leader, Lisa A. Gorski MS, RN, HHCNS-BC, CRNI, FAAN. With more than 30 years in the field, Gorski is an expert in both home healthcare and infusion nursing. As a clinical nurse specialist at Wheaton Franciscan Home Health & Hospice in Wisconsin, an editorial board member of
, an associate consultant for OASIS ANSWERS, Inc., and a published author, her knowledge of the nursin
Through our phone interview, I spoke with Gorski about why she decided to enter into home healthcare, her time as president of the Infusion Nurses Society, and what advice she has for a nurse starting their career.
BONUS: The current issue of Home Healthcare Now is FREE until August 15th on NursingCenter.
Q: Why did you choose nursing as a profession?
I wanted to be a nurse since I was a young child. When I was 5 or 6 years old, I drew a picture and wrote a story about how I wanted to be a nurse and help people! That desire never waned. In high school, my intense interest in the sciences and a summer of volunteer work in a hospital as a ”candy striper” reinforced my goal to become a nurse.
Q: What attracted you to home healthcare?
I knew that I wanted to work with patients on a longer term basis. I had several graduate school colleagues who worked in home healthcare, and at the time, changes in reimbursement led to shorter hospital length of stay and more transitioning to home care. I saw a potential future in home healthcare.
The challenges and opportunities in this specialty were apparent to me, including working with families, as well as patients, and working with them over longer periods of time to keep them functioning well in their home. There is a great need for employing effective patient education to help patients manage their own care. While the assessment and intervention skills that I gained in my acute care experience served me, I needed to develop a new body of knowledge. While I could manage blood sugar levels in a critically ill patient, working with home care patients to manage their diabetes was a different challenge that required not only the clinical focus on diabetes, but also a focus on living with a chronic illness. In graduate school, I studied the issues related to living with chronic illnesses. One of the books I read during graduate school still sits on my bookshelf and still provides me with perspective – Chronic Illness and the Quality of Life
by Strauss and Glaser (1975).
Q: What’s the biggest challenge related to home healthcare and how do you combat it?
One challenge is time management. Home care nurses travel and generally see five to six patients on the same day. Depending on the needs of the patients, there is also a considerable amount of time coordinating care and communicating with other involved healthcare professionals. As any home care nurse will tell you, there is a considerable burden of documentation. And you must be accountable to that patient and family. When you leave the home, you have to think about what happens or could happen when you leave – have you addressed critical issues to ensure that your patient will be safe when you are gone, as there is no one else there until you get back. Think about the patient with a running infusion of a chemotherapy drug. Does the patient understand what to do and who to call if an alarm occurs or if there is an adverse reaction; is the phone number to call for problems readily available?
On the bigger picture side, the pressures of ensuring positive patient outcomes with reimbursement restraints are challenging. An overarching goal of home care is to keep patients safe in their homes. The hospitalization rate for home health is a publically reported outcome, and hospitals are penalized when patients return back to the hospital within 30 days. As a nurse who has worked in home care for 30 years, the level of patient acuity has certainly increased. I believe the challenge for home care nurses is to become less focused on the tasks to be done, such as wound care or other treatments, and more focused on identifying the nursing diagnoses and managing the outcomes. Keeping patients at home requires that the nurse possess exceptional assessment skills, that risk factors for re-hospitalization are identified and mitigated, that ongoing monitoring identifies and reports early/subtle changes in condition to allow early intervention, and that there is significant attention paid to medication management.
Q: Why are you passionate about infusion nursing?
I became a home care nurse during the mid-1980s during that period of great growth in the home care industry. Transitioning patients who required infusion therapy from the hospital to home was a growing trend.
At that time, I managed many patients who required home infusion therapy from simple IV antibiotics to complex parenteral nutrition. My critical care skills combined with my growing experience in home care issues served me well in that area of practice. However, one of the issues that I identified was that exceptional IV therapy skills are not enough in home care. Because patients and families are involved in various aspects of self-care related to the IV infusion, the home care nurse’s skills in patient education are equally important. Patients are often anxious or may have functional limitations that impact the ability to learn and manage, and these must be addressed. My first published article in Home Healthcare Nurse
in 1987 addressed the patient education issue. I later wrote three books on the topic of home infusion therapy and am in the process of writing another.
Q: You served as the president of the Infusion Nurses Society (INS) from 2007 to 2008. How did that role impact your profession in nursing?
After being involved in the INS for many years in a variety of local chapter and national positions, it was an honor to serve as president for that year. Subsequently, I continued to serve INS as the chairperson for the 2011 Infusion Nursing Standards of Practice and am currently serving again in that role for the standards that will be published in 2016. There is a rapidly growing research base for infusion therapy by investigators across the world. Working with my amazing infusion therapy colleagues to search and review the literature and to develop evidence-based recommendations and educate the infusion community has contributed to improved patient outcomes and reduction of preventable complications. My INS involvement has led to so many opportunities. I have had the pleasure of doing many presentations across the country and some international presentations. I regularly talk to or have email discussions with nurses, pharmacists, and physicians regarding infusion related issues and practices. I recently had the opportunity to present in Santiago, Chile and Buenos Aires, Argentina and will be doing presentations in China later this summer. Clearly, nurses not only in the U.S., but across the globe, are striving to provide the best practices for their patients.
Q: For a nurse starting out, what would be your number one piece of advice?
Nurses today have so many opportunities in many different settings. When you leave a position, you want to feel as if you’ve mastered it. Really learn your first job and develop your skills, especially in working with other healthcare providers. Identify where your strengths lie and use them to determine where you want to go. Also, get involved in nursing organizations relevant to your practice. I am also a member of the National Association of Clinical Nurse Specialists and the American Nurses Association, which have provided me with more information and knowledge and more contact with colleagues who share similar interests and challenges. I recently attended the International Home Care Nurses Organization (IHCNO) where I was inspired by reports of research and home care practices in several countries. Involvement in practice beyond our daily organizational work keeps us fresh and motivated!
Q: Finally, what do you envision for the future of nursing?
It is really bright! There are so many opportunities for nurses in a variety of settings whether clinical or non-clinical. Nurses are shaping healthcare policy and are increasingly involved in politics. Our critical thinking, expertise, and leadership make an incredible impact in patient care. We are
*Do you know an inspiring nurse to be featured for the next Nurse On the Move? Email your submissions to