Published
The question: Should I switch clients? Family is being particularly difficult.
I'm pretty new to my job (only a year of long term care experience), and would like some input on my current situation. I am currently in home health, but was not oriented to the family nor given much information on family expectations. Just primary dx of the pediatric patient.
Client is alert and oriented, and adolescent and dependent of the parents. I am virtually on the verge of switching clients because the parents are not communicating clearly what they want ahead of time for their child.
According to company policy we are to follow care plans, and physician orders, and practice nursing based on best practice.
However, much of the time I find myself sitting back, and doing very little for the client. I feel like I'm stepping on Egg shells around the parents. One of them is very crass, and has sat me aside and stated "You do not tell my son what to do," When I merely suggested that the client may want trach cares while he is up in his chair. Then told me to sit upstairs for nearly two hours until my shift was over.
I've had to reiterate many times that it is their right to refuse cares at anytime and that I just need to document it.
During another day, there was an order where the client needed straight catherization four times. Two scheduled, and the other two are up to the client (if she needs to void).
Mother suggested that perhaps we should wait until next nurse arrives (7-7:30pm). THe last time the client voided was 3pm, and had been spending time with the family until 6. I provided a bedpan for the client, and no avoid so I palpated the bladder to see how distended it was. It was distended, and I asked "Do you feel like you need to use the straight catheter?" At this point, I did tell her that her bladder was a little distended. The response I recieved was "I don't know I think I might, yeah." I attempted to steer her towards her mothers suggestion to wait for next nurse to arrive. However, she promptly told me "Sorry I don't think I can wait." So I initiated the straight catherization, and recieved about 350mL.
The following day, I was pulled aside by one of the parents inquiring why I needed to straight cath the client when the mother strictly communicated that she did not want her daughter cathed. Throughout the shift, the client's family gave me crass remarks about small things and miscommunication, and I felt like I was being treated like a child rather than a professional.
Sometimes I find it difficult to sum up what I'm trying to say. I am told to be quiet even though I have an expounded explanation for the issue at hand. Perhaps even a skilled babysitter. The careplan is rarely followed per client request, and I was asked not to call the doctor for clarification if I can just ask the parent questions.
I am told that my work is appreciated by the family but the way they have lashed out towards me when things do not go a certain way has indicated otherwise...
I've even been compared to other nurses they've had experiences with.
I'm not quite sure how to handle this as a relatively new RN to HH/Private duty industry. I know everyone has told me to chart like there's no tommorow, but should I consider switching clients or will this be the way most clients are in home health?
Edit: The company refers to their company as Home health, but the job is actually Private Duty Nursing.