The alarm clock goes off about 6:30 a.m., but Chris Mitchell, registered home health nurse, is already awake. Racing out from under a quick shower and shave, he alternates between getting dressed and making phone calls to doctors and patients.

It's a pace that Mitchell will keep up for the next 16 hours.

During that stretch, he will race around L.A., fulfilling a role of driver, teacher, office administrator and, of course, nurse.

"I thrive on a hectic schedule and I love juggling between patient needs and the logistics of getting to a certain lab on time," Mitchell says. "So this suits my personality perfectly no time for boredom."

It also suits the personality of plenty of other Angelenos. Mitchell is one of more than 500 home health care nurses in the Los Angeles area earning an average annual salary of $40,000 to $50,000, according to industry sources. And with the home health industry continuing to grow, thanks to the influence of managed care, among other factors, their ranks are expected to increase in the months and years to come.

The term home health care worker might be somewhat misleading, considering nurses like Mitchell often spend more time in their cars than in patients' homes.

Mitchell refers to his Thomas Guide as his "bible," stealing quick glances at it as he heads down surface streets toward his first appointment.

From Mitchell's first week on the job as a home health nurse, he realized this is what he wanted to do. He loves the independence, something he didn't have when he worked as an operating room nurse in a hospital.

"I have quite a bit of flexibility, not in terms of the number of patients I see each week, but in the time and day I see them," he says. "The personal interractions with patients provide me with the personal satisfaction of feeling like I'm able to do a good job, versus being in a hospital where you never really can make a personal relationship with a patient."

As for the drawbacks, Mitchell does not cite cranky patients or cleaning bedpans. His chief complaints actually might be identical to those of a police officer paperwork and traffic.

The paperwork "keeps growing and growing every year," he says. But as much as he dislikes the paperwork, his tolerance for traffic is even lower.

"I avoid freeways between 8 and 10 a.m., and after 3 p.m. if I'm still out doing visits at 3, I'm dead meat," says Mitchell, 41, a five-year veteran of the job.

Mitchell typically covers more mileage than most home health care workers in L.A. because his employer, Olsten Health Services, is not affiliated with a hospital or otherwise tied to a particular community.

Mitchell arrives at his first patient's house by 9 a.m., 11 miles from his West Hollywood apartment. He checks the woman's blood pressure, teaches her daughter how to apply a medication patch, and is back on his way just before 10 a.m.

Nineteen miles and two freeways later, he is at his next patient's home, a man who has a diabetic foot ulcer. Mitchell dons sterile gloves, removes the patient's dressing, and examines the wound. He soaks the patient's foot, applies a fresh dressing and, within a short time, he is back on the road again.

Such is the nature of many of his calls. Quick in and out. Get the job done and move on.

More time-consuming are Mitchell's "startup" patients. Such calls require completion of a stack of paperwork that includes a full assessment of the patient's medical history, assessing the living situation, possible problems, goals and support systems.

Mitchell's first startup of the day is a man who lives at a board and care facility. The health needs of the man, who suffers from neuropathy (pain, tingling and numbness) and other ailments, are beyond the scope of Mitchell's services. So after careful assessment of the patient's condition, two trips up and down the elevator, friendly greetings to a few residents, Mitchell concludes his job here is over.

It's now 12:30 p.m. and Mitchell is in a catch-up mode. He has one more patient, and four hours of paperwork ahead.

This patient is another startup, one requiring infusion therapy. This procedure takes about two hours and calls for a nurse to be present the entire time. After scheduling a return trip for each of the next three days, Mitchell jumps back into his car for a trip to South Central L.A., 24 miles in the other direction. He is now working at breakneck speed to beat the afternoon traffic.

His last scheduled patient of the day has been taught by Mitchell to administer his own IV antibiotics. Today he only needs his blood to be drawn for a weekly CBC and chemistry panel. However, the blood sample must be dropped off at a lab for processing, so Mitchell races off to downtown L.A. to do the job.

Having not eaten since breakfast, Mitchell zips into an El Pollo Loco for a quick burrito. It's 4 p.m. and he is finally finished with his daily visits.

Despite the late hour, Mitchell arrives home in 45 minutes because he is going against traffic fortunately. Settling into his West Hollywood apartment for three hours of paperwork and phone calls, he is ready to relax. But life has a different plan. This is his day to be on call. And at 9:45 p.m., his beeper goes off.

After attempts to troubleshoot over the phone prove futile, Mitchell dashes back into his car at 10 p.m. and replaces the IV tubing for a woman at her home, which is only eight blocks away. At 11:00 p.m., Mitchell crashes into bed.

Luckily, Mitchell has an extra day off under his belt from having worked the previous Saturday. He decides to take the next day off to recoup.

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