OSCEOLA, Iowa — Brandi Dyer is a nurse. She doesn’t work in a big city hospital. She has a desk in an office just off the main drag in this county seat town. Her job takes her to farms and small towns across a swath of five rural southern Iowa counties.
Dyer is a nurse and supervisor for Unity Point at Home. She and the six nurses and one therapist she supervises provide home health help and in-home hospice care for a large rural area.
“It’s not unusual for me or one of my nurses to drive 200 miles in a day,” she says.
And in the past year, during the COVID-19 pandemic, that job became even more difficult. But Dyer says the work went on, just like it always does. Her nurses continued making in-home visits and caring for their patients, though there were times the patient didn’t want someone coming into their home or when the nurses had to go into homes where COVID was present.
“Weather is a bigger factor for us,” she says. “And cell service.”
But Dyer, who grew up not far from here, would not trade the job.
“I have a wonderful staff,” she says. “And I absolutely love home care.”
The days can get long. They usually start with a quick staff meeting and a look at everyone’s schedules. Often Dyer has already spent time the day before calling the patients to be seen the next day. Then there are visits to about five or six patients. Finally, there is the drive back home to the small acreage where she and her husband and daughters raise show pigs.
It may lack the minute-by- minute excitement of an ER nurse or a surgical nurse, but it makes up for that frantic pace with the necessity for home health nurses to think on their own when they are far from any doctor or hospital, and where they may not have the equipment or supplies to do the job the way it would be done in the hospital.
“As a home health nurse you have to be in tune with your assessment skills,” she says. “You are the eyes and ears for the physicians.”
None of that begins to account for hospice care. The differences are simple but the details are complex, Dyer says. When doing home health care work, the nurses are dealing with patients who are often recovering from surgery or injury. The nurse is checking on their health and educating them about things they could do to recover faster.
But in-home hospice involves caring for someone who is preparing to die. It is about managing pain and making the patient comfortable in his or her final days.
“End of life is a lot of work,” she says. “It’s a privilege. It’s hard but also a privilege.”