be concerned – it’s from Sky TV offering a deal. We laugh. No TV here! I take his bloods but I’m concerned about him, so I ring the practice to arrange a community outreach nurse to visit him.

Then I visit a local general practice to give brochures to their hepatitis nurse. I could have posted them but this gives me a chance to update her and to use the toilets!

The following three patients are all at home, so I get in as much patient education as I can while doing their blood tests, again emphasising the importance of regular blood tests. However, I do understand many can’t get their blood taken at the labs because of long working hours, limited transport, or because it is low on the list of priorities in a busy and sometimes chaotic life.

I’m visiting my 4.30pm patient at the request of Middlemore Hospital gastroenterology department as he has missed his last two appointments. When I rang him on Sunday night, he told me he had moved to a new address in Mangere. He hadn’t received his appointment letters. I do his blood tests and find out he has run out of his hepatitis B antiviral medication, as he was too busy with the move to get a new script. I remind him how important his medications are and he says he will see his GP tomorrow. As I leave, I advise the gastro department of his new contact details and request a new appointment for him.

5.15 to 6.30PM: LAST PATIENTS

This is always a busy time as all my working patients are home and wish to see me. Blood tests and education completed, I finish my day by dropping off my blood samples at Middlemore hospital.

7.30PM: HOME

Pets fed. Tea is cooked. I’d like to say we sit around the table sharing amusing anecdotes about our day but My Kitchen Rules is a family obsession. We all watch together. During an ad break, I call the patient who wasn’t at home and set up a new appointment for Saturday morning.

10.00PM: SLEEP

As I prepare for bed, I think about the things I am grateful for. Not far down the list is my job. It allows me autonomy in my practice and the privilege of seeing my patients in their homes and workplaces.