Nurses aren't maids!

allnurses Guide · May 18, 2011

quoteAnaCatRI shouldn't be asked to clean. Why doesn't anyone understand how demeaning it is to ask a professional to do that? When was the last time a physician was expected to do a patient's laundry?
I don't know any physicians providing 1:1 care for a whole shift

Hm well there you go then! I'm saddened that you would imply that AnaCat is picky and thinks she's a princess by that, "joke" because she used the word "demeaning" rather than a word that would have made her sound less-- elitist?

It sounds almost as if you view this as a "Jesus washes the feet of His Apostles" type of spiritual exercise. As someone who feels very secure about my spiritual worthiness, I can tell you with no hesitation whatsoever that bringing religiosity into this is totally inappropriate.

I cannot remember how many times I have cleaned up dried formula (left for me by the family) and other messes.

Why did you put that in your post?

Most of the patients I've had do not live in well kept homes. Some families just don't know any better,

BS. Paternalistic horse----. This is along the lines of "we cannot allow MacDonald's into poor neighborhoods because "they don't know the difference between a salad and an extra large order of fries". Assuming people who have it together enough to take care of a family member sick enough to need nursing care when the nurse is not there don't know any better in insulting to them.. Most people have at least seen a Pine-Sol commercial on TV.

some lack motivation and some never learned regard for others. I try to educate and motivate

.

How do you do that, exactly? Because I'd like to use your method on my son. He lacks motivation. But I lack the motivation to pick up all his soda cans off the floor.

I know you probably don't consider me a professional, but irregardless of title or credentials, it is never demeaning
to serve another person.

How anyone feels about that is their own business. That extremely broad statement has nothing to do with a job someone has - she can try to teach basic hygeine on the off-chance nobody taught them how to clean things when they educated the parents to be at home primary caregivers but healthcare providers aren't there to learn how to be Joan of Arc. Really unfair to AnaCat to lay that on her.

allnurses Guide · May 19, 2011

I'm certainly not free from feeling angry when treated with disrespect or when observing blatant abuse of tax money (my share is in there)

Well that's good because I was just about to ask you to walk me to Hawaii

I feel much better when I approach these situations in a matter of fact way.
. And don't forget about your most powerful tool - documentation. I would expect that at least the office staff would see the light when confronted with, "... I'm afraid the pt. may lose skilled nursing hours when the state care coordinator reads that a lot of our time is spent performing custodial duties." ...and document you must.

" I'm not here to do your houselhold chores". Works for me!! :) I'm not sure about your state -- but in my state nobody reads through the narrative portion of our notes (except to spot audit) and the "state coordinator" (I guess you mean the State employee who is the go-to person for that account?) never gets anywhere near the chart, let alone read nurse's notes. and there is no check-off box for "vacuuming" and "scrubbing crud off the refridgerator door". These issues would need to be addressed during the q 30-60 day recertification process with an appropriate referral.

The average agency, when confronted with the choice of a client leaving their agency or a nebulous belief someone somewhere is analyzing nurse's notes for signs of them doing stuff the patient/PCG has already signed a document acknowledging they are not responsible for will undercut the nurse first most of the time.

The way hours are arrived at is based on the assessment of the patient's level of acuity, not on their housecleaning needs. In the absence of any documented need for social work support, it's assumed that people know how to clean their own houses. It is much more important that we document what we do that can't be done by the HHA, rather than documenting things we do that the HHA could also do.

DizzyLizzyNurse · May 19, 2011

A few things families have tried to insist the nurse do: clean globs of dried formula off the bathroom walls, clean all the bathrooms in the house, act as a waitress for their dinner party, and insist that a nurse do all the OT/PT excercises at the patient's school when the district has hired a 1:1 aide to work with them.

:confused::confused::confused:

I had to explain to a wife once that I was not there to wash the kitchen floors or clean her bathroom. She gave me a little attitude but that was the last I heard about that. Sorry but if you devalue what I am there doing because you don't think it's much work, then take care of your husband yourself!

EllbellRN · May 19, 2011

I completely applaud ventmommy and would take a case in her home any day. I am an RN and the mother of a child with complex medical needs receiving 70 hrs/week of private duty nursing. I have exceptional nurses who not only respect their profession, but respect my home and my family. I have never asked the nurses to do laundry; they have offered. Not because they are bored, but because they are dedicated to providing exceptional care to my daughter and exceptional support to our family.

If you are working in home care and expecting similar "shift" work as a hospital setting, you are doing a disservice to yourself and the home care patients you care for. As an RN, I strive to meet the all the needs of my patients and if a mother wants me to fold her laundry or put away dishes or mop her floor, I would do so in a minute. I would do this not because I think it is a "nursing" responsibility, but this is what the family and child need at the moment. Home care nurses need to realize the family needs are also the child's needs.

At the end of the day, as an RN I know I am making a difference in the child's life by providing excellent nursing care and supporting their family as well. As a mom, I must be doing something right because I have had the same staff of homecare nurses for 5 years and several more looking for the opportunity to work in my home.

I wouldn't want any nurse working in my home and caring for my daughter if she equates doing laundry with maid service.

JeanettePNP, MSN, RN, NP · May 19, 2011

This isn't a laundry issue, but it does bother me when I come on duty and the child has a dirty diaper that she's obviously been in for a WHILE. Yes, changing diapers is part of the care I provide, but gee-whiz, if your kid poops BEFORE the nurse comes on duty, don't wait for the nurse to come and change it.

allnurses Guide · May 19, 2011

This thread is certainly unique. Ventmommy and EllbellRN, we aren't talking about parents or families like you. I'm a little bit puzzled as to whether you are criticizing AnaCat or just telling us that you don't take advantage of your nurses, that your nurses are just more selfless -- I don't know.,

In any case, it's beginning to remind me of the ED nurse threads when other nurses arrive to give a lecture about how lacking in compassion they are when they vent about drug seekers or people who take advantage of the free services they get to call an ambulance to give them a ride to the hospital.

You do realize I hope, the risk to our personal safety by driving alone into bad neighborhoods, trying to take care of the many gunshot wound cases where the gang member only almost died, (but his social circle is the same) psychotic, intoxicated relatives, swarms of cockroaches, or be murdered in the living room of a Detroit home, or the fear we experience when one of us arrives to find a lovely display of Media on the coffee table.

At the risk of further tsk tsk replies, I point out we are talking about people who being on public assistance, don't live in the most desirable environments. Just because the particular home AnaCat described was not one of the worst, somehow I think she's encountered worse, or the agency takes on the worse. I applaud ventmommy, too. But I don't applaud what I think the reason might be behind your telling us how great your home is or how your nurses aren't "like that".

It's true! There are a goodly number of people who don't appreciate the free nursing care they get, and try to get the most free stuff out of the free stuff they already have. I'll pass on further elaboration for fear of having my character attacked as well. I think I'm OK on that. No wait. I know I'm OK on that. I'll skip the self-serving list of all my good deeds and times I've gone above and beyond to prove I don't think I'm above doing laundry.

SDALPN · May 28, 2011

Personal experience with the laundry issue:

I had a patient I worked with for a few years. The mother started asking us to do laundry. We did it with hesitation since it was "for the patient". However, as we all know...give someone an inch and they'll take a mile. Soon after that the family started leaving their clothes in the dryer for us to fold before we could move the patients clothes in the dryer. After that they would start leaving the clothes wet in the washer. Well we couldn't leave the wet clothes...so of course they got dried. It quickly became a habit of the family to leave the wet clothes in the washer.

I think its best to leave nursing to nurses and leave housekeeping to housekeepers. Parents should be parents. The reason we are in the home is to provide nursing care and education. We aren't babysitters, maids, repair people...etc. If the agencies would make this clear when they started a case there would be a lot less frustration on both sides. But the agencies are scared to be honest with the families. So it isn't discussed when a case is started and then it leaves a grey area.

Don't get me wrong...if I have a wonderful family who treats me right, I'll go out of my way for them when it is *needed* and not expected/demanded of me. The parents that work should think about how they respond to a boss they like vs. a boss they don't like. Its the same way in the home.

As I'm writing this, I'm in a home where the parent just asked me if I would like him to pick up a movie for me while he is out. Of course I said no. I wouldn't feel right saying yes to that. But knowing how well they treat me makes such a difference. I will bend over backwards for this family. They also provide coffee and tea all day for the nurses along with a fluffy couch and big screen tv. I know this isn't the norm and only fill in on this case. But I always thank the parents for being so kind.

caregiver1977 · May 28, 2011

I was assured by someone at the national corporate office when I first took the job that corporate doesn't tolerate local offices expecting nurses to do household chores, and to report it to them if I am asked to. If the agency tells me tomorrow that they told her I would be doing laundry, I will report the office to corporate.
I'm tired of hearing about customer service! Someone has to say enough is enough with the customer service garbage. They're PATIENTS, not customers! And how can they be all about customer service when the state/Medicaid is paying the bill? Having a kid who needs private duty nursing they can't afford without government assistance does not equal winning the lottery and getting free maid service. I'm actually really here so mom has the free time so she can work, sleep, and do her own housework. Sigh...

*putting on my flame retardant suit*

Okay, I think that the whole customer service thing has maybe been taken too far, but it is not completely garbage. There are patients who have been treated like crap by nurses, doctors, etc and nothing was done about it. People have had racist, sexist, you name it things said to them by health professionals (my husband could tell you stories about being called "boy" when he was in his 30s). I don't think people should have to put up with being humiliated unnecessarily just because they are sick. I won't even go into the medical misshaps as well.

But as with many things, this whole customer service thing is punishing good nurses along with the few bad ones.

But on the other hand, I think it is unfair to nurses and doctors and down right DANGEROUS for patients to get the idea that healthcare should functions as a "Have It Your Way" Burger King. I think that customer service should insure that patients get treated with dignity and respect without robbing health professionals of theirs.

I think the mother in this instance should have an official outline of what your duties are.

caregiver1977 · May 28, 2011

***I became a nurse to help heal people, and that is all I care about - healing people. I do NOT give a rat's behind if anyone thinks I give good customer service. I do NOT strive for 5! I DO strive to keep your butt alive. Nothing else matters to me. Dr. Gregory House is my hero (even if he is a rude jerk to nurses).***
I am NOT subservient to my patient's parents. I don't OWE them respect or have to do ANYTHING they say!

I feel for anybody who thinks Dr. Gregory House is a hero. I'm sorry:uhoh3:

Even if people are on state assisted healthcare, and are making other choices you don't like, they still deserve respect because they are a person. You deserve respect from your patients, their families, and the agency you work for because you are a person. I think people have forgotten what respect is. Just because you respect someone does not mean you have to roll over and do anything they say. If you feel the agency you are working for is disrespecting you, then maybe it is time to find another job?

roseymay16 · May 30, 2011

I had the same experience. I was asked to do laundry and straighten out closets and draws when I had down time. Also during night shift when patient was sleeping no TV after midnight and no sitting on the couch, must be in a chair at the bedside.

Kyasi · May 30, 2011

Exactly! There are home health aides. If they need non-skilled care, they should do it, not licensed nurses! The only reason some agencies require or have rudely brainwashed nurses to think that it's ok to ask a nurse to clean is because dumb nurses let them! We have to stop it! I'm not doing grunt work for the tiny pay I get (or any pay, because if cleaning was something I was willing to do for a living, I would have become a maid and saved myself a LOT of money by not going to college)! I have a license! My putting up with the tiny pay is because I only have one patient, it doesn't mean I'm stupid and can be treated like a dog! If the parents want a maid, they should get a maid! I said before, for an ADULT patient who lives ALONE, it might be appropriate to expect some housekeeping, but NOT for a child. Parents don't get to put their feet up because some dumb schmuck nurse is willing to be taken advantage of and play maid! I'm a healthcare professional. not a menial laborer. ALL nurses deserve respect. It is NOT ok to say "you work in home health to keep kids out of institutions, you're not a real nurse, so you should just shut up and realize you don't deserve the same pay, benefits, or respect that a hospital ("real") nurse gets!" And yes, that IS what some of you have implied here! We are nurses, not domestic help!

I'm going to throw in my 2 cents here. I've been following this subject with interest. In my agency, we consider HHA's and CNA's to be skilled professionals also. Although we have 'light housekeeping' on the patients careplan, we make sure that the HHA is there to do skilled care (bathing, transferring, ROM, toileting etc) If there is time to wash the 'patients' bedding/towels they can do that and they are expected to clean up the dishes the patient uses or that the HHA uses to prepare a meal for the patient. I found this comment about letting the HHA's do it to be a little demeaning to HHA's. I started out as a CNA many years ago and as an RN, I try to never forget that. HHA's deserve to be treated as professional skilled caregivers also. In our agency, Homemakers and Attendant caregivers do the bulk of this type work.

I have worked for many years as a PDN and most of them were on high tech vent cases. My last home care case (9 yrs) was for a child on a vent (sounds very similar to Ventmommies situation) I was there for usually a 12-13 hr shift and there was a lot of down time since the shift started at 5am when the child was asleep and she also napped during the day. Despite all the vent checks, suctioning 5-25x / hr, updraft/vest tx, charting, ordering supplies, etc there is no way all that filled an entire 13 hr shift. I was happy to wash or fold my little girl's laundry. She soiled lots of underpads, clothing, etc during the day and if in doing for the child, I indirectly helped the parent, all the better. Sorry if that is an unpopular viewpoint but I'd rather stay busy then watch TV. My patient was never neglected while I folded her laundry or organized her drawers when I put it all away. Now if the family threw the laundry at me and had an 'entitlement' attitude, it would be different. I read a lot about nurses being asked off cases for no reason and how they don't feel respected... Respect is earned. I'm not saying it is earned by doing the family laundry but the "I'm a professional" attitude comes through loud and clear to a patient and family. I used to hear it in the hosptital too when nurses refused to do anything a CNA was supposed to do.

I work in management now and hear both sides of the situation. I often receive the calls from parents asking a nurse or HHA off the case and rarely is it for no reason at all. It is usually about the nurses attitude.

Ok, putting on my dart proof vest now!

Kyasi

Kyasi · May 30, 2011

"I am NOT subservient to my patient's parents. I don't OWE them respect or have to do ANYTHING they say!"

Wow, I just caught this. When you are in someones home, I feel that you do owe them respect. It is absolutely necessary in a home care setting. You can be respectful without being walked on and you have the right to refuse to go back if you are so mistreated. If you can't be respectful in the home care setting, I suggest you find another type of nursing. Respect is needed in all areas of nursing and I wonder why anyone would choose the health field if they can be respectful, period.

I don't think it is unreasonable for a family to request that a nurse take off her shoes. However, it is a requirement that all our staff wear shoes for protection, so we ask that the staff be allowed to use protective shoe coverings or if they are regular full time staff on the case, they often keep a pair of shoes that they use only at that home at the house. It is invasive enough on a family and their privacy to have 'strangers' in their homes all the time, so I think we all need to do our best to respect them and honor their requests within reason.

Kyasi