Making the transition to a clinic setting after working as a home-visiting nurse, this nurse practitioner is reminded of the importance of defining the patient's goals of care.
By Michelle Nall, MPH, ANP-BC
I moved to Florida three months ago to take a job as a primary care nurse practitioner in a clinic for the underserved and uninsured. This position followed four years spent as a home-visiting nurse practitioner working with high acuity, chronically ill patients in the Boston area. I didn’t realize it would be such a transition to go back to taking care of patients in the clinic setting after spending several years caring for them in their homes, on their turf, and on their terms. Just as I was starting to feel I had a handle on this new job in this new setting, a patient threw me a curve ball.
Mrs. Jones, an 80-year-old woman with mild dementia, very poorly controlled hypertension, and diastolic heart failure, came into the clinic with her son, a middle-aged man who, when he wasn’t working local day labor jobs, was his mother’s primary caretaker. The reason for her visit was listed as “needing lab work” and she had not come to our clinic in over a year.