As we enter flu season amidst the pandemic, the Iyashi Care team continues to support older adult patients and their caregivers, as they adapt to staying safe and healthy. The team collaborates with each other to make sure each of our patient families’ needs are addressed.

Joshua Northcutt, RN

Of all the team members, my role may be the hardest to define, as my tasks change often depending on the patient’s situation and the team’s capacity.

As a registered nurse, listening and making phone calls are key components of my role. I listen to what caregivers and patients might need and look at the whole picture of care. This can cover a wide spectrum of needs, from medical to emotional, that all fall under palliative care. Through our conversations, I help Iyashi Care patients and caregivers navigate through their illnesses.

My Work Day and Triage Calls – The Catcher on the Team

Every work day looks different, making it difficult to define my “typical day.” I take the triage calls, which can come at any time. I assess the messages and determine the treatment priority for patients by the severity of their condition.

An analogy for my role is a baseball catcher. I constantly have my mitt ready and must correctly assess where the ball needs to be thrown to ensure the needs of our patients are addressed in a timely manner.

A Day as a Palliative Care Registered Nurse:

8:00 a.m.
My day begins with reviewing overnight calls, hospitalizations, or emergency department visits. This helps me and the Iyashi Care team update patient charts and see the latest developments in a patient’s care plan.

8:30 a.m.
The Iyashi Care team huddle begins. We do a very thorough assessment of each patient, including information from my calls with the patients and families, and make recommendations on what our next steps should be. A lot of preparation goes into this collective huddle.

Members of The Iyashi Care Team (L to R): Dr. Yuichi Edwin Yanami, Kanako Fukuyama, and Joshua Northcutt

9:30 a.m.
Following the huddle, I make phone calls and virtual visits, either monthly routine calls or urgent ones as prioritized.

For example, I had a triage call come in about stomach pain one of our older female patients had. I assessed this needed immediate attention and passed it to Dr. Yanami.

10:30 a.m. – 2:30 p.m.
I speak with patients and family members on various topics ranging from their medical condition to their goals of care. Here are some calls I took during the day:

10:30 – 11:00 a.m.
I called a cancer patient who was having pain management issues, to follow up with a new medication prescribed by Dr. Yanami. He seemed to have no side effects for now, so I asked him to continue monitoring his symptoms. I shared this with Dr. Yanami and set myself a note to follow up later in the week.

10:30 – 11:00 a.m.
I had our monthly check-in with one patient who is a widow living alone. I check-in every month to see how she is doing, especially since she is still grieving, and to see if she has any updates such as recent falls or changes in her health.

Joshua making phone calls

12:30 – 1:00 p.m.
I received a call from a patient taking over 10 medications due to multiple conditions. A few of these are prescribed by Dr. Yanami. The call was for a refill. I asked her a few questions to get insight on how well these medications were working.

I took notes to give Dr. Yanami a better idea of the situation so he knows what to prescribe. If he feels he needs to check in with the patient before, he will schedule another appointment.

1:30 – 2:00 p.m.
I called a patient’s sibling, who was unable to attend a recent virtual meeting about the patient’s future care and when they must make a decision on transferring to hospice. I updated the sibling with the information discussed, so all family members were on the same page.

2:00 – 3:00 p.m.
I checked in with the daughter of a patient who has Alzheimer’s on their goals of care. We called to make sure the family still wanted to keep their mother at home as much as possible, with any necessary outside help. Some patients and their families are changing their preferences due to the pandemic, so we recently have taken more calls about goals of care. I also wanted to make sure the daughter wasn’t feeling stressed and to check in on her overall wellbeing as well.

3:00 p.m.
After making those calls, I reconnect with Dr. Yanami and Kanako about updates on our patients or changes in care plans.

3:30 – 5:00 p.m.
Closer to the end of my day, I revisit any triage calls. These calls are then followed by final updates. I close out my day by preparing documentation and plans for the following morning.

Reflections on my Role

Every day brings something new. This is what makes my job dynamic and fulfilling. Sometimes I will spend the majority of the day with just one patient if they are having a lot of symptoms and need additional support like medication assistance. Other times, conversations center around goals of care or advance care planning.

Even before the pandemic, calls were the main way for me and the team to connect with patients.

Some patients tend to enryo, thinking the doctor is too busy to follow up on some of the smallest changes in their health, or caregivers don’t want to bother the team. I make sure that they are able to express their thoughts without any worry or burden.

It’s during these types of conversations where I like to joke that Dr. Yanami, who is an incredibly compassionate and wonderful person, never feels upset when anyone calls. Instead he gets his feelings a little hurt when people don’t call. Hopefully, they can then realize that we welcome those one-on-one meetings and that we want to hear from our patients.

Read more about Iyashi Care
Take the Iyashi Care Assessment Here

Other Iyashi Care Stories:
“The Most Important Thing Is I Feel Secure Now”: Tales of Service and Support From an Iyashi Care Patient
The Team that Listened to Me, My Mother, and Our Needs

Other Articles and Resources:
Intro to Palliative Care
Palliative Care Resources
Iyashi Care FAQ