What would you do in this situation?

Nurses Relations

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Long story short, I'm a relatively new nurse, and just got hired to a home health facility. However, I was assigned to an also new adolescent client. Parents appeared very friendly and welcoming at first.

However, as the days went on I started to notice that they can be extremely sharp or crass towards me when something is worded wrong before I can correct myself, or times when they believe I am making independent choices without any clinical judgment or without permission (by family, client and physician). I've always asked my client's permission before I do anything. This has always been the case since I started working as an RN. I am not being given a chance to reexplain regarding the situation before my head is bitten off by the family. At times, I'm being spoken to more like a child than a healthcare professional. Their expectations from the parents of me do not reflect company expectations nor is the careplan or physician orders followed very well when I work. I do document like it's my licensure insurance. Clinical manager is aware, but they've also stated that they've never had problems with other nurses (mostly NOCs). I work days.

I've only been working with them for several days, and this is the impression I'm already getting from the family.

What would you do in this situation as an RN?

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You have a case where the parents have long crossed over the border from anxious.. to controlling. The agency is allowing this for $$$$$.

You're new and you will be tested. Do not allow comparison to yourself and another nurse.

You won't be able to change the situation, move on.

By any chance is this the "M" agency?

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It's not the M agency. I'm just anxious about losing my license. They are just outright mean when something does not go their way or if I'm not doing something THEY WANT instead of what the agency tells me I'm supposed to do. I can't even call the MD for questions without being scolded at by the family. I was told that they "do not want me to go behind their backs just to ask questions"

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Sounds like you need to inform your supervisor that you can no longer work that case. I also work for home health and I wouldn't put up with that.

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Sounds like the parents have some significant control issues. And I am sure that their insurance pays for home health, when they could retain more "control" with a traditional private duty nurse situation that they hire and pay for out of pocket. Which you are not.

I would ask to be taken off of the case,and follow-up by asking your supervisor to have a patient care meeting to discuss with the parents what is part of the care plan, and what is not. Or this will continue to be an issue--They are more than likely informed of such things, however, the disconnect seems to be that they would seemingly like to run the show, and unfortunetely for them, you have a care plan that runs the show.

You mentioned that the other nurses that they have had have been night nurses. Is having an RN during the day new for them? If so, it is even more of a power struggle to have them relinquish control over what they felt "worked" for them in the past. I also have the thought process that if there is a new day nurse, then one was needed--perhaps the patient was not being cared for appropriately--hence the "don't go behind our backs" statement. In other words, one of the night nurses must have noticed something was amiss, hence the day nurse coming into the picture.

One of the obligations of a home health agency, and home health nurses is standard of care. Which parents can take personally, as a "slap in the face" on how they took care of their child. And sometimes there is just not one thing wrong, per se, just that the agency can make more money by putting on another nurse for re-imburseable skilled care that insurance pays for.

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Specializes in Infusion Nursing, Home Health Infusion.

I have done home infusion for a long long time. The feeling I am getting is that the agency has allowed this behavior to continue and you are not the first nurse to experience this. What you need is strong leadership from the company and hope they take a stand for the benefit of the patient and all the nurses that care for this patient. A team conference should be called and all nurses that are involved in the care or as many as possible need to compare notes to get an accurate assessment of the situation. Once that is completed you need to come up with a plan of action so all nurses and management are on the same side and no one is backstabbing each other. The situation may so far gone that a letter from management may need to be sent to the family stating the expectations of the agency,clearly stating x y and z. For example, the care plan and MD orders will be followed,the RN is expected and to call the MD or LP for any change in condition and for any new orders and that the nurses and caregivers will be treated with respect. The family signed a contract with admission to the agency to receive nursing services and most of these contracts not only explain the patient's rights but they explain that all staff will be treated with respect. I can get the exact wording from my open packet but it is very clear what is expected.

The agency needs to give them x amount of time to comply and see changes or they will be dropped from care,with notice of course. I work for an agency that will not hesitate to support the nursing staff in this manner and we have dropped many patients for failing to keep the contract they agree to. This family needs a new and detailed contract that clearly states the changes that will occur or they will get a thirty day notice that gives them time to seek another agency.

I am can surmise you do not want to appear difficult but if the agency is not proactive in getting these changes you need to ask to be dropped from the case. I can foresee nothing but a mess for you to detangle! The family will make trouble for you. I am a very flexible, kind and caring. knowledgeable nurse but if I am mistreated all bets are OFF the table and something will be done because I simply will not take any more abuse from patients or families. I also have no hesitation in documenting any abuse as I have seen an increase in a sense of entitlement and a a lot less gratitude from those seeking medical and nursing care.

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Thanks for the supportive inputs on the situation at hand. I will be contacting my HRG manager on Monday to switch cases. I wrote a long email to my clinical manager entailing details for their next care conference. The family currently is relatively new to the company. What they have been told by the company seems to conflict with what nurses are oriented to from Day 1 they are with the company. I went through the documents again just to reassure myself, and I did do what was expected of me regarding cares.

I just hope that the next nurse won't encounter the same rude behavior that was directed at me during my 12 hour shifts. More importantly, finding someone that will bond with the client.

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I love hearing from nurses on here as it gives me great comfort and confidence to continue my career as an RN.

I had been working with a family for a few days, and found major issues that would have put me in a bind in the long run. However, because the client was new, I did not have any orientation days or meet and greets. I made a thread in the PDN section in regards to what had happened (link below to the thread). So I decided that I'll be switching cases pretty soon here (Monday).

I'd like to hear from nurses from several specialties of nursing. Which is why I decided to pose the question here.

How would you guys/gals go about with gauging family members prior to being assigned the case during the meet and greet?

I understand that sometimes we won't catch everything during the first visit, but what should I be looking for or asking during the greeting process with the family and client?

https://allnurses.com/private-duty-nursing/help-new-private-896136.html

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

multiple duplicate threads merged as per the TOS

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When a client tells you to leave the room where your patient is, and to sit somewhere else for two hours, it is time to leave the case. Did you put that in writing and give the statement to your employer?

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Did something change in the pt. condition to lead to having an RN on day shift?

I agree that at this point it is time to change assignments and your manager needs to discuss with the family what the rules are for your company. If they want the services, they have to know the limits. I am not blaming you for the haziness of limits. Night shift nursing in the home is very different than day shift. They are in new territory, also. The parents need to hear from a supervisor that you were doing per policy and that the next nurse would be held to the same standards. If the company takes the side of the parents in a way that is not supportive of you, the employee, start a job search. You will see the same behaviors from the company over and over again.

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Yes, they were adjusting to huge changes in the patient's condition, gt, vent, and a trach. I understand there are major differences in facility vs in home nursing, but I felt like I should have been working at a minimum wage job when things hit the fan. THey constantly remind me of how grateful they are to have 24 hr nursing, but everything they've said to me sort of negates that when I was following facility protocol + best nursing practice whilst learning more about the client/family.

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