When Roxanne Marlar was first approached with the offer to join a new specialty pharmacy in Texarkana, Texas, she declined. The job was providing infusion therapies to mostly adult patients in their home. But she was a neonatal intensive care nurse working with premature babies, and she loved her job. She was not interested in making a change. Ever.
But she reluctantly agreed to meet with pharmacist James Sheets for dinner at a restaurant near her home in Little Rock, Arkansas. She found him funny and quirky and maybe a little overly optimistic. He talked about his plans for the new company he and two partners were starting. They were going to grow from a small, local business to a nationwide pharmacy in the next few years. Didn’t she want to be in on the ground floor and be part of this success?
“It just sounded crazy,” Roxanne says. “I had never heard of immunoglobulin therapy. How could I do this when I don’t even know what it is? So I looked it up and it sounded interesting, that you could send a nurse into a patient’s home to give them this drug. I didn’t even know that was an option in nursing. It piqued my interest, so I decided I would just try it out. If I didn’t like it, I could always go back to the NICU.”
So in May of 2016, she started out with two patients as the only full-time nurse, and the business actually did grow into that nationwide service James had predicted. Today, CSI Pharmacy serves nearly 650 patients in 46 states. Roxanne is now Vice President of Nursing, leading a team of 103 infusion nurses, a director of nursing, five regional supervisors, and several support staff. She also oversees dozens of agency nurses contracted in geographic areas where CSI Pharmacy doesn’t have a nurse on staff.
Roxanne has always been a people person, so the thing she loves about this work is being able to spend time with patients—a minimum of four or five hours for every monthly intravenous immune globulin (IVIG) infusion—and the chance to get to know them on a personal level.
“At CSI Pharmacy, every patient has a primary nurse who comes to do the infusion every time,” she says. “They start out as a stranger in the patient’s house, but that changes quickly. A relationship is built, and the nurse really becomes like family for the patient.”
As an administrator, however, Roxanne doesn’t get that special time with patients as much as she would like. Now she spends most of her time overseeing the nursing staff, making sure they have the resources they need, and making sure patients receive the highest quality care possible. Still, she fills in to infuse patients in her area when needed, because she knows how important it is to spend time with patients, even for administrators.
“Our supervisors usually continue as the primary nurse for at least one or two patients, so they are still in the field,” Roxanne says. “It’s always good to lay your hands on the patient so you remember that what you’re doing on the administrative side is still all about making a difference for patients.”
The relationship that develops with the patient and their caregivers is sometimes a surprise to the nurses Roxanne hires. The infusion world is very different from working in the hospital or other areas of nursing. It gives the nurse a lot more flexibility and autonomy and the chance to be with patients in a whole different way. When nurses come to CSI Pharmacy, they often say they want to take on just a few patients. Just like Roxanne did, it doesn’t take long, before they ask for more and say they want to do this full time.
“Home infusion has my heart,” Roxanne says. “Taking this job has been the best decision I ever made. I will never do anything else.”
