I'm a nurse, not a babysitter!!!

[CloudySue]

I sometimes don't understand how people get approved for skilled nursing care. A lot of parents seem to obtain services and think they got a free nanny. I had one client who needed someone to go to school with her just to keep herself from smacking herself in the head and to feed her and change her diapers. She easily could have done with a HHA. Plus there were 3 aides in the classroom who were there to handle those things anyway. There was only one med she took and the school nurse could have easily have given it to her. Another case, a 23 year old MR girl, the foster mother would do all the meds and start the tube feeds right there in front of me, turning down my offers to do the actual skilled nursing care, since that's why I was there. Nope, all I was there for is to play with her all day, just to entertain her with musical baby toys. Those were long days. Another client, a 12 year old MR girl, mom just needed someone to take her for a walk in her stroller and push her in her swing, but mom gives the meds. If the girl seized, mom would push me out of the way and care for her herself. I know some mothers are control freaks with care and meds, but I dislike feeling underutilized. I enjoy working w kids and don't mind doing these things, but I wish the nanny tasks were in addition to actual skilled nursing care. Straight babysitting is not what I worked so hard in school for.

[BuckyBadgerRN, ASN, RN]

I'm currently doing home health via an agency for a 9 mo vent dependent child with a constant G-tube feed. I have to say that Mom is VERY good about drawing the line with the older 2 siblings. When she runs an errand the older girl has asked to "stay with the nurse lady" and Mom tells her absolutely not, "nurse lady" is here for your baby sister, not to watch you. I am going to nights starting next week so my interaction with the siblings will be minimal.

[threebrats46]

I have my own kids and as much as I love kids I dont think I could deal with other peoples. I def wouldnt want to deal with the parents. I applaud you all!

[prmenrs, RN]

Moms of kids w/spec needs have trust issues. They've been around the block a few times w/their child. If they don't know you, they don't "trust" you, but they do need you. If something goes wrong, even if she knows what to do, she needs back up. If you don't do things the way she was taught, she'll have a problem w/you.

"How do you like this done?" "I need your help w/[client's sibling]; it's not really safe for either one if I have to keep track of both." "What can I do to make this easier for you, Mom?" "Let's see if we can find something for sibling to do so s/he doesn't have to hit us to get attention.'

Parents are still grieving for the child they didn't get. They may have pulled their "big girl panties" up and learned to deal w/what they got; they love the child beyond belief, but every once in a while they get a case of "it's not fair!"

I guess I'm saying maybe your clinical skills aren't being utilized, but you can help the client and Mom in a big way--you just have to figure out what and how. Start by asking her to tell you the client's story.

jmho

[applewhitern, BSN, RN]

Prmenrs: Very good point! I enjoyed your comment.

[ventmommy]

I completely understand that some nurses, including in my home, were under utilized. If I couldn't really trust your skills enough for me leave to get a fountain drink from 7-11, there was a good chance that I wasn't going to let you do anything besides suction and set up feeds.

Conversely, I can't tell you how many stories I have heard from my nurses where they totally allow themselves to be used and abused by patients, parents, grandparents, etc. It pained me to listen to some of them. We had a nurse that had another case where she was routinely physically abused by an undisciplined school-aged child. And I mean abused. She came to my house with bruises, cuts and bite wounds. And the parents did not provide a seat for the nurses. They were to stand or sit on the floor. When she first got that case, I thought her husband had started abusing her. I was so worried that I sat her down and told her how much I was worried about her and if she needed any help, she could talk to me and I could help her find resources in our area.

I also find it appalling how some families completely cheat the system by telling Medicaid they have no insurance and getting 16 hours of care from that and then telling their own insurance that they have no supplemental insurance so they get 8 hours from there. We couldn't get 24 hours between Medicaid and our private insurance when our son was being suctioned every minute and couldn't ever be alone. Not being able to pee for 8 hours while waiting for the nurse to get there sucks.

That being said, I adored the vast majority of our nurses and was touched when they came to the hospital for hours to sit with us and bring us food, then to say goodbye and then for his funeral.

[kids]

It's not the parents who decide whether or not their child gets a nurse vs a HHA. It's the State regs or insurance company that dictates that pediatric cases get a nurse when a similar adult case gets a HHA.

[SDALPN]

kids, thats not completely true. I had a case where the family was given CNA's. The CNA's slept on the job or didn't show up and weren't knowledgable on anything other than the act of the task they were performing. They also couldn't change the GT. The family complained and said they would rather go without anyone than have staff like that. They insisted on a nurse so that the GT could be changed and assessed as part of his care. The family managed to get the ins company (can't remember which one of if it was through the state) to provide a nurse. They had no trouble after that. So with the right situation a parent can push for and receive their choice in nurse vs CNA.

[PediLove2147, BSN, RN]

I totally understand your frustration. I did PDN and a lot of the time it was playing games with very little nursing. I made the switch to acute care because I could not take it anymore. I loved the kids I worked with but after one passed away I felt it was time. I still am considered back-up so I do a shift like every other month. I get to see my kiddo but my sanity stays intact.

[LPN Nurse]

These parents do NOT need nursing care they need a nanny and it is ridiculous that home health Agencies allow for this to go on all because they make money on nursing being in the home. Almost every case with a child with a disability has Medicaid insurance, so with nursing documentation that they are to READ, how can they continue to approve the nursing on tax payers money when it obviously is NOT needed!

I am a home health nurse for pediatrics and I am frustrated with these parents. I am an LPN and it is not my responsibility to entertain ANYONE! I am there to provide NURSING care to their disabled child. Not do homework, not play video games, not to babysit the other children in the home. PERIOD.

My case thinks if they choose to go swimming, it’s the nurse’s responsibility to assist their child with swimming. NO! It is not. Hire a swimming instructor or assist your child yourself as other parents do!

They think whatever activities they choose for their child to participate in, is the nurse’s responsibility to assist the child. Again, no it is the PARENTS responsibility.

The best part is when the parents don’t work and were trained to care for their child but want nursing instead or if only one parent works and the other is home anyway and capable of caring for their child. Sorry but is laziness on most of them.

My opinion, there should be NO nursing allowed in the home if parents are present and available to care for their child. Especially if one or both parents don’t work.

We wonder why cost of insurance is so high, well when unnecessary nursing is given just because they can get it——there ya go!

I sit in a home 8-10 hours a day and only provide care for a GTUBE patient that sleeps up to 11 hours a day with the mom home every day that sleeps as much as the disabled child. Mom is knowledgeable in the care and TEACHES the nurse’s how to provide the child care. So, there ya go. Is nursing really needed? No, it is not. Wasting taxpayers money just because they can get it.

Sorry, but I document EVERYTHING that happens in the home. If they leave other children in my care, I am documenting it. Parents sleep all day while I am there, I am documenting it.

Bottom line, I am a nurse and get paid to provide nursing care! I am NOT a babysitter or an entertainer and I will NOT provide that type of care for any of them! If I lose my job, well they are a dime a dozen in the nursing field and guess I will have to move on when it happens.

This nurse is over it!

[quiltynurse56, LPN, LVN]

With the companies I work for, it is explicit that we do not care for other children in the home. Our assigned patient is our focus. I have had only one family who felt I needed to put up with their unruly child. I left that family fast for that reason and others.

When the family needs nursing care, I enjoy the job. Right now I have a child who does need the care provided. The mother may or may not be around, yet she does have 3 other children at home so I do see the need for the nursing care.

I have had assignments where I was the nanny. Don't like those at all.

[moretonel]

I'm starting shift care (private duty, extended care home health - functionally all the same, one on one skilled nursing care for up to 12 hours per shift) for the first time, soon. I'm reading AN discussions to get a feel for the issues pertaining to shift care.

It seems there is a lot of down time. Curious, if not interacting with the client, what else would you be doing during the shift? Just trying to get a heads-up.

[caliotter3]

Whatever you do, if it has the potential to look recreational in nature, make sure to clear it with the client family first. And even then, I avoid doing such activities in front of them during day or evening shifts. I have found they will tell you it is ok to do this or do that, but then they give you a sideways look when they spot you and/or some will even complain to the agency although they said it is ok. It goes without saying that all possible nursing interventions should be caught up with the patient at the time you veer off. And some agencies have rules about some activities such as cell phone or personal tablet use.