Interview with Joyce Ballard, Home Care Nurse

Joyce Ballard is a Home Care Nurse for the city of Cincinnati, Ohio.

How did you decide to get into nursing?

I was raised in a small suburb of Boston and attended a Catholic High School. In 1960 there were probably three choices for women who wanted a career: teaching, secretary work or nursing. None of these options spoke loudly to me at first, so my best friend and I went to work a year for John Hancock Insurance Company. We also volunteered at a local nursing home and actually found it to be a delightful experience - especially the aspects of caring for people and doing things that seemed to make a difference in each of their lives. We looked forward to it with new purpose and pleasure. We talked at length about our potential to become nurses ourselves. It seemed quite difficult. Could we actually be strong enough to do what we observed the other nurses doing on a daily basis?

I received very little encouragement from my family. Performing strenuous and sometimes dangerous work with relatively low pay didn't seem to appeal to them. This made me want to enroll even more. I then applied to an inner city hospital on the West End of Boston and was accepted.

Tell us about your nursing career.

Hospital Nursing was a great experience for me right out of school. I stayed in Boston and worked there for six years, first as a staff nurse and eventually as the acting head nurse. The first CCU was opening at our hospital and I was asked to be included in the first group to be trained. This consisted of six weeks of formal and on the job training. We all felt like pioneers. We were using brand new, state of the art equipment. It was a wonderful learning experience.

After staying awhile in Cardiac Care, I discovered Home Care. This is what I had really been looking for. So many aspects of Home Care really appealed to me - seeing what happens to people after they leave the hospital, the one-on-one relationships, meeting families, working with other professionals in the community (social workers, counselors, etc.) - it was such a new and exciting approach to the nurse/patient experience.

Most of my Home Care patients lived in Maine. After eight years of driving through mountains, valleys and snowstorms, we decided to move to a warmer climate. I began working in the inner city and discovered I liked the hustle and bustle there. I felt engaged and like I was a part of everything.

I eventually transferred into a home hospice unit. This is where care is given to a terminally ill patient in his or her home. This was my finest hour as a nurse. It taught me so much about myself and living life to its fullest. I wasn't focused on death and dying so much as making each day count.

Today I am sixty years old and am working as a Public Health nurse and continuing to make home visits to inner city people. I love it as much as ever. My feeling is that I am successful and much blessed to have a job that I love and that I continue to learn from every day. There is endless value and joy in being a part of a diverse team and surrounded by so many younger nurses who seem to hold the same purpose in life - the purpose to reach out to people in need, support them toward their goals to recovery and preventative health and encourage their independence. At the end of the day it's good to feel that the world is a little better off due to our efforts and commitment to caring.

I have never regretted my choice of nursing as a career and I've never had any problems finding work. If I were to start out as a new grad today, I would definitely choose to become either a cardiac nurse specialist or a wound care-ostomy nurse in geriatrics - wound care, because it is like patient care and very close to my heart. I would like to know everything about a specialty rather than be a generalist and know little about everything. I would love to broaden my outlook more and travel as a nurse for a short while, working in other countries or with a group doing missionary work. There is so much a nurse can do today.

What is typical day for you as a home care nurse?

Monday morning I look at my weekly schedule that I made out last week and update it - arrange patient names by priority, get weekend report for changes or new patients to add and call my patients and discuss best times to visit. By now I am familiar with the early birds, the people who won't appreciate an early call and the diabetics who will eat breakfast if I don't get there by 9 am.

My patients are usually within a 10-15 mile radius. I must consider driving and visit times and plan accordingly. I must stock up on needed supplies (dressing kits, gloves, etc.), record my mileage from office to house and note time in home and between patients. I must also consider between-trip stops such as medication pickups, food pantry stops, meetings with family members and/or visiting doctors. I may have an appointment for a joint visit with Social Services to assist or facilitate learning or visually impaired clients. I have to supervise the health aides who provide personal care and homemaking. I may need to meet a physical or occupational therapist if they are discharging a client. I am considered case manager and must coordinate all care. For example: Mr. Jones will need his blood sugar checked and blood drawn and brought back to the lab. I follow doctor's orders and set up an individualized plan based on each client's needs. Every 60 days I send a report to the medical doctor and call to see if I should discharge the patient or continue care. Paperwork is a big part of the job and everyone complains about it. There is always at least one unpleasant aspect of every job. I spend a good part of my day calling doctors to report changes in condition, obtain orders for wound care and relay lab results.

The key responsibilities in this job is to case manage my own assigned group of patients (usually around 15 or so), make sure they are receiving the care ordered by their medical doctor, complete paperwork at all points of care and prepare the client for possible hospitalization. It is also my job to perform all nursing assessments, educate families as well as the patients in post-care and follow-up in order to prevent future complications and hospitalization.

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