Meet Kathy Quan: Influencing Nurses for Over Thirty Years

Brenda Winters

Kathy Quan has been a nurse in home health care for over thirty years. She was also a field nurse who then moved into the roles of nursing supervisor and quality improvement (QI) specialist. She has additional experience in staff education. Kathy owns several blogs -- including The Nursing Site Blog -- and is the author of seven books.

In this article, Kathy shares her personal journey as a home health care nurse and her expertise in the nursing industry.

What is the motto that drives you as a nurse?

“Nurses make a difference in someone’s life every day." It’s so very true, and it has always served to cheer me up when everything seems to be going down the tubes.

What do you enjoy about being in home health care? What are some challenges?

I actually work in hospice now as the QAPI nurse for five hospice offices, but I've worked in home health for over 30 years. The reason I chose home health was that I wanted to be able to spend one-on-one time with patients and their loved ones and caregivers.

I love patient education, and this has afforded me the opportunity to combine my love for writing with the development of patient education materials that are easy to read and understand at the patient/caregiver level. I love how I can actually see how I made a difference for patients and families as they learned why they needed to take their medications. It is also great experinece to review the foods that patients keep in their pantries and show them how to read nutritional labels. I can see how environment and social situation affect health status so directly.

In acute care, you never see what’s happening in patients' worlds outside of the hospital; you never get to spend enough quality time with patients and families, and that always frustrated me.

Home health and hospice has been my niche. As I've moved into various administrative roles in the past 10-15 years, I've loved mentoring both clinical and non-clinical staff to help improve the quality of care we provide.

Was writing always a hobby for you? How do you think you’ve used your writing to help current and aspiring nurses?

I began to write the day my dad brought home an old upright typewriter. I was about 11 or 12 at the time, and I was fascinated by this machine; I was able write something coherent and not just hit the keys randomly. I found I had a lot to say.

As a nurse, I've used my writing skills to provide patient education materials and later to help mentor nurses to improve their documentation.

Back in the 1990s, I was exploring this new thing called the Internet, and I started a website for home health nurses (Housecalls-online.com); I felt there was a need to share information about home health with others in the field. Information is power and a lot of bad things were happening in an industry dominated by rampant fraud and abuse. Good agencies and home health professionals needed to know what was going on and how to avoid the various issues and pitfalls.

I started HomeHealth101.com a few years later with an eye to focusing on OASIS/Medicare documentation tips.

In late 2004, I took on the position of "Guide to Nursing" at About.com, and I spent three-and-a-half years writing articles and newsletters and managing the discussion forum. I had 1-2 million page views per month on that site, even as it continued growing.

From exposure on that site, I was asked by Adams Media to write The Everything New Nurse Book, which remains an Amazon Best Seller for nurses; it has been redesigned fout times and each edition sells very well. It’s a simple, no-nonsense guide with the goal of helping those who aspire to become nurses to find a path; it also supports them during that crucial first year. It’s not rocket science, just plain common sense.

In 2007, the powers that be at About.com decided to combine several of the most popular health care career sites in hopes of growing them even more, and I moved on. I was allowed to take my articles and publish them on my own website, and so TheNursingSite.com was born. A couple of years later, I started blogging on TheNursingSiteBlog.com.

I love mentoring new nurses and helping them bloom and find the confidence to survive and remain in the field. I also hope to provide established nurses with the tools to help nurture our young instead of bullying them and eating them alive. I wrote Exploring the Home Health Experience: a Guide to Transitioning Your Career Path in 2015 as a guide for nurses and other health care professionals to understand this part of the continuum of health care and to see if it’s a fit for them.

What is the most memorable situation you’ve faced as a home health nurse?  Was there a time when a patient wouldn’t have otherwise survived if you hadn’t been there on a visit?

There were many. There was an elderly gentleman with no family who was discharged from the hospital post-CHF. He took a taxi home from the hospital. He was bewildered how he would even survive the night because he had no food and no means to obtain any until he was stronger.

I called our social worker, who made arrangements for Meals on Wheels, but that of course wouldn’t start for several days. After all of my admission questions and teaching was complete, I went to the local market and bought him some food and staples to last until my next visit; he sobbed in my arms when I came back with bags of groceries. He quickly learned his regimen of meds, lowered his salt intake, and with the help of the MSW was able to restore his relationship with his estranged daughter. We obviously made a difference for him.

Another patient was an elderly woman, and I’ve written her story a few times. She was a widow who lived alone but had a group of friends who took care of each other (but inadvertently almost killed her).

This woman was taking digoxin. One day I arrived for a visit and she told me she had been experiencing chest pain for a few days. She hadn’t called me, nor had she called the doctor because her friends told her about their little white heart pills that they take for chest pain. It seems she thought that her little white pills were the same thing. One day, she had to take three for her symptoms, fell asleep, and she was better when she woke up. She noticed she was much weaker and a little short of breath when she tried to do anything, so she just took it easy.

When I returned to the home, her heart rate and blood pressure were quite low. She was short of breath conversationally, but had only slight pedal edema and clear lungs. Upon questioning, she described seeing a yellow halo around objects in brightly lit roomsl; I notified her doctor and sent her off in an ambulance.

My patiend had had a mild MI but survived. It took a lot of effort to convince her and her friends that not all little white heart pills are the same; they must read labels, never take each other’s medications, and contact their doctor when they have new symptoms.

In light of the recent election, where do you see the future of the home health care industry heading?

The home health and hospice industry has experienced a great deal of fraud and abuse since the 1980s, but it has been pretty well reigned in now. However, if regulation is tossed aside, fraud will once again run rampant; foreign interests will swoop down and take advantage of profits to be made by abusing our industry.  That would harm our reputation and wreak havoc on the quality of patient care.

I also worry about what lengths they will go to change the ACA. Some do seem to have come to their senses about not tossing it out entirely, but the Big Business aspect will get worse, and that’s one of the biggest problems plaguing health care in the first place.

I did see that Trump’s Health and Human Services nominee opposes the prior authorization aspect for home health. While it’s not a perfect solution for preventing fraudulent care, we have to keep watch over the criteria for admission to home care and hospice.

As nurses and insiders in the health care industry, we must continue to educate the public and hold tight to our ethics. It’s going to be a bumpy ride, to say the least!

On a positive note, there’s a great piece of legislation that I’ve been a part of for years; it’s non-partisan and financially neutral. Now more than ever we need a National Nurse for Public Health (HR 379 and S1205) to lead and direct nurses to be on the same page in regards to educating patients in navigating the health care system and participating in their own wellness and health care.

Learn more on what the Trump presidency means for nurses

What's the best advice you ever received? Who gave you this advice?

It wasn’t exactly advice per se , rather more a form of education. One of our professors was very intimidating and always put us on the spot; she taught us to think on our feet and use our critical thinking skills.

One day, she entered a patient’s room with me and helped to examine the patient, pull her up in bed, and get her ready for breakfast. I was impressed that she was so warm and compassionate with the patient since she was such a cold drill sergeant with her students.

When we left the room, she questioned me about the patient. She then asked me what color the window curtains were, what was on the bedside table, what program the patient was watching on TV, and several other apparently non-clinical details. I answered most of them correctly and wondered what in the world she wanted to know all that for! She didn’t do this with everyone, and we were all curious.

At our next classroom session, she explained that she often used this to teach us to see the whole patient and take in the whole picture. Mr. Jones wasn’t just this body in a hospital bed, he was a person who was ill and needed our help to return to his prior status. Then she warned us she would continue to do this randomly and our grades would depend on our answers.

In home health and hospice, it is essential to see the bigger picture and mold our plan of care to fit the individual. I use that professor's technique when nurses are at a loss, and it can help them to look beyond the task-oriented aspects of the visit.

What advice do you have for young nurses just starting their careers? What would you say is the key to a long and successful career?

I always suggest a strong background in general med/surg in order to hone your skills and have a broader exposure to treatments, nursing care, and illnesses. Finding a med/surg positions is not always possible, but even a short sting in this type of setting will makes you a more well-rounded nurse before you find an area of specialty practice.

Home health and hospice are at the top of my list as the best nurse niches ever, but they aren’t for everyone.

You must remember that you will have to sacrifice a lot. Hospitals are staffed 24/7, 365 days a year. You will work weekends, holidays, and yes, even your birthday.

As the new nurse, you’ll get the worst schedules and often be given the most challenging patients. Some nurses will bully you, and others will be afraid of your knowledge and skills and try to discourage you. However, others will welcome you and help and encourage you; they remember what it’s like and they will mentor you.

Give yourself time! Always remember that you didn’t learn everything in nursing school; it’s impossible to do so. Nursing is a lifelong learning process, so be a sponge and soak up all the information and knowledge you can. Ask questions when you are uncertain. Do no harm! Make a difference in someone’s life every day!

Next Up: Nurse Spotlight | Carol Gino

Brenda Winters

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