Monica Beshara’s skills and roles have changed during 27 years of nursing, but her calling has remained constant. “I always wanted to be sure that the patient was getting exactly what he needed,” said Besara, CWOCN, NPC.
That calling led her to become a certified wound and ostomy care specialist and eventually to manage wound care and pulmonary patients in both acute and ambulatory care settings.
A desire for more autonomy led Besara to become a nurse practitioner, a role she has had for almost five years.
“I went back to school because I just wanted to be a little more involved in the decision-making for the medical processes of patients,” she said.
So when she heard about a new Visiting Nurse Health System program that delivers primary care to patients at home, Beshara didn’t think twice about applying.
“Home health is 100 percent about the patients,” she said. “You’re taking care of them in their environment, with their family. You see the challenges they have and have to adapt your health care accordingly.”
Beshara is the first nurse practitioner to work in Visiting Nurse’s Physician HouseCall program.
“We’re not trying to compete with other primary physicians, but many elderly patients aren’t mobile or don’t have access to primary care and would benefit from it,” said Mark Oshnock, CEO of Visiting Nurse Health System.
The program, which was initially aimed at serving Medicare patients, was designed to serve seniors with chronic conditions who are homebound or don’t have a primary care physician. When their conditions worsen, these patients often end up in the emergency room, which is hard on them and is expensive for the health care system, Oshnock said.
He believes physicians or nurse practitioners making house calls is a better solution.
“We’re like a mobile doctor’s office,” Beshara said. “Dr. Espinoza, our first physician, visits the patient initially to do a physical exam, assess needs and create a plan of care. Then I make the follow-up visits.”
Beshara performs most of the diagnostic procedures that are done in a doctor’s office, such as drawing blood for laboratory analysis, performing electrocardiograms, measuring oxygen levels, monitoring blood pressure and managing IVs. She can also help patients manage medications prescribed for various health issues.
“I’m using all my nursing skills and, fortunately, I also have specialized wound-care knowledge,” Beshara said. “There is such a need for this service, and with health reform under way, this is a solution for so many people. It’s a very efficient and economical way to deliver care.”
Recently, Beshara visited a 70-year-old man who had never been treated by a doctor. His family had taken care of him by using mostly home remedies. After she discovered that the family had a history of diabetes, Beshara gave him an EKG test, drew blood and checked his cholesterol immediately, and got him on medications that could help.
“When I worked in home health years ago, I saw many elderly patients who needed to visit their doctors to get prescriptions renewed or their conditions checked,” she said. “Traveling and waiting for a 30- minute doctor’s appointment would wipe them out. Now they can get what they need without all the trauma and stress of getting in the car and going to the doctor.”
Beshara schedules regular check-ups, and patients can call when there’s an emergency and need to see a doctor or nurse practitioner sooner.
She is thrilled to be part of the team establishing the protocols and developing the program from the ground up. Beshara believes it’s a model for delivering better care to homebound patients who have multiple health conditions.
“My passion is to make it right for the patient from the start, and I believe we’ll be adding another nurse practitioner and physician soon,” she said.
Remembering to dot the I’s and cross the T’s at each patient visit is a big responsibility, she said, but that’s what nursing is all about.
“At the end of the day, it’s so satisfying to know that you’ve really given your patients everything you could, and at a minimum inconvenience to them,” Beshara said. “That’s energy-saving and lifesaving.
“What I like best about this program is that it is all about the patient. We can improve their health in their own environment. We can meet their caregivers and give them the support they need and make a difference in all their lives. I’ve found my niche.”
