Big brother watching...among other things!

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    I would like the opinion of nurses who work in the home setting in regard to my situation. I am currently assigned to a child whose parent has surveillance cameras in the home. They are are not hidden, and are in plain sight. I understand that these cameras are put in place for the safety of the child (but are somewhat uncomfortable for me). However, when I sit down to eat at the kitchen table, I don't feel comfortable having a camera focused on me while I am eating lunch . There are also other things about this case that don't sit well with me. The child's father got upset with me when I called the Dr for an order to give an OTC medication that he told me to give! He felt that I had no place calling the Dr, even though I explained that I cannot give medication without a Dr's orders. Another thing is that he is reluctant to talk about the child's medical history, and looked upset when he noticed that my supervisor had left an educational handout for me about the child's diagnosis (a chromosomal disorder). As a nurse, I feel that it is of utmost importance to know the past medical history in order to know what symptoms to look for, interventions, etc. What gives? I don't understand why he is so paranoid. Thanks for reading my post, I had to vent!!!!
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  3. 15 Comments so far...

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    One thing about private duty home health is the family is reluctant to give up any kind of control regarding their child's care. It takes time to build rapport to get to the point where they will trust your clinical decisions.
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    In every home health case, to one degree or another, control is the name of the game. They tell you what to do and how to do it. You can take up matters with the family if you want to get headaches and ulcers, but it is usually better to do what they want, as your supervisors will instruct you to do, and spend the extra time in documentation in order to cover your license. Otherwise, you just won't have a job and the agency will quit trying to work with you soon enough. The agency typically will not back you up, no matter how important the matter is. My agencies have either told me in person or have had written policies that cameras and recording equipment are considered par for the course. I choose not to work in that kind of an atmosphere, but I will tolerate a baby monitor if it seems that an acceptable, somewhat "normal" attitude is in the house. What you describe is more than likely a place I would not work at for very long, if at all, if they were to continue that type of behavior. Tell me that I cannot call the doctor and I have just worked the final shift in your home. I draw the line there.
    fkpecina and Bella'sMyBaby like this.
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    There have been a whole run of experiences with quirky parents lately! Please, anyone! Does anyone have a peds case with parents who aren't paranoid and suspicious of nurses? Phew! Maybe it's just a coincidence.

    Anyway. . .hardygirl it sounds like the dad doesn't have (or maybe choosing to forget he knew) the role of the agency. Is the child really young or recently diagnosed with whatever it is he needs nursing care for? If so, he should know that pamphlet and rules for giving OTC meds are routine in agency care. If not, he doesn't have a clear grasp of why a nurse is taking care of his child as opposed to an unlicensed caregiver. They may think you are there to carry out their pre-determined list of tasks and require their permission to use the nursing judgement you went to school to learn, but obviously that isn't the case or skilled nursing hours wouldn't have been approved by the third party payer.

    It's always something of a "control dance" though, and the one useful bit of advice I got from the DON of the first agency I worked for was about the give and take we do, and basically she said if it's a family ritual to do a procedure a particular way that is not actively harmful to let it be. So the "dance" part becomes where do you draw the line and stand your ground?

    There are a few times I've said to people that that if they refuse to allow me to exercise my judgement as a nurse, I will not stay in their home and be a go-fer to implement their poor choices for their child's health. Recently one had pretty severe frank bleeding from the trach, which wasn't improving, but wanted me to stay through the shift for the sole purpose of suctioning blood out of their trach for 7 hours. Yeah maybe they will complain etc etc etc but oh well. I care more for my license than I fear a tantrum and/or threats "this will be reported".

    Another insisted that Vaseline be used to lubricate a catheter and flipped out when I refused to do that because "they've been doing it that way for years!" Again- not going to compromise.

    The camera thing- perhaps you are very clumsy and accidently dropped a dishtowel over it? OTC med- can dad give it himself, then write up an order to cover yourself? Oddly enough, people can be very protective of their doctor-patient duo and resent being kept out of the loop.
    Last edit by nursel56 on Aug 21, '10
    Bella'sMyBaby likes this.
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    One of the most difficult clients I have is when involves the use of cameras. I don't know,but what's the point of them if you are letting the nurses know they are there? I'm sure everyone would be on their best behavior when they know they are being watched. A hidden would be better. I kind of like cameras being in use (when not not pointed at me anyway) because often times whom the parents think are good nurses(you know the smiley,overly friendly to the parents type) are actually bad.

    As far as otc meds ask dad to give it. I have called the doctors offices myself but they were not any easier to explain the need for an order for us home care nurses. One of the office nurses even had the nerve to call the parents and tell them that they don't need an order. Most people,including other health care workers,think us pdn are just there to do daily tasks and nothing else,including our brain power.
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    As a parent who has had a child being cared for by some pretty sketchy nurses (thankfully, the small minority of the group), I completely understand and endorse the use of cameras.

    It's not about control, it's about verification and accountability. To you it's a job... or even a patient. To me, though, it's my kid and the single highest priority in my life.
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    Sketchy nurses? And how long did you let them stay around once you had your damning evidence? I am not "sketchy" and see no reason to give up any of my civil rights in order to work anywhere, verification and accountability are better had through personal observation. Walk into the room every five minutes.
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    Quote from caliotter3
    Sketchy nurses? And how long did you let them stay around once you had your damning evidence? I am not "sketchy" and see no reason to give up any of my civil rights in order to work anywhere, verification and accountability are better had through personal observation. Walk into the room every five minutes.
    Yes, "sketchy" nurses.

    Being in a hospital, it was not within my power to "let them stay around" or not. I availed myself of the only option that I had - to speak to the manager who could not guarantee that the nurse would no longer be assigned to my child - but who did agree that I would be notified with sufficient time to arrive and watch her. In the other two cases, somebody was already present for the duration.

    I don't see that one's civil rights are violated by cameras (and given their ubiquitous presence, the courts have evidently agreed).

    It would be nice to be able to walk into the room every five minutes but that's not always possible. The cameras provide accountability when someone's eyes are not in the room.
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    Well my take on this is most "sketchy" nurses think they are awesome and the best nurses ever. It's the sane competent nurse that the cameras really hurt.

    I would not work in a home with cameras present. Not because I wish to get up to madness and mayhem but because it would make me paranoid and liable to make more mistakes. I don't parents watching what I'm doing because if they are there there is context and I can answer any questions that come up.

    I think a camera in a facility setting is different as it's watching many people but one in a home is watching me specifically. A camera in a home says to me also that the family might be trying to enrich themselves through lawsuits.
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    When the individual has mentioned their intent to sue several times (five or more times in less than four weeks) in serious conversation, one should take them and the intent of their camera seriously. Monetary gain makes a lot more sense than altruistic concern. Altruistic concern is shown through personal participation in the surveillance process and lack of references to intended lawsuits.
    Not_A_Hat_Person and LovebugLPN like this.


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