Homecare Nurses

[nursemartin00]

If there are any overnight home care nurses out there, Id like to ask you about your work environment. Do you sit bedside? In the dark? Tv on or off? Any type of lighting?

My home care client used to have his tv on every night without fail and if lighting wasn't adequate I would turn the hall light on. But now the family requests:

I sit at bedside of my patient with the tv and lights off except a night light. Is it too much to expect a person to sit in the dark with no noise and stay awake?

It makes it very difficult to assess my patient in the dark and provide cares.

I plan on talking to the office regarding these circumstances. Any suggestions or advice?

[meanmaryjean, DNP, RN]

I worked overnight homecare for many years. I always sat in another room, lights and (sometimes) TV on and listened for my patient. (Vent dependent little ones usually). Ridiculous requirement from parents. Your agency needs to stand up for you. Mine did when parents 'insisted' that I work in my stocking feet to protect their carpeting. OSHA does not take kindly to people working without shoes!

As a 'side effect' of night shift homecare work - I can pretty much tell you everything you'd ever want to know about any product hawked in a middle-of-the-night infomercial! :)

I completed my BSN and part of my MSN online while working homecare. My patients usually slept, and it was the perfect opportunity as it forced me to study - there being not a lot else to do. (Obviously, the parents were OK with this as it helped my alertness - and they understood the challenge of remaining awake in a quiet house at 0300)

I'm applying for a job as an online adjunct instructor, and thought about picking up a PRN homecare job again and doing all of my grading around my patient's schedule.

[Double-Helix, BSN, RN]

How often do you need to do assessments and provide care at night? It seems like the assessment and "care" (I'm assuming personal care) would disturb the patient by themselves, never mind a low-intensity light so that you can see what you're doing. Is your patient that unstable that it's necessary to be able to see him clearly all of the time? If he hooked up to any machines that would alarm if there was a problem? Even patients in the hospital don't have someone watching them 24/7.

I used to do home care as a CNA. My client was a four year old with a seizure disorder who often had trouble sleeping. She needed to be held and rocked a lot at night. In order to create the best sleep environment for her, I would often sit with no lights and no TV. It wasn't easy to stay awake, but it's one of those things that you tell yourself you need to do. When she would sleep in her bedroom, the family installed an infrared video monitor so that she could be in a quiet room with little stimulation and I could see her from the living room.

If you're concerned about being able to see your patient and assess him, I would first figure out how often you need to do full assessments, and when you can do focused assessments. Getting adequate sleep is very important for the patient's health also, and if it's not necessary that you be staring at him all night, I don't think it's unreasonable for the family to request a low-stimulation environment. Once you know how often you need to do assessments, discuss this with the family and explain that you will keep the stimulation to a minimum as much as possible, but will need to use a low-intensity light to perform your assessments X amount of times per shift. But reassure them that you will do so in a way that the patient is disturbed as little as possible.

If you're concerned about staying awake due to the lack of stimulation, some other posts suggest some good activities that might help keep you busy without disturbing the patient. Also ask yourself if it's necessary to sit directly at the bedside, or if you could monitor him just as well from the other side of the room, where your movements might be less distracting.

[lyfhckr]

I'm still a nursing student but working as a CNA and we rotate to be sitters if a patient needs one or in a 5150 hold. We already had an incident where the sitter fell asleep and the patient was already turning blue so now they let sitters use our hospital laptop inside the room, bring books, your cellphone, etc. just to stay awake. Sitting is not easy and we don't just sit there and do nothing, at home would be very difficult since there are family members keeping an eye on you LOL if i were to be a parent who needs home care for my little one, ofcourse i want him/her to be comfortable at home because it's my child's life we're dealing with.

[tnmarie]

Y'all are allowed to take laptops to work? Wow!

I've primarily done night shifts for the last few years and have been really lucky. Most families allow at least a lamp to be on. In places where I wasn't allowed, I used flashlights and/or book lamps. I did work once at a place where they wanted NO lights or movement and I never went back. I also had a case where just about any light hurt the pt's eyes but I didn't feel comfortable sitting in the dark with him because he was trach/respiratory. Had to just go leave it to the nurses who WERE comfortable doing that. Bottom line is you have to work it out with the family and if the family can't tolerate what you feel you need for safe care, sometimes you have to move on...

[frankie,RN]

i think you wont be able to adequately do your job if all the lights are off. in the end, if something happened, the board would be asking, "what would a prudent nurse do." i wouldnt feel like a safe nurse if i had to care for a child in total darkness. how can you know their skin color, does the child have a pulse ox?? that would make me feel a little better. if you cant see them turning blue at least that will maybe give you some forewarning. My agency does allow us to bring a laptop/ipad/whatever. i bring my laptop and stick one earbud in so I dont disturb the client. I also bring a booklight to do studying for my bsn program. i personally think its too much to ask you to sit in total darkness. a little source of light is ok. i would be pickier about the nurse making too much noise at night.:)

[SE_BSN_RN, BSN]

I work 2 nights a week, and have permission from my client's mother to bring a laptop and my wifi. I can get a lot of homework done that way. The family keeps a lamp at the desk where I chart, a lamp at the bedside, and a lamp in the bathroom. I don't watch TV, but they ask the volume on the TV be kept low when pt is sleeping; and with the noise of the oxygen, air purifier, and other machines I just don't watch TV. (I am not a big TV watcher anyhow.) I do listen to iheart radio on my laptop, or bring CD's to listen to, and a book to read, and , of course, don't forget snacks! I don't have much to do at night, just a few things, so its hard to stay awake.

Check with your agency and see what their protocol is. Good Luck!

[RNsRWe, ASN, RN]

Seems like they want a MUSHROOM sitting there in the dark, not a live human being.

Unreasonable, IMHO.

[tuhcoolyuh]

I currently work 12 hr night shifts in home care with a pediatric vent-dependent patient. I work in the hall outside the room, or go downstairs for 5-15 minutes at a time with a baby monitor on. I pass the time by reading, but I have a lamp at my desk in the hallway. If I were confined to the patient's room, I would probably bring my laptop and sit on the floor or something so the light doesn't wake the patient. I use a flashlight to assess the patient, or the overhead light is on a dimmer if I need more light.

[RNGriffin]

This is where you have to have a back bone and speak up for your license. You know you are not able to perform your duties in the dark. So, if they wish for him/her to stabilize, you need to be able to do what you are there for. I used to have a patient who wanted to keep the room dark, but this patient had apnea. How in the **** do you expect me to do an assessment or monitor you with your house completely dark?

Need less to say, I said exactly those words( without the cursing).

[amoLucia]

Seems like they want a MUSHROOM sitting there in the dark, not a live human being.

Unreasonable, IMHO.

And it's a heap of manure that's being shoveled to have her sit in the dark.

[donna.rose]

I work nights for Bayada. My client is a 17 yr old with trach and vent. In this case I have to sit at bedside. The family has a small fold up table with a small lamp for us to use. No tv, but we can bring our cell phone, and I bring my iPad. I have helped on cases where we could sit outside the door, in the living room and did have a television. I have been with this case for 10 months.

We do have a flash light I cut on and sit up when I need more light. That helps a lot. Yes, if I couldn't bring my iPad or droid phone to get on FB or read on Nook I would fall asleep..

[nursemartin00]

My client is 18

Has trach needs lots of sxn, apnea monitor, and tube feedings/meds.

My agency didnt do much to help me out.

Said they'd call mom but who knows if they did or not?

My clients mom is CRAZY!!! For real

I called in and she text me ALL weekend harassing me. The weekend nurse quit recently and moms paranoid. She was asking me, you quit too? Cuz i never responded. So stressful!

Another concern Is mom dispenses all meds for the week in a daily med box. Throws all pill bottles in trash. Unacceptable to me! Needless to say I will not be returning.... Job search is on :/