OSCEOLA, Iowa – Brandi Dyer is a registered nurse. She doesn’t work in a big city hospital. She has a desk in an office just off the main street in this county seat. Her job takes her to farms and small towns in five rural counties in southern Iowa.

Dyer is a nurse and supervisor for Unity Point at Home. She and the six nurses and a therapist she mentors provide home health care and hospice care to a large rural area.

“It’s not uncommon for me or one of my nurses to drive 200 miles in a day,” she says.

And last year, during the COVID-19 pandemic, that task got even more difficult. But Dyer says the work went on, as it always does. Their nurses continued to make home calls and care for their patients, although sometimes the patient didn’t want anyone to come to their home or when the nurses had to go to homes where COVID was present.

“The weather is a bigger factor for us,” she says. “And cellular.”

But Dyer, who grew up not far from here, wasn’t going to trade jobs.

“I have wonderful staff,” she says. “And I love home care.”

The days can get long. You usually start with a quick staff meeting and a look at everyone’s schedules. Often times Dyer would spend time in the day calling patients to be seen the next day. Then there are visits to about five or six patients. Finally there is the drive home to the small area where she, her husband and her daughters raise show pigs.

It may lack the minute-to-minute excitement of an emergency room nurse or surgical nurse, but it balances that frenzied pace with the need for home nurses to think for themselves when they are far from a doctor or hospital and where they may not Have the equipment or supplies to do the job as it would in the hospital.

“As a home nurse, you need to be consistent with your assessment skills,” she says. “They are the eyes and ears for the doctors.”

None of this explains hospice care. The differences are simple, but the details are complex, says Dyer. In home care, nurses deal with patients who are often recovering from surgery or injury. The nurse will check their health and let them know of things they could do to help them recover faster.

However, in the home hospice one has to take care of someone who is preparing for death. It’s about relieving pain and making the patient comfortable in their final days.

“The end of life is a lot of work,” she says. “It’s a privilege. It’s hard, but it’s also a privilege. “