A day in the life of ... a clinical nurse specialist (older persons)

June 2016 Vol. 16 (3)

Michele King shares a day of juggling finding respite beds, ward visits lunchtime meetings and working with frail older people and their sometimes tearful but grateful children.

 

King

NAME: Michele King

JOB TITLE: Clinical Nurse Specialist (Lead) ElderHealth, MidCentral DHB 

LOCATION: Palmerston North City Hospital

 

6:00 AM DAY STARTS

Our home is on the outskirts of Palmerston North. As I get ready for work, I usually see the city lights switch off as the sun rises. I enjoy the 10-minute drive to the hospital – the short commute is one of the great benefits of living close while still enjoying rural living, particularly as the morning radio tells us about the traffic hot spots delaying commuters elsewhere around the country.

 

7:00 AM  EARLY MORNING ROUTINE

The advantage of getting to work early (apart from securing a coveted close parking space) is to shape the day. I am fortunate to lead a team of ElderHealth clinical nurse specialists working in a variety of roles within the hospital, the wider community and outpatient areas, as well as a new role established in an integrated family health care centre. No two days are the same in this role.

A quick catch-up follows with my community team CNS colleagues. I then head to the assessment and rehabilitation ward to meet the charge nurse to discuss ward occupancy, referrals, discharges and those who may benefit fr

om community follow-up. At this time I also note the overall hospital ward capacity.

 

8:15 AM ELDER HEALTH TEAM MEETING

It’s back to the outpatient area of ElderHealth where we meet daily with the geriatricians, older adult psychiatrist and community nursing teams to triage and allocate inpatient and community referrals. It is also an opportunity in an interdisciplinary team environment for all members to discuss patient issues. People choosing to live with risk, possible elder abuse and neglect concerns, patients with cognitive impairment and without an Enduring Power of Attorney (EPOA) are some of the most challenging things to discuss. The complexity of each assessment often requires us to call on the breadth and depth of experience we are fortunate to have in our team.

 

9:00 AM  MORNING CONTINUES

I confirm last week’s plan to provide a residential respite bed for one of our community patients with severe cognitive impairment. This is a great opportunity to review his medications, assess his continence issues and provide a break for his supportive family. I make phone calls to his daughter, to his GP and the RN at the facility. I will follow up with a visit to the facility tomorrow.

9:30 AM  CLINIC: FRAIL PATIENTS & WORRIED FAMILY

A patient I visited in her home last week has come to an outpatient clinic to see the geriatrician I work closely with. Her family are concerned about her short-term memory and falls. Her daughter was tearful but very grateful and somewhat relieved as she acknowledged her mother’s vulnerability – all the things that made Mum who she was had changed recently. At the home visit, I started the Comprehensive Geriatric Assessment (CGA) – a medical, cognitive, functional and social assessment. I noted postural hypotension and identified several culprit medications. I also heard of her recent 3kg weight loss and the daughter’s fears that her mum may be forgetting to eat.

It was evident the medications were not being well managed and there were obvious environmental safety issues. I was able to start the conversation relating to advance care planning (ACP) and also to address the importance of an EPOA. I explained my assessment findings, including the cognitive screen, which identified concerns relating to executive function and the impact this has on decision-making, planning and completing tasks. We discussed safety risks. They agreed to several referrals for support. I listened to what were the most important areas for them. I attended the clinic appointment today and will provide follow-up after  the additional tests are completed. This hopefully will improve her outcome, reduce hospital admissions and potentially reduce the need for long-term care.

Two more outpatient clinic appointments follow. Many of the assessments relate to the frailty syndrome – falls, delirium and dementia, polypharmacy, incontinence, immobility and end-of-life care planning. This often involves health and social care. Unlike many other specialities, often we are not able to ‘fix’ a problem but we can provide interventions to ensure a person lives well with their condition.

The opportunity to work and be valued in a supportive team environment is a highlight of this job. Also the privilege of being invited to meet someone in their own home is never lost on me.

 

12:00 PM LUNCH MEETING

Lunch can be an elusive activity – it is usually shared with my team or while attending a meeting. Today it is Quality and Clinical Risk. Along with discussing targets, incidents, projects and audits, this is the forum where I report on some of the networks I belong to – the local Older Persons District Group Network and the regional Health of the Older Person (HOP) network.

 

1:30 PM  INPATIENT WARDS VISIT

I visit the acute wards to review and ensure a plan is in place for those patients who have a ‘special’ or close supervision, usually due to advanced dementia or delirium.

 

3:00 PM OFFICE TIME

Back to the office to attend to emails, phone messages, letter to GP and complete patient notes. It is a chance to work on some of the project initiatives and education session planning.

 

5:00 PM HEADING HOME

I leave work, more often than not having taken home some project work to ponder or a presentation to write in peace!

A walk near home, a phone call from one of our three adult children and dinner with my husband is a good end to the day – maybe another look at those travel brochures, then bed. :

 

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