Private Duty Annoyances

[Jo Dirt]

This is just to gripe because I'm upset. I started doing private duty (as a private contractor) and had originally agreed to three days a week. Of course, at the end of the shift I was working Saturday the night help called in. I was scheduled to work 24 hours the next day so by staying all night and then the next day I would have been there 48 hrs.. I called the staffing agency and they told me to let the family know I was going to have to go home. Well, the patient (who is very whiney) starts complaining I can't stay here by myself! I know they didn't tell you to go home! So, sucker I am, I stayed the night. The next morning I called the staffing agency and reminded them it was not legal to work more than 24 hours in a row and they told me if her family was not going to come sit with her she would have to sit by herself. So, I left.

This patient has family next door who WILL NOT come to sit with their mother, even though it was supposed to be explained to them when they got this Medicaid service that 24 hr care could not be guaranteed and there has to be a willing and able family member who will take over care of the patient if a shift cannot be covered. The patient has a big strong teenage grand daughter but said her mother wouldn't let her miss church to come stay with her (it was Sunday morning). And the daughter who won't miss church also has a heart condition and can't come take care of her mother, even though all you do is literally SIT with this patient all day, nothing strenuous at all. And it's funny that she can't come sit with her mother because of her heart but she regularly goes shopping and runs up and down the road all day in her vehicle...

Anyway...

I left and even though I came back 6 hrs. later the family was absolutely furious that I left the patient. They all say there is a nurse who regularly stays a lot longer than 24 hrs. and that I'm lying about it being against the law to do more than 24. I was personally told by someone from the state board of nursing that it most certainly is against the law.

Then, the busy body (who is a single person) who the family brags on for staying up to 60 hours at a time tells me not to leave the patient like that again when I see her later in the week. I don't apologize and I say if the family doesn't want the patient to be by herself THEY can come sit with her. After all, I have three small kids and an invalid husband and I don't really have a choice about whether to leave for days at a time or not. So she backs down after that and says she understands.

The family hates me but the patient thinks I'm wonderful (even though she was mad at me because I left.) And since I don't have any other real job prospects at the time I guess I don't have much of a choice, either. So, when the family does stop by for five minutes they sneer at me and I sneer back. But I hate working in conditions like this.

It is causing my stomach to hurt. It seems like you will either be walked on or make yourself look like a selfish uncaring ***** if you stand up for yourself. The family could care less I had responsibilities at home and was not going to abandon my family. And I was also told by the state board of nursing that home care is different from the hospital or nursing home and that after you have been at the patient's home a reasonable amount of time it IS NOT abandonment to leave. Nurses I tell this to don't believe me, though.

I do have one nurse there who is sympathetic to the situation, though, and says she has left before. I still wish Scotty would beam me up.

[sharlyb]

You have my sympathies for this challenging situation. Having done a fair bit of home care and private duty nursing over the past 27 years as a nurse as well as presently working in home care hospice I can relate well to the dynamic you have described.

There are two key issues in this situation that I think you would do well to focus on:

A. The agency told you that it was OK to leave.

B. The state board of nursing told you that it was ok to leave.

That would be sufficient for me. The way I see it, this family is manipulating you. They are playing on the fact that, unlike them, you feel a sense of commitment and caring.

My suggestion is that you (calmly and politely) tell the patient and family that you will leave when you are scheduled to leave. Then do it.

If the family acts enraged, let them rant. Refuse to allow yourself to be pulled into their negative dynamic. Do not let yourself become entangled in the net of negative dialog. Repeat the basic message if necessary i.e. I will leave when my shift is over. You don't need to explain anything or make excuses. If you do you will only be treated with disdain and viewed as weak and manipulatable. What the family or patient choose to do about the situation is their responsibility. They clearly have resources that they can tap into. You have been assured that it is not patient abandonment to leave. You have a responsibility toward your own family. Let the patient and family say what they will. You will only be manipulated if and when you allow yourself be drawn into their dysfunctional dynamic. People like this will not find it easy to keep any nurse. If you allow your sense of needing this job to dominate, you have given them full control over you. In the end you will most likely keep the job and your sanity if you stand your ground.

[LaRN]

I did leave. What I take exception to is being treated like a selfish heartless patient abandoner. Of course, I can leave if I don't like the way the family treats me, but I shouldn't have be put in a position where they have a chance to treat me like crap because they don't want to be bothered.

I say the agencies should take more responsibility to see the patient and family UNDERSTANDS this.

I feel the rage build up when I think about it.

Unfortunately agencies tell the patients and families what they WANT to hear. Why? because they aren't the ones that have to deliver the promises they give. But you do.

It should be carved into their heads that they are to never promise anything out of the ordinary unless they are willing to do it themselves.

Example: your patient informs you that the office manager promised her she would get a pedicure and manicure with a hand massage>>>your response? call the office manager and ask her what time she plans to be here to give that manicure.

[DDRN4me]

As a former hh nurse ( i did pd for well over 15 yrs).. and then was a manager at an agency..i can tell you that even if medicaid will pay for 24 hour care there is a clause in the contract that states care is not guaranteed and there has to be an available caregiver if there is no nurse available.

therefore by you calling the family and notifying them that your shift is ending you have given them notice that they are the next available caregiver (tag, youre it!!)

this is not abandonment. so if you stay on the case (there must be others you could switch to??) then you might need to have a sit down with pt and family and remind them of same. sometimes it is their fear that they will do something wrong or "something will happen" when they are in charge.

not to hijack or upset any one..kellie; what I have learned is that many nurses do private duty for just the freedom you are describing that you dont like. although it might not work for you it is probably why they chose that kind of work...jmho. mary

[LaRN]

PC or not, the family sounds like trash. Period. Sometimes when people are asking you for the impossible, it's best not to give excuses or reasons, because you can't reason with people like this. They know better and they are just trying to get what they can out of you, hoping all the while you will fall for it. In cases such as this I just LOOK at them. LOOK and just saying nothing. Eventually they will wind themselves down.

I am the least PC of any nurse I know and when they mentioned the nurse who always stayed past 24 hours I would have had to say "oh really where is she?":nono:

[CLC172]

you sound like the perfect family member:smilecoffeecup: . but you know both sides. i think you gave good advice. i too would casually say to that nurse something about "are you ok?".

[color=#483d8b]but to mm, don't let this family guilt you into staying. and don't let them have you feeling badly either. that's their goal, to make you feel so bad that you'll stay.

[color=#483d8b]i've gotten over that stuff after doing hh now for 4 years. i used to really be a sucker for quite some time. i just have a big old mushy heart and had some trouble saying no.

[color=#483d8b]then it had an effect on my own health and sanity and i had to start taking care of me. mm, you are pregnant and stressed and i know from a lot of your posts that you have had it with nursing. so please take care of you and don't let these inconsiderate types push you even further away.

[color=#483d8b]as nurses we can find a way to set limits so that we can still enjoy our career, help our wonderful patients, and take care of ourselves.

cattitude, i really like what you had to say here. i'm still a student, and i've actually taken a little time off of school to work on myself. one thing i have learned, through counseling, was about setting boundaries. people can be really intimidating and manipulative if you let them push you around! i had a hard time with saying, "no," to people and i kept feeling like a victim, like i never had a choice because people needed me.

i know many people go into nursing because they have the "helper" personality, so i see where it could be easy in this field to get taken advantage of if you don't have a strong sense of what you are willing and able to do, and be able to walk away when you know you have fulfilled your task. other people can take advantage of our good nature by using guilt trips, which i'm sure work much of the time because in many cases, you are dealing with a sick, hurting person.

ok, now i'm writing a book on this subject, so i'm going to sum it up. i get sad when i see nurses on here who are burnt out due to all of the stress others have put on them, and i hope that by taking a little time off to work on getting myself stronger, i will be able to have a positive nursing career, without allowing people to walk all over me. thanks for all of the posts, guys!

i'm going back to nursing school in the spring '09. i have 3 semesters left until i'm an rn!!!

[JentheRN2007]

Maybe I don't understand how it works but can't you report the agency for breaking the 24 hour rule? These rules are made for a reason and I understand the shortage problem but doesn't it just get worse when further nurses such as yourself are being taken advantage of like this...?

I know you need the job now from what you said but do you think you could hint to them that you may need to research your rights into this matter since you are getting nowhere with them?