What are they telling us/not telling us

[holly2422]

I am a new LPN and was hired by hospice. I wait for an assignment and commit to 3 days of 15 overnight hours each night and document every 15 minutes as long as the patient survives.

when the case came to me, it was by text, I wanted to know where the assignment was and about the clients condition. My response was basically do you want it or not, I'm a little busy. I chose to take it, being afraid of rejecting the first case is not so good.

the case was in a very bad neighborhood, mice and roaches in the home, the patient unresponsive with a trach, gtube and running a constant fever that would not budge.

no gloves provided by the hospice the first night in this home (thank goodness I had my own for the suppositories and trach care).

During one night I suctioned the trach, as a new nurse and not informed by my nursing school it was shocking..... a large yellowish gobber came ejecting out and a piece flew several feet in the air. I had no mask on or supplied with one from the hospice. I was more concerned about getting the gloves on quick because the episodes of congestion would come on quick. Thank goodness the piece did not hit me in the face.

The one daughter and father in the house were terribly ill and I questioned the antibiotic and why it was prescribed for the client. No one at the agency could give me an answer. The family barely spoke English and did not seem to know either.

Well, I find out after the passing that the client had pneumonia. As my first round in home care, this is an early lesson and makes me wonder what an agency can tell you and not tell you about the client (airborne, droplet and bloodborne afflictions).

Could I be walking into a care setting with someone with EBOLA, TB ... etc and not be informed prior by my company ?

I am aware of infection control, I even asked the agency if they would supply me with an N95 mask if needed for a client with TB, they looked at me strange.

I understand the danger of nursing, I want to be a good nurse, to help my client through the end of life process and to make them comfortable and at the same time want to protect my own self.

I could sit in a home with full protection not knowing if the client has a major contagion, but that could be over doing it.

does anyone know what an agency is obligated to tell us about our clients ?

thank you in advance

[BuckyBadgerRN, ASN, RN]

I think you're in over your head. Hospice/home health is NOT a place for a new nurse

[holly2422]

Well, the family gave really good feedback and I worked my butt off for 15 hours each night trying to maintain a decent temperature of 100.0. I have been out of work for more than a year, I need a job desperately before I lose my home, car etc. So, apparently I'm over my head with life in general

But, that does not address my question of what can an agency inform us about the client

[BuckyBadgerRN, ASN, RN]

When you work "on your own", you will have to figure a LOT of things out on your own. I repeat, a new grad nurse has no business working without a safety net of other readily available co-workers, ON SITE.

Well, the family gave really good feedback and I worked my butt off for 15 hours each night trying to maintain a decent temperature of 100.0. I have been out of work for more than a year, I need a job desperately before I lose my home, car etc. So, apparently I'm over my head with life in general

But, that does not address my question of what can an agency inform us about the client

[holly2422]

Hi Bucky..I think you are trying to be helpful in your way. In the state I live in, it is very common to place new LPNs in home care and hospice, it is a way to save the company money? I did not lie on my resume to indicate I have experience, the company already knows this.

Perhaps in the state I live in, they do things backwards here, getting a job in a long term care facility is rare and next to nothing to get a foot in the door. I did not start as a CNA either. Immediately on receiving my license, I ran my resume around to 20 locations, maybe 20 more job applications online and in the end, the only offers I received were from the home care and hospice.

I really wasn't asking about having a hand held though. I wanted to know what the agency can tell us about the patient. I can assume they can withhold the afflictions, not knowing if I am walking into a SARS , EBOLA, TB patient. It would be nice to know to prepare myself with a mask (unprovided for by my agency , by the way). Even a seasoned nurse apparently isn't privy to this information.

Trust me, if I could work in long term care with other humans around me I would, it is very lonely in the middle of the night alone in a home with a dying patient.

I did not put myself in this position, it is all I could find in the way of work and if I have no business doing this work as you think, then possibly my agency should be punished for hiring a slew of new LPNs. Things must be done the right way in the Midwest...kudos to you and your successful career

I for one am very discouraged early in the game, wish I never racked my head in chemistry and anatomy. I wanted to help people, but the system is not about helping, it's about making money. I am just a tool to get the job done for them and nothing more.

[JustBeachyNurse, LPN]

Contact OSHA. Review CDC and OSHA guidelines. Leave and report the company. You were not adequately trained if you never suctioned a trach before. You should have at least precepted with another nurse. Yes the agency is obligated to provide PPE. The odds of having an in home SARS or Enola patient are almost zero. The public health department would be involved with SARS, Ebola, TB etc

Company should provide gowns, gloves and basic masks. High risk airborne like TB would likely be facility based hospice with a negative pressure room.

20 applications is nothing.

[NurseSpeedy, ADN, LPN, RN]

I've worked for a few different home care companies over the years. The ones that I worked at originally were large organizations and they would not accept a nurse without a couple of years experience.

Now, I have had a patient switch agencies and those agencies were....well...small. They did hire new nurses right out of school. Even then they gave them a couple hours of orientation with another nurse on the case if they chose to accept the case. Prior to accepting, the nurse would have the opportunity to review the chart and plan of care to see if it is a case that they could be safely assigned to. One of the larger home health companies that I worked for had a chance to validate my past employment and experience, but they still required all nurses to demonstrate competency on a manikin and then once assigned to a case, meet with the RN assigned to that case and demonstrate competency working with that patient (such has trach care).

You know how hard you worked to get your license. I would seriously suggest finding an agency that is not going to just throw you out there in a situation that you are not prepared for. You should be able to at least go to the patient's home for a couple of hours with another nurse who knows the patient, demonstrate the skills that you will need to be able to do on your own, and then if you feel comfortable then maybe that case would be a good fit. This also allows the patient (and often their family) meet you and decide if they feel comfortable having you assigned to care for them.

Honestly though, I have never had a case where I didn't have a chance to at least view the orders and care plan prior to meeting/accepting the case.

[jcourtnay]

Shop around more for a job that you are happy with and then, when you find one, STAY there....too many nurse change jobs too frequently. So much so, in fact, that if you are dependable and enjoy your employ, career latter will take you places that are far beyond your expectations

[Cactus Nurse]

I'm so sorry to hear about your horrible experience, but it sounds like you survived and are willing to continue and that shoes great work ethic! You're dedicated!

I work in home healt, not hospice though. My agency will usually email me the POC before I start the case. I read it over to get an idea of the patient. I have seen that some families will train me themselves OR the company has allowed me to cover a shift with the other nurse so I can shadow them because I will be working their off days.

My company has never offered me any supplies nor will they reimburse me! Ridiculous, I agree. However whatever you buy, keep your receipt and you can write it off in your taxes... Yea you have to wait til April I know...

Note- when I worked as a caregiver before I got licensed, I had a smiliar experience and almost died. It was only 2 hours, but felt like 24hours... I called the agency the next morning and told them I will never go there again because there were roaches everywhere, the place smelled of cat urine, everything was a mess, and it was not healthy for me OR the client. I even said no other caregiver should go there either! I even suggested social services go there, she def needed to be in LTC... it was bad...

You make the call how bad things are- if you think the living conditions are so bad, don't work it... not ever patient lives in the ghetto with a trach and fever....

I feel like the beauty with home health is the ability to pick and choose my patients...

Good luck!

[JustBeachyNurse, LPN]

I'm so sorry to hear about your horrible experience, but it sounds like you survived and are willing to continue and that shoes great work ethic! You're dedicated!

I work in home healt, not hospice though. My agency will usually email me the POC before I start the case. I read it over to get an idea of the patient. I have seen that some families will train me themselves OR the company has allowed me to cover a shift with the other nurse so I can shadow them because I will be working their off days.

My company has never offered me any supplies nor will they reimburse me! Ridiculous, I agree. However whatever you buy, keep your receipt and you can write it off in your taxes... Yea you have to wait til April I know...

Note- when I worked as a caregiver before I got licensed, I had a smiliar experience and almost died. It was only 2 hours, but felt like 24hours... I called the agency the next morning and told them I will never go there again because there were roaches everywhere, the place smelled of cat urine, everything was a mess, and it was not healthy for me OR the client. I even said no other caregiver should go there either! I even suggested social services go there, she def needed to be in LTC... it was bad...

You make the call how bad things are- if you think the living conditions are so bad, don't work it... not ever patient lives in the ghetto with a trach and fever....

I feel like the beauty with home health is the ability to pick and choose my patients...

Good luck!

Writing off is not simple. You must have a high enough adjusted gross income and owe taxes to the IRS. If you are in a tax credit position there is nothing to deduct because you don't owe. And only a percentage of your expenses is deductible off your tax burden.

(Meaning if your tax rate is $1100 and you have a head of household deduction and child tax credit & say your resulting tax rate would be -$500. You would be ineligible to itemize your deductions as you can't deduct further against a tax credit as you don't owe taxes)

[SarahLPN2RN, LPN]

Sorry you had such a terrible experience. As far as being a new nurse in home health/ hospice, it's fine. The problem is your agency. No matter who (LTC, agency, or hospital) hires a new nurse, it's their responsibility to properly orient. I worked home health for several years. I don't know what state law is where you are, but in NY, employers have to supply personal protective equipment. I know it's hard to find jobs right now, but seriously, I would never walk into a situation where they refuse to give report, not knowing if I have the skill set necessary to take the job. Be assertive, know where your boundaries are and what you're comfortable with, it's your license on the line.

[JustBeachyNurse, LPN]

Correction OSHA mandates that your employer MUST provide PPE