Santee resident Karen Smaniotto, 28, thinks...

Santee resident Karen Smaniotto, 28, thinks she has one of the best jobs in the world. Much like a pioneer doctor, Smaniotto, a home health-care nurse, travels to patients’ homes, dispensing health care with a dose of genuine concern. She was interviewed by Times staff writer G. Jeanette Avent and photographed by David McNew.

In Pennsylvania, I worked on a medical surgery floor for about 2 1/2 years. I wanted to get into home health even while I was at the hospital.

The hospital environment was becoming stressful for me. The amount of responsibility and accountability for a hospital nurse is enormous. Veteran nurses will tell you nurses are doing a lot more than they used to do. We’d have as many as six patients, and they’d all be ringing their service bells at once. It’s just an incredible amount of work to be doing.

I was looking for career options. I had a friend in home health nursing, and she was always telling me about it.

It took a while because of seniority. Other people with more job experience got the job before me. I’ve been working for Scripps Memorial more than a year.

Hospitals are releasing patients to home care because their problems can be handled at home, people want to be at home and they generally do better at home.

I consider this job very easy to deal with, but the medical knowledge required runs the gamut. My work is a lot of teaching and patient education. I teach patients about their medicines and when to take them, about their disease process and what they’re dealing with, and safety in the home.

With newly diagnosed diabetics, I have to teach them from scratch how to care for themselves. I also draw blood, care for wounds, and, in one case, I was able to get a portable chest X-ray taken in the home.

When I get admissions from the hospital, I go out to the patients’ home, evaluate them and set up the frequency and plan of care. For example, we arrange to see a patient two to four times a week for four weeks and then one to three times for five weeks.

Each visit, I spend anywhere from 30 minutes to an hour with them, and sometimes longer. The majority of my patients have Medicare, which pays 100% for our services for a nine-week period.

I average about five people a day. In a typical day, I’ll have a patient with a bypass graft in her leg. I’m instructing her in wound care. I’m also seening a lady with emphysema and diabetes, and I’m seeing a lady who had a repair of a herniated disc. She’s more of a physical therapy patient. I’ve been teaching her pain management. She’s learning when to take her medication before the pain becomes so severe in order to nip the pain in the bud, and I’m teaching her distraction techniques. Turn music on, turn the TV on so the mind won’t be so focused on the discomfort so much.

We do have home-care pediatric nurses for children, but the majority of my patients are older. They’re all pretty much in their upper 60s and 70s. They get really close to me. At first when I go see them, they say, “I don’t want to be bothered, I’m fine.” Then over time, we build a therapeutic relationship, and then at the end they don’t want us to go.

In the hospital setting, I had a few patients where I was able to be their primary nurse because of a long hospital stay. We’d have that bond and we were both sad when they’d leave, but nothing like in home health nursing.

Some cases are terminal. I just discharged a really neat 82-year-old lady dying of colon cancer. She was incredible. I used to just want to cry because of the way she was about her death and dying and her acceptance of it. She would talk abut it, joke about it. She’d be sitting in the room with her nephew and niece and her nurse’s aide, and she’d have us all chuckling. She was a very classy older lady who just had the funniest sense of humor. She was sitting there weak, pale, sick and dying, yet she was entertaining us. She was an incredible, high-spirited positive lady. I went in taking vital signs and seeing about her nutrition, but there wasn’t anything really skilled I could do. So I made a referral to hospice through our social worker, and they took over the case.

There are a lot of depressed patients too. I have a patient right now who’s been in and out of the hospital with chronic heart failure. We’re approaching the holiday, and her husband just died a year ago.

Those with emphysema and chronic heart failure and patients in and out of the hospital a lot, those are the ones most depressed. I just try to allow them to ventilate their feelings and try to find their positive coping mechanism and get them involved in things they used to be involved with. They feel a lot better just by being able to get things off their chest.

But I’m not bothered by it. I do think about my patients, but I don’t usually take their problems home with me. In between patients when I’m driving, I process my feelings and concern and work through it.

It’s a great nursing job. Anybody who’s burnt out at the hospital, instead of leaving the profession, I’d say go to home health unless they’re interested in something else.

There’s not a lot of stress with this job. Yet we’re assessing and monitoring patients. We’re in touch with the doctor as necessary. Say a patient’s feet are starting to swell and they need an increase in diuretic medication, we call their doctor. If their blood pressure is up and they need more medication, we get that arranged.

We update doctors on their patients, and how they’re doing, and hopefully we can keep people out of the hospital. The doctors rely on the nurses in the field.