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Nurse Practitioner's Improve Patient's Quality of Life

Betty Smith, a 96-year-old great grandmother who lives in New Jersey, is mostly unable to leave her apartment, but not unhappy. “I love my little apartment,” she said. “I love it just as much today as I did when I moved in years ago. I have everything I need; it’s nice and it’s cozy.”

Betty, who has several health issues, used to go to doctor’s appointments, which required her to walk downstairs. However, it became an arduous task, especially having to wait to be seen by the doctor. When a friend recommended Visiting Physician Services (VPS), the home-based primary care arm of Visiting Nurse Association Health Group (VNAHG), Betty called and sought their help — between heart conditions and the risk of falling, she was struggling with daily tasks.

As part of the VPS team, a nurse practitioner named Emily Keller stepped in to visit. Emily’s role is to look at the big picture of her patients’ needs and to create an extensive plan of care. “A lot of times patients have issues where their symptoms overlap; treatments for one condition can cause side effects for something else,” Keller said. “Through a medical history or testing, you have to sort out what symptom goes with what cause.” And Emily did exactly that for Betty.


Nurse practitioners like Emily Keller combine the care and patient-focused mission of nursing with the decision-making abilities of a physician. (Photo: Visiting Nurse Association Health Group) (Photo: Visiting Nurse Association Health Group)

Betty had been suffering from shortness of breath. Before Betty saw Emily she was prescribed an inhaled medication that was supposed to help her breathe better. When Emily met Betty for the first time and examined her, Emily realized her trouble breathing was not going to be helped by the inhaled medication. Instead, Emily explained that Betty’s history of CHF (congestive heart failure) was contributing to her shortness of breath as well as swelling in her ankles and that she needed a diuretic. This medication change has made a difference in Betty’s quality of life.

The kind of medical detective work that Emily did for Betty is part of what a nurse practitioner who makes house calls can do, given the time to ask questions and the chance to see the patient in their daily environment. “Emily came quite a few times to see me,” Betty said. “She sits right down, gets her computer out, asks me questions until she can’t think of anymore to ask me… and she tells me, ‘Ask me anything you want to ask!’”

Nurse practitioners like Emily combine the care and patient-focused mission of nursing with the decision-making abilities of a physician. For instance, nurse practitioners can conduct examinations, provide diagnoses, prescribe medication and treatments, and more. In 20 states, nurse practitioners even have “full-practice authority” and do not need a doctor to sign off on most decisions. Overall, the Kaiser Family Foundation (KFF) has estimated that nurse practitioners can provide 80% to 90% of the same care that primary care physicians are able to provide.

As part of the VNAHG network, Emily is able to offer patients a wider array of services and resources for those who need it. “It’s nice to be part of the VNA Health Group, where those services are available,” she said. A few of these services are physical therapy, social work and skilled nursing. Betty said she loved the physical therapy she received, which helped her use her walker again. In the VNAHG and VPS ecosystem, the nurse practitioner is an integral part of the care team who sees patients more often than the doctors.

House calls also make it easier to keep an eye out for other issues — whether it’s an inaccessible bathroom, financial challenges that make costly medications difficult to afford or the lack of family support. “You get the complete picture when you are in the home and you’re establishing a relationship,” said Emily, who chose to work with VPS after nursing school for these specific reasons. “I knew from the beginning I didn’t want to be where it’s a revolving door, and you just spend 15 or 20 minutes per patient.”

The advantage for Emily also translates to an advantage for Betty — both in the increased time her nurse practitioner and doctor spend with her, and the major advantage of no waiting times in offices. “Emily calls me 20 minutes prior to my scheduled visit to remind me she’s on her way and says, ‘I’m coming over, is that alright with you?’” Betty said. “I tell her, ‘That’s fine with me!’”

If you or someone you know could use at-home care like Betty’s, contact the Visiting Nurse Association Health Group today.

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