The role of a nurse practitioner in Hospital at Home

From a background in renal transplants and high dependency patients, nurse practitioner, Angela Fairnie has found her place in Hospital at Home (H@H).

The journey to H@H

I started my career as a clinical support worker in the gastrointestinal ward. For 13 years before moving to my current role in H@H, my background was in renal transplant and high dependency.

I then completed the clinical decision making course and was keen to use these new skills. When a role in H@H came up that would allow me to use my new qualification, I leapt at the chance.

I've always enjoyed working in acute care so a role in H@H appealed to me. In particular, I enjoy the dynamism of the work in the H@H team.

A typical day in H@H

The day to day of H@H varies, but there is a consistent structure. The team works from 08:00 to 20:00. At 08:00 every morning there is a handover. This may last half an hour or it may last an hour, it all depends on the number of patients to be seen that day.

New patients have a visit scheduled on the day they are referred. Depending on the time that they are referred, it may be in the afternoon that they receive their visit. When I spoke with the team at Healthcare Improvement Scotland, I had just returned from administering IV antibiotics to a patient.

Patients are generally allocated to team members based on location. Members of staff are allocated to one area. It is good to have continuity, so where possible, the staff will try to see patients on consecutive days, depending on shift rotations.

The best thing about H@H

The best thing about H@H for me is getting to see patients in their own home. I really get to see how much they appreciate the service. In my experience, the expectations from patients in hospital are different and I find they really appreciate what we can do for them.

Seeing a patient at home also allows me to see all the different facets of their life. It really makes a difference getting to meet patients’ the families and carers. They are often the first to notice changes in the patient, often even before the patient. As the main cohort for the Midlothian service is people aged over 65 years old, many of whom have dementia, having the option to stay at home is invaluable.

Developing within H@H

I see a lot of opportunities to develop within my role in H@H. At the moment, I’m looking into doing prescribing training, which will support my development to becoming an advanced nurse practitioner. I would like to continue on in H@H regardless of what else might change in my career. I really enjoy the work in H@H and my team.

Next steps for H@H

In Midlothian we would like to develop by introducing Peripherally Inserted Central Catheter (PICC) lines as part of treatment options to patients. We would also like to introduce allied health professionals into our team.

While the service operates for seven days a week, the team does not include medics over the weekend. Instead, we contact the hospital consultants if needed over the weekend hours. This is another area for development that our service is looking into.

Finally, an expansion of the patient cohort is an area that I would like to see expanded. At the moment we sometimes admit younger patients but not a as a general rule. We are aiming to expand to a younger cohort in future.

Working in H@H

Working in H@H can seem daunting at first because you don’t always know what you’re walking into. You have lots of responsibilities and need to be able to trust your instincts and clinical judgement.

To work in H@H, you need to be able to adapt to different situations, think on your feet and have good clinical judgement. Being able to improvise will be a key asset for anyone that works in the service. Being non-judgemental is incredibly important in a service where you are visiting people in their homes.

I would say that anyone considering applying for a role in H@H definitely should! There is good job satisfaction in H@H, and the patients are really nice!