Home Health Nurse Safety

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    In home health care, I have seen a growing increase in the amount of concern over the safety of our nurses out in the field. Is it really appropriate for a nurse to go to a client's home to change a foley, alone, at 2am in the darkest, most violent part of town? How are other homecare agencies dealing with this issue?
    Last edit by JULESNYRN on Sep 17, '04
  2. 23 Comments so far...

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    Hi, Julie!
    Welcome to the board!

    I work in home care also. Luckily, I do not have to do beeper call. I do assigned visits on my weekends.
    Let me ponder the topic a bit, and come back to it..
    ~SunnyGirl
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    I did home health for 9yrs. I cant think of any reason why you would need to replace a foley at 2am. Why cant it wait until 8am? Even if it gets dislodged and is causing pain - you're supposed to teach the family or pt how to deal with emergencies. When I do have to go into a bad neighborhood, I usually call the local police station for escort. It depends on the size of your town, I guess. Our policemen have always been great about that. I think Home health will eventually have to start providing some sort of security in special circumstances. Lord knows, they get enough money to do it. Lets see, pay wages to a security guard for a few hours - OR pay for a huge lawsuit filed by the nurse who was injured because she was made to go alone or risk getting fired....hmmm, hard decision.!
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    Weird that you post this today. I just read an article in American Journal of Nursing last night regarding Home Care Security.

    It can be found in the September 2004 issue of the AJN, Vol. 104, No. 9, page 96.
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    I have worked for 3 agencies, and never would we make a visit like that in the night unless there was an escort. A foley is NOT an emergency at 2am, even for a neurogenic bladder. It can wait until daylight.

    If there is such an urgent need for care that is cannot wait, and the area is that bad, tell them to call 911. The only time a nurse should consider going out for a visit in a scary area is for Hospice, and then with an escort or the police escort is a great idea.

    If the area is that dangerous, should you even go there in the day time alone?? One agency in our area does not have escort, so they just refuse to accept cases there.

    Sunny?? Is the date right on this post?? Is it really you? Yay!
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    Additional thought. Contacting the police for an escort to a patient's home is most likely a confidentiality violation. Don't flame me....I'm just stating a fact. Identifying oneself as a home nurse nurse and informing another person that you are providing home care services at a particular client's house is a violation of that client's confidentiality. I'm wondering if agencies get written permission from home care client's to contact police for after hours escort services?
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    Quote from Ross1
    Additional thought. Contacting the police for an escort to a patient's home is most likely a confidentiality violation. Don't flame me....I'm just stating a fact. Identifying oneself as a home nurse nurse and informing another person that you are providing home care services at a particular client's house is a violation of that client's confidentiality. I'm wondering if agencies get written permission from home care client's to contact police for after hours escort services?
    I see where you are coming from, but my thoughts are nurse safety over confidentiality. Confidentiality would not be violated to the point that condition or reason for visit would be released. Someone could see you at the admitting desk and learn that you were in the hospital. Births are printed in the daily paper (mom, dad, and baby name - along with what hospital). There are loopholes in the confidentiality thing. I think that this type of situation would be a good place for another one.
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    Well, we have HIPPA to deal with today which makes confidentiality rules even stricter. In the case of birth announcements, the parents are choosing to announce the birth of their child in the daily newspaper. That is their confidential info that they have the right to release. If a person is standing at an admitting desk, s/he is choosing to stand there. While you are correct in your thoughts about nurse safety, I am quite confident that calling the police, identifying oneself as a home care RN, and requesting an escort to the home of John Smith, 120 Main Street IS a confidentiality violation. Clearly there are extenuating circumstances in such a situation, but after sitting through SO MANY HIPPA trainings, if this type of situation is routine for an agency, then it is probably prudent to have the patient sign a release form for this type of info.

    I'd be interested to hear from some QA and compliance folks on this issue.




    Quote from RN4NICU
    I see where you are coming from, but my thoughts are nurse safety over confidentiality. Confidentiality would not be violated to the point that condition or reason for visit would be released. Someone could see you at the admitting desk and learn that you were in the hospital. Births are printed in the daily paper (mom, dad, and baby name - along with what hospital). There are loopholes in the confidentiality thing. I think that this type of situation would be a good place for another one.
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    Safety is a big issue for hh nurses. I don't work in a big urban environment but a very rural area where I frequently have to use 4wd to reach patient's homes. But the risks are still there although somewhat different. I have to think about what happens if I get a flat tire or break down out in the middle of nowhere. Methamphetamine production has also become a big problem in this area. We have actually had several patients that we have encountered this with. The police come to our office several times a year to give talks on the latest things that are happening in the area. For the meth they told us what products, smells, and behaviors to look for. There are basic precautions that all hh nurses should take. If it doesn't feel right, get out of there. Never block your access to an exit, keep you car in good working order, let someone know where you will be going. If I didn't feel comfortable going somewhere I wouldn't go. There is no reason to put yourself in a potentially dangerous situation.

    As far as changing the foley at 2am, I have never had to do this but I have had to go out at this time for prn visits before. I have also had to go our for scheduled visits at this time for IV's.
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    I cannot imagine putting myself in this kind of situation personally.My hat's definitely off to those who do. I tried home health for a short while and was struck with how vulnerable we are out there alone.

    It is similar to what police and EMT's do but without the protections of numbers. I prefer the relative safety of a hospital, because this is my comfort zone.

    Hey, this would probably make a great topic for a TV series...Home Health Nurses and what they encounter. Maybe ya'll should pitch the idea to TV.....anything that helps the public understand what we do is important to our profession.


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