akward situations in the home

[smartnurse1982]

I. Have done 2 cases this week that have situations I never seen Before. I work 11pm to 7 am. Yhe cases are chikldr

Children 4 years old with gbutton. Mom sleeps with the child in a full size bed. I feel kinda awkward becase I sit in a chair about 5 feet from the bed,meaning I can see both of them sleeping. The case is alright but I don't know how I am going to get used to it. Also,mom is looking and scrutizing everything u do. She also turns off all the lights so the only light I have is a flashlight. Anybody ever run into any awkard situations in the home setting? Please share!

[tothepointeLVN, LVN]

I NEVER sleep on the night shift and never will. Don't think I could either. I take my knitting and read books

[Blackcat99]

Sleeping at night-Yikes:eek:. What if something happens at night and the alarm is not functioning right and doesn't alarm? I think we are being paid to actually observe the patient and not to rely on an alarm to wake us up. I will never forget the story I heard about a nurse at one of my old jobs. He had been a very good nurse at the psychiatric hospital. He had been working a lot of double shifts to help out and was exhausted. He agreed to work nights as a 1:1 with a suicidal patient. He accidently fell asleep in his chair and the patient killed herself. Now he has to live with that for the rest of his life.

[tencat]

Apparently a lot of people on nights with private duty nursing do sleep. I don't think it's a good idea, but I imagine it's a lot harder to stay awake in a quiet, dark house, especially if the family won't let you use any electricity....one patient I know of did that to the night nurses: Made them sit in the dark and not plug in their computers.

I wouldn't do private duty unless I had to. I can't think of a more boring way to work.

[nursel56]

It is bad. My patient has had nursing in the home for a long time. Many of her past nurses had full time day jobs and actually get pi ssed at my patient for bothering them.

I don't find it boring. I probably wouldn't have chosen it if I hadn't been in a desperate situation financially. I've learned so much from my patients about what it's like to be disabled, the ventilators, etc. Things impossible to learn in most settings, and I've worked in all except LTC.

[ArwenEvenstar]

I wouldn't do private duty unless I had to. I can't think of a more boring way to work.

Boring? I only wish private duty was boring. I left private duty a few months ago after doing it for over 4 years. The nurse frequently must deal with much "drama" (complex psycho-social issues) with these families. Sometimes I thought nurses with psych backgrounds (haha) would be more qualified for these cases. Also, patients that qualify for a private duty RN, usually have very complex medical needs. For example, one case I worked was a ventilator dependent child with a trach, round the clock nebulizer treatments, frequent suctioning, and chest PT. Also had a PEG tube for all feedings/ many meds, got urinary straight cath QID, etc, etc. Plus the child was mentally okay, so you had to "amuse" them and deal with typical child behavioral issues. This case kept me BUSY! Far from boring! From my experience, boring cases were the exception, not the rule.

However, I suppose overnight shift would/could be very boring, but I never worked nights myself...and this thread is more about nights.

In general though, I think private duty nurses are unfairly stereotyped as having boring jobs and losing all their skills. I actually gained some skills doing private duty, especially related to respiratory. Prior to private duty, I had no vent experience, no nebulizer/chest PT experience (only resp therapists did this at hospital), etc.....

[tothepointeLVN, LVN]

Have to agree with the above post. I utilize my skills more often than most of my graduating class including doing a lot of things never covered in the facility setting training we had.

[caliotter3]

I NEVER sleep on the night shift and never will. Don't think I could either. I take my knitting and read books

I also never sleep on the night shift and inform my patients of that fact. I refuse to allow them to jeopardize my license by placing me in a position of vulnerability by taking up their offer to "turn off the lights and sleep". What other nurses do is their business and I tell the patient this.

[tothepointeLVN, LVN]

Totally agree with caliotter3 on this one. If your going to sleep why bother having a nurse at all.

[nursel56]

Sleeping at night-Yikes:eek:. What if something happens at night and the alarm is not functioning right and doesn't alarm? I think we are being paid to actually observe the patient and not to rely on an alarm to wake us up. I will never forget the story I heard about a nurse at one of my old jobs. He had been a very good nurse at the psychiatric hospital. He had been working a lot of double shifts to help out and was exhausted. He agreed to work nights as a 1:1 with a suicidal patient. He accidently fell asleep in his chair and the patient killed herself. Now he has to live with that for the rest of his life.

Oh, my gosh. I can see how it would be a recipe for disaster for an exhausted person to try to stay awake at night with one patient to watch. I hope they didn't pressure the guy to work, and then have that happen to him, and deal with the general grief and trauma to the girl's family. All of these stories bring up such an important lesson and reminder to me. If you work private duty/home health for a while you will see people taking enormous risks. Let's face it , when we are alone out there we are on the old-fashioned "honor system". I appreciate everybody sharing their stories. We don't have a coffee klatch or break room to go to talk to our fellow nurses.:up

To anangelsmommy- it is policy, they tell you up front that you will be fired if you sleep on the job. My patient and I both spoke to the Case Manager, she seemed shocked and said she would deal with it, gradually it returned to the way it was, that Case Manager left (unfortunately, she was great) and the new one is far less conscientious.

[caliotter3]

Lots of home health nurses that I have talked to when I have met them on cases in the past, seem to have the opinion that home health is a haven to get away with as much as possible. It is difficult to talk to people like this without coming across as a goody two shoes because one prefers to follow the rules or obey the law. They pull lots of things off, with or without the knowledge and support of the patient families, then it is hard as ever to stand up for oneself when one encounters this stuff with a new client family. I tell the family that it is the other nurses' business, but when I come across reportable incidents, too bad, I protect my license. I don't owe another nurse my license because they want to break the law. It is dangerous to sleep at night, permissible in some situations, but not the best practice, and not what one is being paid for, unless clear expectations are being followed.

[nursel56]

You are so right, Caliotter. It's almost a pressure with some. They act like, "who do you think you are, Nurse Nancy?". The other day I called the doctor for something I felt needed to be reported, the pt and other nurses didn't understand, but oh well. I rarely call the afterhours or the doctor, but when I do, I won't let them talk me out of it.

[caliotter3]

I prefer to do what I think is correct than to be the one person who gets caught cutting corners when the situation calls for someone's head on a platter. Others may get away with everything all of the time. I expect to get away with nothing all of the time.