This week Linda Smith will close out a 45-year career doing a job she doesn’t remember choosing. “Nursing was something I wanted to do my entire life. I don’t remember deciding what to do,” she said.
Her current and final position in nursing is clinical supervisor of the Jefferson branch of UnityPoint at Home. She’s been in that role since Greene County public health transitioned out of providing certified home care a few years ago.
Smith held many positions along the way.
After graduating from East Greene High School in 1972, she went to Iowa Methodist School of Nursing in Des Moines and completed a three-year RN diploma program. She returned to Greene County to begin her career, partly because the “man in her life” was Jefferson High School graduate Steve Smith.
She was hired as a graduate nurse – a nurse who has not yet taken or passed the state board exam – and after passing she was officially a registered nurse. She worked on the second floor of the medical center in the med-surg unit for a few months, and then moved downstairs to the obstetrics unit, “one of my favorite spots,” she said.
Six months later she started training in the coronary care unit. After 18 months in coronary care she moved to the emergency department and was supervisor there. She got a lot of nursing under her belt in just a few years.
As Linda and Steve grew their family, nursing provided the flexible schedule Linda needed. Their daughter was born in 1979 and a son followed in 1981. Linda worked part-time for a couple of years, and worked the shift that most easily accommodated the family’s schedule. When the children were young, she worked 3 to 11 pm to keep child care costs down. When they got older and were involved in activities, Linda chose the night shift to be available during the evenings. She didn’t work the day shift, 7 am to 3 pm, until the kids were grown.
She started working on a bachelor of science in nursing in 1986, while her children were still young. She chose Graceland University. “Graceland had the best outreach program here,” she explained, offering a lot of correspondence courses and satellite learning.
The satellite learning allowed her to do a practicum in the Greene County public health department with Cindy Kail as her preceptor. “I fell in love with that. I’d done hospital nursing for 18 years and it was time for a change,” she said.
Smith started working in public health in 1993. At the time, everyone did home visits and took their turns working in the public health clinic.
Her home health visits included a wide range of patients. Visits to new mothers were something she loved doing. “It helped that I had been an ob nurse and a breastfeeding educator,” she said. “It was my passion to get moms through the first few weeks of breastfeeding. That’s so important.”
She talked with new moms before they were discharged from the hospital to set up the visit. “It was all to support them and get them off to a good start,” she explained. She often reassured mothers that she was coming to visit them, not check up on their housekeeping. “I told them if they didn’t have dirty dishes and dust bunnies they weren’t spending enough time taking care of themselves,” she remembers.
Other patients had just been discharged after an illness, surgery, or an accident. She checked incisions, made sure the patients were eating, and checked to be sure their lungs were clear. Those patients were on her case load for four weeks or so.
Some patients, those who were chronically ill, she visited for as long as 10 years. “The point was to keep them safe and able to stay at home,” she said.
In every instance, “home care’s role is to catch things early so people don’t end up back in the hospital,” is how she summarized her job.
Smith has seen many changes over her 45-year career. One of the bigger changes is the amount of paperwork. When she started in home health care, the admission assessment was two pages long. Now the assessment form is 30 pages. “And back then when I started, the old-timers complained about the amount of paperwork,” she said with a chuckle.
With hospital stays shorter now, people go home needing more care than they did 45 years ago. New mothers stayed in the hospital for four days after delivery and the stay after gall bladder surgery was a week. Patients sometimes stayed as long as two weeks after hip surgery.
Surgical incisions are smaller now than they were, and that’s part of the difference, but in general, more people need more care at home.
She also said medication regimens are more complicated than they used to be, and part of her job was to make sure people understood and complied with what the doctor prescribed. She admitted that with about 20 percent of her patients she called the doctor or pharmacist to be certain she understood what the regimen was meant to be.
Health insurance has changed, too. “There used to be one Medicare, one Medicaid, one VA, one Blue Cross, and they all followed the same rules. Now the rules are similar but each type of insurance is a little different,” she said.
She worries about patients, particularly older patients, who have complicated insurance plans. “I don’t think some of them understand what they’ve been sold,” she said.
She’s an advocate for universal health care. “Everybody should have access to healthcare. That’s it. It’s not a privilege,” she adamantly insisted.
What hasn’t changed is the core of nursing. “Basic patient care is the same. We do more complicated things at home than we did, but the basic taking care of patients, meeting their needs and what’s important to them hasn’t changed.”
Her advice to nurses just beginning their careers is to start in a hospital. “You need to get a basic foundation of assessment skills. Most nursing comes from those skills. You could start at a doctor’s office or somewhere else, but your options will be limited if you don’t have the assessment skills you get in hospital nursing,” she said.
Smith’s retirement is effective March 4. She plans to spend more time with her granddaughter, do some gardening, being outdoors, and taking better care of her own health. She’s eager to get back to a walking routine.
She said she’s grateful for the excellent teachers – seasoned nurses and great doctors – who offered her “wonderful learning experiences.” She’s also grateful for the wonderful co-workers she’s had over the years.