Refusing to Accept a Patient

Specialties Home Health

Published

Specializes in Home Health, Geriatrics, Women's Health, Addiction.

I hope I am expressing my thoughts clearly. As a Per Diem or per visit home health nurse we have the ability to decline cases for various reasons. Cleanliness, safety, complexity of the case, pay, animals, smoke, niche, etc. My question is what do you do if you refuse to continue with a patient after you have been to the home and decide for whatever reason you do not want to move forward, for example bug infestation, questionable family members or surroundings, complex case that will have you barely clearing minimum wage, can you compartmentalize what you have seen or experienced and just move on to the next case? Do you just assume the next nurse will take care of everything or do you try to avoid "passing the buck" and initiate referrals, make calls if necessary. I realize you cannot pick up a home and place it in a different neighborhood so please don't think I am insisting on anyone doing something they don't agree with. We have to have a good work life balance. Most of us are in home health because we have a high need to love where we work and not dread going. With this "luxury" is there extra responsibility to clients we are not going to see again? This post is intended to create a dialogue and seek solutions so that patients don't fall between the cracks because their lifestyle or situation doesn't make for an ideal work environment. Please refrain from judging or bashing anyone at this time. I think it is more important that people are honest about their behavior so that we can find solutions and expose any pitfalls in home care. I believe everyone is familiar with our ethical responsibilities, however, I want people to talk about what they are experiencing and witnessing on a daily basis. What are some office policies and procedures for refusing to accept a patient? Please share scenarios and/or solutions. Once you refuse, are you on to the next or do you give it a second thought? What becomes of these patients? Thanks in advance.

I have yet to have my agency supervisors ever show any concern about followup or tying up loose ends when I leave a case. This attitude of non-concern exists whether I have gone for one contact or have been the primary, or sole, nurse for years. They just roll in the new person who will be getting the paycheck instead of me.

I think that as an ethical obligation, I would tie up as many loose ends as I can then verbalize my concerns to both the clinical manager and the new case manager (maybe even the MD office). I would hate to be on the receiving end of a "problematic" case that absolutely jack was done to resolve any current issues. I definitely would feel bad if this patient where to be passed around like a game of hot potato and Im sure when the satisfaction survey comes in the mail to them, they would also complain about lack of consistency on the RN behalf; perhaps a discussion needs to be made to address possible safety issues/liabilities for both RN/agency or patient!

I had one patient that I did a soc on and did not feel safe in her neighborhood/home. I completed the visit, did the OASIS, made all calls necessary to set things up, and then told my supervisor that I would not go back to the home because of safety issues.

Honestly, I know everyone is deserving of medical care, but it's not worth the paycheck to risk my life.

Because I spoke up about being assaulted and stalked, I was blacklisted by my employer. Years later, I still suffer from what was done to me. I had to leave the area, for what that was worth. But at least, on occasion, I can forget that a job has to be associated with personal threat or harm.

Specializes in Home Health, Geriatrics, Women's Health, Addiction.

Thanks for the replies. This is what I was hoping for...awareness...dialogue.

Your primary concern above everything else is YOUR safety.

If you are not safe, you cannot take care of your patient(s).

That being said, simply going to a run-down neighborhood is not reason enough to refuse to see a patient.

I've been to really nice wealthy neighborhoods and seen people living in squalor in their homes.

A complex case that may entail a lot of travel which results in less money for you is not really a good reason to refuse to see a patient if you are already scheduled to do so. The time to refuse would be before accepting the patient in the first place.

I currently see a patient that is very far away and by the time I do the trip and do the paperwork and other followups, I might make $10hr. Other RNs have refused to see this patient.

If you get to a home and find that they are smokers and don't air out the home, that is a threat to your safety.

You CAN request that they not smoke while you are there and open the windows to air it out.

Unless there is something in your job description that requires you to breathe second-hand smoke.

You may get to a home and find the patient is great, the surroundings are nice but there are family members/friends present that are interfering.

They may be drunk and/or belligerent. I would say that would be a good reason to leave and refuse to see the patient unless those family members are not present.

Hopefully the HH Agency would have some policies on this. Mine does not.

Our patient's are required to provide a safe environment for us to go into. So, if there is a dog that the nurse doesn't feel safe with it must be put away, no firearms can be out, basically anything that could fall under my first statement. That being said.... if it's a bad environment that the nurse really doesn't think is safe we excuse ourselves to our car and call our supervisor. If it is an unsafe environment for one of us it is for all. I go to neighborhoods that some nurses won't go to. I feel as long as I go early in the day it's reasonably safe, at night or in the late afternoon I wouldn't go. If it's a messy home I am extra cautious with hygiene etc. If they are a smoker I ask that they don't smoke when I am there, if a dog acts aggressively toward me I will ask that the dog is put in the other room. My agency does have some neighborhoods we just don't go to because of the safety aspect (known heavy gang violence and only 1 way in and out). I've never refused to continue with someone because of the environment. When someone in the home has been verbally abusive to me I will request a switch, in that case the patient did much better with a male nurse. I have found that open communication with my supervisors helps.

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