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Background: Retired nurses with years of education and experience volunteer in their community, focusing on assisting the elderly chronically ill population. Based on the concept of one nurse with one patient/family, each nurse is asked to volunteer 4 to 8 hours per month in home visits, phone calls, or postcards/e-mail. These volunteers make a difference in assisting patients in and out of emergency rooms and unnecessary referrals. Add navigating through a complicated healthcare system and this 12-year program has been a success.
Training and Implementation: The 2-day training involves a focus on goals of the patient and family and patients with co-morbidities or families living away from the area. Nurses use the “4 R model of care not cure” which involves: 1) relating to the patient, 2) review what is happening, 3) revise as appropriate, helping patients to understand, resources available, etc., and 4) reflect on the connection of nurse/patient experience.
This is not “hands-on nursing” and is a referral source to homecare, hospice, hospital/clinical departments, and community organizations. During the 12-hour training a panel of available community resources is used along with representative from the health system departments as appropriate. Two meetings a year for the volunteers include a continuing education and a case management.
Results: The aggregate value of the nurses is: 1) understanding for the patient of their conditions and medications, 2) identification of red flags, 3) appreciation by the family, 4) helping to alleviate stress for patients and families, 5) serve as a patient advocate, and 6) friend and resource for patients. This information is used to evaluate program changes, grant proposals, article publication, and dissemination into other communities and organizations.
Lessons learned
1) Securing the retired RNs immediately upon retirement is crucial. Most nurse retirees are solicited strongly by other non-profit organizations due to their skill sets and ability to work as a team.
2) Emphasis on “no hands-on nursing”: this has proven to be a positive aspect as most nurses do not want the extra responsibility of using nursing skills once retired.
3) Finding a home for the program was crucial, and we stayed away from nursing as it seemed easy to get caught up in direct patient care. We partnered with the auxiliary which allows the volunteer hours to support community service and the auxiliary membership refers patients.
4) Care coordination continues: we found it important to not duplicate efforts of other nurses and departments in the organization.
5) The ability to gain CE was requested: continuing education was approved for the training, and they are invited to many of the hospital CE offerings. These assist retired nurses to maintain an active RN license.
