Advanced nurse practitioner blog

After taking on a Hospital at Home (H@H) role as a fixed term position, Susan Steel, an Advanced Nurse Practitioner (ANP) working with the West Lothian H@H service, simply didn’t want to leave. With 18 years’ experience as a nurse, Susan began her career in A&E, where she stayed for nine years before moving to unscheduled care and doing the district nurse programme for a year. Below, she shares her thoughts and experiences of being part of the H@H team

A day in H@H

While there is no typical day when you’re part of H@H, there are some elements that are quite consistent and happen on a daily basis. For example, members of the team take turns in the co-ordination role for the service. When it’s my turn to do this role, I am responsible for being the first point of contact - triaging calls, delegating tasks and responding to referrals into the service.

Visiting patients

On the weeks when I am out on visits, my days look quite different. The day will normally start from my base at St John’s Hospital in Livingston – from here, I review which patients I need to see, prioritising my route based on distance and the acuity of patients. Another important part of the logistics process is figuring out what equipment I need to take, as being as prepared as possible saves me from having to return back to base.

Assessing patients' needs

There are often new patients to be seen, normally referred by GPs to prevent admission. My first visit to a new patient can often take an hour, which is necessary for me to develop a proper understanding of each patient’s individual situation and requirements. These initial visits will include: a full comprehensive assessment (including clinical examination, medicine reconciliation, prescribing and de-prescribing as appropriate), Anticipatory Care Planning and considering the social and environmental factors which may support the person at home and influence decision making. Some examples of environmental factors are seeing if the patient has any carers or family support, the level of home safety, and whether they can get to the toilet, make their own food and drink or get in and out of bed.

As well as the time it takes to travel and visit patients, my day includes carrying out tests which then need to be sent off for analysis when I return back to base. I will then write out my discharge letters for that day and get them sent out so that there are no delays to GPs. Our team is currently trialling having our team huddles earlier in the afternoon, so that we have time to complete any additional tasks that might arise during the huddle. We use our huddles to discuss plans and options for our patients’ care and treatments, which we will then put forward to the patients, their families and carers.

Building strong relationships with patients, their families and carers

I initially joined a H@H team to get my competency signed off for my district nurse role, but found that I enjoyed the experience much more than I expected. While I already had a lot of experience, community nursing really opened my eyes and I feel like it is the true definition of person centred care. Plus, I get to work with lots of different people and patients, which makes my job very varied and exciting!

Working in a patient’s home, surrounded by their family, pets, photos and belongings gives me an opportunity to spend a lot of quality time with them, making the relationship feel like a real partnership between the patient and me. My patients also have more independence at home and I feel that unlike with having to wait until after they are discharged, they can begin their rehabilitation straight away, even while still receiving treatment at home.

Next steps and what to know before joining H@H

I am now looking to complete my ANP pathway, developing my clinical skills before moving on to advancing my clinical decision making. As part of this development, I am covering a community hospital as and when I am needed to help develop my role further.

In terms of our service itself, I would love to see it open to other demographics, conditions and specialities – I feel it has real potential to diversify and I am interested in seeing how this will progress and develop.

To anyone interested in working in H@H, I would say just go for it. No matter your level of experience, there is an element of uncertainty for anyone moving from the acute ward to the community. This is a process that everyone goes through and the team is there to support someone going through that process, helping them to work through that feeling of vulnerability. Just doing the job builds your confidence, so the more you do it the more confident you will be!

In terms of useful skills you will develop, I would definitely say problem solving (and I know much of the team will echo me on this!) There are many opportunities to practice this skill when working in a H@H service such as working out how to actually get into a house, how to fit a drip stand into a Fiat Panda or how to take apart a commode to fit into your boot! General practicality is essential in a H@H role!