Advice needed

Specialties Hospice

Published

I am an RN who is new to hospice/home health nursing. I am working for a small agency and have some questions to ask of those on here who work in the field to gauge whether I am overreacting to some things I have encountered. Number one: The agency have a doctor contracted but the DON cannot get hold of her for orders/sign documents etc. Consequently pts have to wait extended periods of time for medications or (which i think is more the case) the DON is ordering meds without an order. Number two: One of my pts on hospice has Emphysema and AFib and was complaining to a particular aide that he was constipated. He has colace prescribed with instructions to take x1 day but the aide told him to take two and she would go and get some suppositories and put in for him. Additionally, for some reason she is measuring his legs/feet whenever she goes, the pt thinks she is the nurse and yelled at me the other day for trying to measure his calf because she had already done it. I have discussed my concerns with the DON but she just shakes her head and does nothing about it. I am concerned about my licence particularly with no active physician on board, does anyone think im overreacting or is this commonplace in Hospice/homehealth??

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Specializes in LTC, AL, hospice.

I think you are rightfully concerned. Our medical director is wonderful - available 24/7 and approachable. Your DON and the aide are both doing things outside their scope. Why is the aide measuring anyways? What is she doing with the measurements?

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Specializes in Hospice, Case Mgt., RN Consultant, ICU.

You have every reason to be concerned. I have three years hospice experience with two different hospice companies and the docs were wonderful with each. Our physicians, including our medical director could be in another state, but were only an email away. We used Blackberries so there was no playing phone tag. Do you rely on the DON to communicate with the doctor?

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I think you are rightfully concerned. Our medical director is wonderful - available 24/7 and approachable. Your DON and the aide are both doing things outside their scope. Why is the aide measuring anyways? What is she doing with the measurements?

Very concerning. I had a SW who was giving medical advice to patients unsolicited. I actaully instructed my patients family to tell her that "that sounds like it should come from the nurse" and not a social worker don't you think? The only reason I ok'd them to do this.. the family was taken back by the free advice.

My concern is why the HHA is taking on a more assertive clinical role. Speak to her. Don't yell. It makes you look like the lesser of the two. Calmly ask why or who directed her to do such a task. It's really out side of their scope of practice.. and really makes more work for her. That's the approach I'd take. I have been angry before. Before you react.. take a breath.. then act.

Your DON's giving orders without MD orders.. is on her if she is indeed writing the orders. However, patients not getting pain medications as needed is a huge issue.

Have you thought of meeting in a professional manner to discuss your concerns? I'd document the incidents in a format and bring the said incidents to light.. in writing.

Hope it goes well. FYI.. your situation is NOT normal.

:nurse:

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your concerns are valid, you may want to run not walk

out the door asap and not look back. please let us know

how you're doing.

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