New to PDN, and Have Safety Questions

[KR]

Hi All! Former ICU RN here. Super new to PDN. I have only done my orientation at the office, and a 2 hour meet and greet/interview with mom and met my 12 year old potential client. There has only been one nurse on this case until very recently. He drives patient in his mother's van to appointments, out for movies, etc. A bit of background, pt is a 12 year old with muscular dystrophy, in a wheel chair, currently in halo traction, mickey button, history of seizures, and a trach. Like I mentioned pt is in halo traction, and is fused/pins/rods, etc from C2 down to T5 along with brittle bone disease. Primary nurse and mom both lift patient by themselves. Do you consider this a safe norm?When pt has seizures, which he is having about 1/month, he needs suctioned non stop orally and via trach. My concern in driving patient to movies, appointments, etc is that this sounds like a massive liability to me. 1-What if there is a car accident? or 2-What if patient seizes when I am driving and needs suctioned? Is it normal to be expected to drive patient around when doing private duty?

I am just hoping to get experienced PDN's thoughts before I orient on Tuesday. Thanks in advance for any and all help!

[ArwenEvenstar]

I have been doing PD about 4 and 1/2 yrs now. I hope others will respond besides me because I've never had a situation exactly like this. There are things that are different with home care or private duty compared to the hospital setting. Some things that would not be considered "okay" in the hospital are okay in the home. For example, at hospitals I worked at a hoyer lift was always a 2 person procedure. Not in the home. You hoyer lift by yourself.

You mention that the primary nurse and mother lift the pt by themselves. You mean they team lift the pt together? This would be fine. Or do you mean they just lift the pt by themself alone? Whether this is okay, would depend on the pt's weight. Agencies usually have a lifting weight limit for employees. My present agency has a limit of 50 pounds. (And actually, the first agency I worked at had a NO LIFTING (at all) policy. Unusual I think. If the pt needed lifting, a hoyer would have to be placed in the home.) I am glad my present agency has a limit of 50 pounds because that is all I am capable of lifting. If I am consistently lifting over 50 pounds my back starts to bother me and I feel strained. Some agencies have a higher weight limit than this...If I worked for one that did, I would have to refuse cases that involved lifting people over 50 pounds because I would NOT risk hurting myself (I know my limits) or hurting the pt because of my lack of strength. If the pt is much over 50 pounds, it is my opinion they should get a hoyer in the home. I also noticed you said the former nurse is a "he". A male may be capable of lifting a lot more than a female.

A problem I have encountered many times in PD are nurses who start doing things they should NOT be doing and then the family comes to expect it, and the agency turns a blind eye to what is going on. Ugh. It is easy in these cases for nurses to lose perspective and lack a professional boundary. And then when a fresh, new nurse comes into the case problems can begin because the new nurse sees more clearly the inappropriate things going on....

Driving the pt around would make me VERY, VERY uncomfortable!! I'd have the same concerns as you! Way to much liability. Are you covered under the families car insurance policy? What about your nursing liability? I have accompanied familes on outings with their child, but the family was driving and I was just along to help. Ask the agency if the family has signed a liability release form for the nurse driving the pt around. I'd want to see that a very specific liability release form had been signed. Even if they have, I think I'd still feel too uncomfortable to be driving the pt around alone. Yikes. Let the agency know your concerns and see how they respond. But trust your instincts. Don't do anything that you feel that uncomfortable with... You often have to be very self-assertive in these cases. Some agencies don't give a crap!

SORRY I write so much. Brevity is not my strong point!

[caliotter3]

Never agree to work with a case that you are apprehensive about your abilities to handle. If this case is unnerving to you then ask to be given a different case, at least until you start to feel more confident about what you can deal with. You can also ask for an orientation with the primary nurse that is longer than a normal orientation if you need it. Usual in-home orientation to a new client lasts from two to four hours. However, I have received an entire eight hour orientation to a complicated, involved case. The agency will be willing to give you as much orientation as you need if they want you to work on that case. But if you just feel uncomfortable, there is nothing wrong for passing this one up for the next case.

[caliotter3]

My agencies have a no drive policy for their nurses. However, I have worked on cases where nurse(s) drive the patient around on their own. One family let a nurse use one of their cars for all kinds of errands (personal and for the patient), and she wrecked their car. I have told patients and their families that I don't do driving and they have had no problems with arranging out of the home appointments for days when the "driving" nurse is working.

[Elektra6, ASN, BSN, RN]

We have a no-drive pediatric policy but drive adult clients in their own vehicle all the time. Find out your company policy first. The lifting sounds fine.

[KR]

Thank you all so much for your replies! I mean that mom and the nurse that oriented me lift the patient solo. I know have a few shifts under my belt and talked to the Client Manager for the case. I do not have to drive, and I talked to the mom about this and she is fine with it. As far as lifting goes, mom claims that I will not have to lift her son. That when I am there, he will be in his wheelchair, or if any lifting needs done she will do it. So far this has been the case. And I let mom and the Client Manager no that I will not be lifting the kid by myself. They are both fine with that.

I just want to say that I really appreciated the quick responses, sorry that I was slower to reply!