Tattletale nurse

[IndiKast]

As of November I've been an LVN for 2 years. It's been a rocky ride since our local hospitals don't hire LVNS. I finally found a job 6 months ago in pediatric home health (not my area of interest but its all thats out there unless I'm willing to be drastically underpaid.) Anyway, One of the two main day nurses has suddenly become lazy, neglectful, and a bad nurse in general. She didn't even tell me when the patient went to the doctor for vaccines and was discovered to have a dislocated hip! Two days later (I was off for one of them) I found out from the Mom but boy was I livid! I tried several times to talk to her about it and on the third attempt she even insulted me saying it was written down and she "assumed I could read." Nope. No such note that I've seen but it still should have been in verbal report I think. So, after a week of this I finally reported her but I feel so awful about it! I'm still the new nurse in the team and the new nurse over all. Work mgmt said they'd handle it but I know she'd going to make my life hell now. I'm the only one who was even upset about it apparently. Even the mother said blow it off. Did I do right? Am I being too nitpicky in this house full of nurses? (Yes, the mother is an LVN peds nurse too.)

[pagandeva2000, LPN]

Wonder how my fellow home care nurses would treat this issue in terms of mandatory reporting laws (in California they have increased the liability of nurses who know about something bad going on even if they have no firsthand knowledge of it).

So technically we're not legally required to inform the agency "about" something, but we are legally required to report to CPS or APS, and if we don't we are in the doo-doo. So for example if we know the mother reported it to the school is that where our legal responsibilities end? We don't know in a case like that for sure if it's been reported to law enforcement. Just wondering how you interpret that in a practical situation.

I would always chart my findings and report them to the agency. Keeping them out of the loop can be bad business for the people I am employed for. Not informing them or keeping them in the dark can lead to surprize situations that are not pleasent for all involved. In the case of the pediatric client I spoke about, it was important for me to report it, and I'm glad I did. The RN I reported it to did call the mother, assess the situation and found that there was no harm to the child, that the nurses did nothing wrong, but she was also annoyed that the situation happened 5 days prior, and were 3 other nurses who came across this situation, were told by the mother and child, but it was not reported to the agency.

My thoughts upon first hearing about it was that the child didn't give the situation much thought until she was being bathed by the night shift nurse. What if she then, associated this with one of us? Or what if there was someone in the family who may, in fact, had been abusing her and because she was too young, a poor witness? What if the mother accused the nurse of doing it? I do find that home care can be lax, depending on the situation, because that nurse (whether LPN or RN) is really working autonomously. No direct supervisors on site, etc... Some of the other nurses I knew tended to take these jobs as babysitting and nothing more. There is just as much responsibility and liability as working in a facility. Even moreso, in fact. Sometimes, you discover that families are using home remedies that are contraindicated to their current course of treatment, giving extra medications (usually OTC) that are not on the MAR, patients using drugs, so many dynamics that we can't even imagine them all.

[pagandeva2000, LPN]

Sorry Indie, but the behavior she is exhibiting is quite common in home health. The best you can hope for in extended care cases are those where you do not relieve or are relieved by another nurse and/or where the family is intelligent enough not to get caught up in manipulation originating from any of the nurses on a case.

I have to agree with you there. I have not directly experienced it, but heard plenty of stories about it. Again, I discovered that the dynamics involved in home care can be so complex. You do see families playing one nurse against the other...sometimes getting nurses to do more than what their real responsibilities are, etc.

One of the reasons why I had decided to leave the pediatric case I had was because the child had a half sister that was a wild indian. She was much older (my client was 3, the sister was 14 and their father was in jail); and the mother of my client sort of expected that the dayshift nurse should babysit both, the actual client and this sister whenever she was staying with them. The girl used to sneak out of the house to meet boys, and from what I heard, the family would blame the nurse if this happened-meanwhile, she had NO responsibility towards this sibling.

Some families expected for the nurse to change her hours at any given moment, would expect them to be responsible for the siblings, other family members, and many other situations. When conversating with some of these nurses, I would find that a few of them accepted this because they were no longer used to working in facilities. Sometimes, if there are three nurses involved in a case, and one of them does not agree with what the others are planning, then, they try and find a way to oust the odd ball from the case because that is messing with their program...all sorts of things. You may know your efforts, but can't really determine what the values or motivation of that other nurse really are, so, I feel your pain.

[nursel56]

Indikast- I would call her reaction pretty tame compared to what it could have been, in fact it sound exactly like a certain nurse I work with! Usually even the "bff" act isn't entirely above board with them. But you are moving on with your life!

Pagandeva and Cali- thanks for your thoughts on the reporting issue. I would report everything to the agency too. Hopefully they would take appropriate action for their part, but our first duty is to make sure we follow the law. There are a lot of things to think about when we're working out in the field.