Telling a patient you will be working other cases?

oramar · Feb 27, 2010

You know what you have to do and you have to do it soon. You have to set limits for this client. You have to tell her the truth, keep it simple. Tell this person you have other post graduation plans. Don't let her paint you into corner or put words in your mouth, don't use terms like "maybe" or "well I will see". If you catch her making assumptions set her straight. You may have to get out of this case all together. Site your allergies and your asthma, it will be the truth. Start learning to set limits right now. No better time than now. If you don't learn to set limits you will find that staffing people in clinical situation taking advantage of you left and right.

roser13, ASN, RN · Feb 27, 2010

I totally agree with the above post. Just wanted to add that you shouldn't be surprised if it takes more than one conversation for the mom to believe that you mean what you say. One technique that manipulative people often use is to simply ignore anything that is said that they don't like.

I would not be surprised if you are simply unable to work this case in the long run.

realnursealso/LPN, LPN · Feb 27, 2010

It's better to let your company handle it. As you know in homecare we can accept or decline any shift. We get no benefits, so this is the trade off. If you aren't comfortable working on this case, tell your employer. The mom can't self schedule, so actually when you are ready, ask to be taken off this case. I know the kids tug at your heartstrings, I've been doing high tech Peds homecare for many years, but if you aren't comfortable on this case, it's time to go. Just don't comment back when she makes those statements about you doing the case full time, or be very vague. I'm guessing here, but I think that the thought of never seeing your patient again is the root of your problems. It's sad to say goodbye, homecare is a whole different world and you get close to the whole family. But think of how hard you worked, and all the wonderful things that are on the horizon for you. PM me if you want to talk. :)

caliotter3 · Feb 27, 2010

You have no obligation to tell her. It is the company's responsibility, and almost all of the time the company will take care of it. Families do not believe you when you tell them that the company assigns you to your cases. Placing the same nurses on a case each week is only done as a convenience to all involved. There is no given that this will occur. I always tell my clients this up front. You will find it a lot easier on yourself if you leave the case. Otherwise, she will make your life a living hell on the shifts that you do work for her. Manipulation is almost impossible to break.

anangelsmommy, ADN, BSN, RN · Feb 27, 2010

When I first started working this case, I had a very hard time saying no at all....my first response was to say "oh I will call my husband and see..." well my husbands response was "sure why not" he didnt get that I was tyring to get OUT of doing a shift until we talked about it later and he now understands that he will never now agree to a shift over the phone. And I actually have gotten better myself about it too. I usually just say that I dont have my schedule and my husbands and that I will have to check these things when I go home etc. I dont feel as pressured as I did when I first started. When I first started I guess I felt like I had to please everyone and I may lose my job if I may lose my job if I wasn't taking shifts offered to me. But now I realize that even if I only do one shift in a month, I still have my job. although I am still taking slack from my client. I hate that she feels like she needs some explanation from me. part of me getting into home care was that I remembered when I had home care for my own child, I had a few nurses that would call up and say I have this day or that day open, do you want a nurse? I loved the idea of that kind of flexibility! But this client will make comments as I walk out the door like "oh go ahead and just leave..." and yesterday, she was demanding to know what happened to me on the schedule this month and why I was only on there one time. Well, gee uh, I didnt really want to share that I didnt do well on my last exam and I need to put my time in on studying, and I am going on vacation for a week, my husband is flying to colorado to ski for a week and that I only took one shift because I rather spend my daytime hours studying so I can become the RN that I dream of becoming!! oh and then when she threw in the comment as I was walking out the door about having me FULL TIME I about stopped in my tracks and thought UH OH... time to start figuring out how this is going to be put to rest before it gets even put in her mind....I really truly think that she thinks we are all at her beck and call 24 hours a day if she wants us. And her child is quite stable yet she can only talk about how ILL her child is and she will make everything more of an issue than it is. The baby is happy and playing yet she will point to her and say LOOK, there is something really wrong with her!!! She likes her to be sick because she craves the attention. And I can understand being used to your baby being sick and being almost afraid to get used to the baby getting better , almost being afraid to jinx it- I have personally been there- but it is not that. She makes every grain of sand a mountain. anyway I digress. And yes, I keep saying I may get off the case, many nurses have come and gone, but I do love this baby, it is what keeps me coming back that and right now it fits my schedule and also there arent a lot of nurses that are still on her schedule so the probably arent giving me new cases because that would take ME away from THIS case and this woman has made a HUGE issue of it with her insurance company and everything - she calls the insurance company every month and complains that the nursing company isnt getting her enough coverage etc.

But if I can find some closer cases and my schedule opens up once I graduate, I will be weaning myself off it I think I just may have to for all the reasons that were said...plus I drive 45 mins to get there and my own health is suffering. my asthma doc would shoot me just for working the case in the first place! lol! and I wonder why I always sick, at first I was thinking it was the baby and I thought they always smoked outside and then last night I realized they are smoking inside now-probably because of the weather, and also realized that the so called outside cat also stays inside....so big clues on why I always get sick when I leave this case.

oh and roser you said manipulaters just ignore you....oh my gosh, they ignore you and they just cut you off if you are saying something they dont want to hear and uh....they also tend to just not let you talk if they arent the center of attention is what I have learned in this house! yeah...I have tried education but it doesnt seem to go far here. I tried to get mom to join a support group that would actually support her in educating her about her childs condition instead of having her support come from the friend that keeps getting her all hyped and scared, and you got to love it - the friend got on the phone with me and tried to convince ME that the doctors just hadnt told the mom that the baby had an aneurism??? I tried to tell her that there was no supporting evidence that what they had found was just a blood vessel in a different place - she is trying to convince mom it is an aneurism and that the baby is at risk for dying at any minute etc. I told her to call the doctor and ask the doctor to explain the results of the test to her and confirm this with her. Oh and she said "well its not like she has great drs...uh she goes to one of the worlds leading childrens hospitals!!!!!! ok, I am ranting for sure now. so you can see how good this case is for me, huh? I guess I always pictured home care being more like you go take care of children, you love them and care for them and then go home, end of story.....

hmmm, I guess I have to start working on how to phrase what I will say. I might like to do once a week here through the summer and see how it goes. but definately not FULL TIME and then I need to have the company look for other cases for me - I already have a few others I just need the time to put in on them and one is a vent/trach case I have really been wanting to do so I can get more vent experience. And if that isnt good enough....then I guess then that will be it! she isnt the type of person though that will really want to hear it...thanks for your feedback

angels mommy

caliotter3 · Feb 27, 2010

You were out of line when you discussed the medical issues of the patient with a third party on the phone. A violation of HIPAA. You need to step back and evaluate your behavior in all of this. Your posts indicate that you are entangled beyond professonalism and it is not entirely the fault of the client. You need to leave this case. Your asthma is the perfect excuse.

anangelsmommy, ADN, BSN, RN · Feb 28, 2010

I didnt actually discuss the case...the mom handed me the phone and the woman was talking saying that isnt this that etc etc and I just said " mom needs to discuss this with her doctor, the women then said, she doesnt have the best doctors...." I handed phone back to mom, I was very uncomfortable and very unsure of WHAT to do exactly but do you really think that that is violating hippa? I didnt discuss the case with the woman, The woman for some reason she felt it was her mission to convince ME?? with information that mom and her had been discussing I basically didnt want anything to do with the conversation but this mother is always looking for me to reinforce her beliefs....so she just handed me the phone and a woman I dont even know was just talking away. she has done this before to me in situations where I was really caught off guard, for instance I was in the ER one time and the DR was asking questions and she started fabricating answers....I was aghast...I really didnt know what to do for instance a little saliva suddenly became vomiting. And then she looks at me for reassurance.

And actually I try very hard not to divulge any information I shouldnt, in fact, I always struggle even on this forum with what information is appropriate and what isnt and I use a name other than my usual name so that I hope that people wouldnt be able to figure out who I discussing when ask for help for a patient care plan or in this case, my patient. I certainly hope I am not violating any patient confidentiality. I really do believe I have not done that.

angels mommy

anangelsmommy, ADN, BSN, RN · Feb 28, 2010

I see how that could have been read that I was convincing the friend- I meant that I was trying to convince mom that there was no convincing evidence that it was anything but a blood vessel in a different place and to call the doctor to explain the findings. NOT the friend. I dont care what the friend thinks, I dont know her and never met her. I think she just wants someone with the same condition so she has a support for herself. But she is stressing out my patients mother even more than she needs.

realnursealso/LPN, LPN · Feb 28, 2010

I can see all of this in my head as you write it. Some of the mom's of these little angels, can be very un-nerving at times. It's like we are their safety net. Some are scared, and I suppose they could be, but some are attached to nurses being in their home, and for a better explanation kind of munchausen like. They would never hurt their children physically, but , tend to exagerate their children's symptoms to continue the adoration they get from being the "Mom" of a sick child. I'm sure deep down this mother can see her child is getting better and soon she will have to take care of her own child, not nurses. As far as talking to one of the mom's friends, I wouldn't ever do that again. If she puts the phone in your hand, just give it back or lay it down and walk away. Tell her you could lose your job, or license for discussing her child's health with anyone, except a dr. or her. Also, may i suggest that you go to your DON, at the agency and discuss what is happening at your case. This mom sounds toxic, you need to quit this case and tell your DON, why. It will break your heart to walk away from your patient, but better to walk away than to lose everything you have worked so hard for.:redpinkhe

allnurses Guide · Feb 28, 2010

They've already drawn you into a manipulative web, which happens so often in home care. By allowing the scheduling of shifts to take place between the nurse and the family, you opened the door which is very hard to shut again. I've learned to tell people that I cannot agree to any changes in hours without going through the agency. It's so easy to become an unwitting player in a family drama, often it is very gradual and motivated by sincere concern for the family.

As oramar said, you've just got to tell her. You may let the agency do it, but prepare for all hell to break loose when you see her again. Parents who (often correctly) believe you are more than a nurse to their child, feel betrayed when the agency delivers news like that. They are very possessive when they get a good nurse, and really I don't blame them a second for that. They also actually get jealous when you have other patients. It isn't fair to anyone, though, to continue to let them believe you owe them some sort of emotional debt.

What happens after she knows the truth about your future plans, depends on how she will react. This can take many forms, but think of it as the 5 Stages of Grief and do not take it personally. Prepare to be accused of all manner of things, up to and including hypocrite, phony, liar. . this is what happens. She may give you the cold shoulder.

After all that, some families eventually accept the new reality and are fine. She might not, but I don't know. This lady appears to have psychological issues regarding her child's illness that need further evaluation. I hope the Case Manager and her child's doctor are made aware of these things!

The most effective thing I have ever found to do if you have to leave or cut hours is to foster the bond the family has with the other nurses. Since you have had a child on the receiving end of home care services, you instinctively knew how to relate and validate the parents. If they start to complain about x y or z, suggest how they might communicate their needs with that nurse, and mention a positive quality of that nurse. Almost always they will say, yeah, you're right. . .anyway just some of my experiences. As good as it feels to have families value us so much, it feels pretty bad when they turn on you, and I hope that doesn't happen! Best to you!

anangelsmommy, ADN, BSN, RN · Feb 28, 2010

realnurse - good suggestion about the phone - I have to say I was so caught off guard I didnt know what she was doing, she handed it to me i thought it was one of the drs at first because she often does that to me, she will call a physician, especially when she gets worked up about an issue and then just hand me the phone. And most of us have noticed mom's "munchausen" tendencies and it has been discussed on more than one occasion. We are told to treat it delicately and not to reinforce the behavior and that is about it. The DON is well aware of all the behaviors in this case, This is only a small part of the story.

Nursel56- I can tell you from MY part there will definately NOT be any scheduling OUTSIDE of my company scheduler, PERIOD. I recieved an email as did all the nurses on this case that we are not to schedule with the parent on this case and I will NOT do it. besides the fact that it is outside of what I am being told to do and generally against company policy - it would make my life difficult - that is what the scheduler is there for. that at least is one fall back I could count on if I need an excuse.

If she starts trying to blame me for things or be difficult with me because I am not giving her the time she wants, then I will definately remove myself from this case, that is one thing I will not tolerate. I have never done anything wrong on this case and I dont want to get a bad review just because I dont want to work more time. I dont actually know many of the other nurses, but I have trained a few of them, so I will ask how they are doing. And I know the other day, she was telling me that one of the nurses was really good on Dr.s appts. I try not to really ask much about other nurses because she likes to talk "trash" and I dont want invite that kind of talk. I am really trying to discourage her from discussing any of the other nurses because she has a habit of discussing all the ones that have left, and why they left etc. and I usually just say "well that is between you and them, or you and the scheduler. She has mentioned these things in front of nurses I was training and it wasnt appropriate, I had to cut her off and I know she was angry with me. I guess if she discussed good things that would be ok, but I am not sure she is able to distinguish the difference, I think if I open the door to this discussion, she will just start talking and some of it might invite talk that is inappropriate. but how do you bring this up with someone that doesnt really allow you any opportunity to talk to them? If it comes up in conversation, I might be able to say, hey I might be able to do one regular day per week or something like that but if she is just going to do these snappy little things as I walk out the door I feel like I should just fit one in to as i run to my car....oh not really I will be working at the hospital and other cases, you will be lucky to see me once or twice a month....vrrroooom vrrroooom (car drives off). ok it was just a joke. lets face it at this point since I havent graduated yet, I dont know for yet what my plans will be yet so that will be the truth and I can say that I plan on doing a variety of thing but that I do hope to also do some time on her case, but that will be up how she reacts i guess.

I do appreciate all the feed back here. I think being able to discuss it here first definately is much better than suddenly walking in and not knowing what to say.