A Day in the Life of an ACRN
At Contessa, Amedisys’ high-acuity service line, nurses have the unique opportunity to join the Recovery Care at Home program as an Acute Care Registered Nurse (ACRN).
Like their hospital counterparts, ACRNs are responsible for starting the patient’s care, including performing a comprehensive nursing assessment, medication reconciliation, safety assessments and implementing standardized protocols. In the Recovery Care at Home program, however, this high-acuity, hospital-level care is provided in the comfort of the patient’s home.
So, what does a day in the life of an ACRN look like? How is it different from working at the bedside in a hospital, often with a high nurse-patient ratio? Is it like home health nursing? We sat down with ACRN Kim Comabig Espinosa to find out more.
Why the ACRN role is unique
Kim says that the thing that attracted him most to the ACRN role was the idea of caring for people at home but still retaining his acute care skills. And, as an ACRN, he’s happy that he can use everything he learned as a nurse in the hospital.
When asked why an ACRN role is a great choice, Kim says, “I would say autonomy. You finally get to put everything you have learned over the years as a nurse into practice and use them independently.” He also emphasized that he loves being able to spend more time with his patients. “I don’t feel like I’m being rushed– I don’t feel like I’m halfway out the door trying to get to the next patient. It’s quality time with the patient. And you actually get to know your patients.”
The beginning of a shift
At the beginning of each day, a clinical manager gives each ACRN their assignment for the shift. While there are different shifts available, care is structured so that patients have a morning visit and an afternoon visit. Sometimes one nurse is doing both, and sometimes care is handed off to another shift.
“The morning visit is crucial, because that is when we set up a telehealth visit with the provider in the Virtual Care Unit (VCU),” says Kim. To do so, the ACRN:
- Performs a full assessment
- Uses a digital health monitoring kit to measure blood pressure, weight and vital signs and upload them to a tablet in preparation for the virtual physician visit
- Does a medication reconciliation
- Evaluates the patient’s need for any durable medical equipment (DME)
- Gives report, including care recommendations, to the provider
- Assists the patient in conducting the telehealth visit via the provided tablet
Once the visit is complete, the ACRN can then refer the patient to other resources needed, often with the help of a social worker. They also spend time offering patient education, filling gaps in health literacy for both the patient and their family members.
Over the course of a shift, Kim says this process allows for the ACRN to see between three to four patients on average.
Other responsibilities of an ACRN
Along with assessment, advocacy and patient education, ACRNs have other responsibilities that utilize acute care nursing skills. As Kim relates, “You have to have a good, sound knowledge base when it comes to acute care. Because you are going to be independent in the field, and you as the ACRN are the eyes, ears, nose—every sense— for the provider.”
He also says that top-notch assessment skills play an important part in the job. “Your assessment is what will help determine the clinical interventions for the patient.”
Other typical duties of an ACRN include:
- Identifying and acting on changes in the patient’s condition
- Evaluating and revising care plans based on changes in patients and/or their environments
- Documenting all assessments and interventions
- Collecting specimens as required (including phlebotomy)
- Starting and managing peripheral IVs, midlines, and PICCs
- Administering medications including IV medications as ordered
- Inserting foley catheters as ordered
What are some challenges of an ACRN role?
Being on the road means juggling logistics is a part of being an ACRN: this includes the travel time and distance between patients, and scheduling things like medication doses and blood sugar checks appropriately. But Kim explains, “there’s a lot of communication — you’re not really alone. I have another nurse in the field on the same shift. We check in with each other at the start of shift. If for some reason I have problems, say, getting an IV or getting a blood draw on a patient, I reach out and ask if they’re close by and if they can help me out. We establish that rapport with each other and we have a lifeline.”
How ACRNs make a difference in the lives of their patients
ACRNs have a unique ability to positively impact their patients’ lives thanks to the nature of in-home visits. As Kim says, “The biggest impact I would say is being able to know their socio-economic situation. Because in the hospital, we see them as the same patient as everybody else. You try to make an intervention based on a diagnosis, but you don’t always understand how they came about that diagnosis.”
In the home, Kim shared that it’s easier to see how problems like food insecurity, caregiver stress or even clutter and dust in the home could be affecting a person’s ability to get well. “A lot of it you would think we aren’t able to do any changes, but we are. Being able to get meals delivered in the home to eligible patients while they’re in our care, for example. And taking the time to help them understand why they have to be compliant with their medications.”
Wrapping up the shift
At the end of an ACRN’s day at work, documentation must be completed and the next shift must receive a report on their patients just like any other nursing position. In some cases, this might be after the afternoon visit is completed, if the ACRN’s shift allows. As an ACRN, Kim says that the role has changed his outlook on his profession: “I felt like I was a burned-out nurse, and it’s brought back the joy in nursing for me.”
To see available ACRN roles, check out our job postings.