Private duty rant...

Specialties Private Duty

Published

Specializes in peds palliative care and hospice.

Hi all...

I am sorry to rant...but this bothers me.

I worked a private duty case last night with a child that I have been with for about 2 months. When I got report from mom she said she hadnt had a bm in 3 days and gave her miralax in apple juice shortly after I got there. (of note, this is a fragile cardiac kid). About 1/2 hr after the miralax she was straining, sweaty flushed and crying. Mom consoled her and changed her. Her poop was baseball sized (big, round and hard) and had blood on the surface. I called her pcp and he was not concerned, as she was constipated. I called the day nurse and she was like, that happens.

At this time it is important to note that a)said event was NEVER documented b) Mom was NOT aware and c) Caseworker/DON was NOT aware.

Since when is bloody poop (small though it may be) not reportable to parents?!!!!

We ended up going to the ER with her in the middle of the night for various reasons and she was dx'd with an anal fissure. So....who knows how long this has been going on and no one has known about it? She has pooped for me and mom and we never noticed it before.

Like I said...Just a rant. and....Moms like to know these things. If it were my kid I would not be a happy mommy!

Thanks for listening :)

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I think I missed something in your post, but it seems that the other nurse is sweeping things under the rug, probably out of laziness, or a desire not to take action or responsibility. Maybe you could get something in place with the PCP to alleviate this situation. I feel sorry for the child.

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Specializes in LTC, Memory loss, PDN.

What event was never documented? I agree with caliotter3.

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Specializes in Pediatric Private Duty; Camp Nursing.

"Said event" was not said! I'm assuming you mean that the nurse's quote "that happens" means she's seen bloody stool from time to time. And I just have to clarify... was this stool merely shaped like a baseball, or was it real, regulation baseball-sized? That in itself would be more the concern to me, and the blood would just be a result. That poor kid was having a brown baby!

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I'm confused here too. Wasn't "said event" something that happened when you were on duty? If so, Mom knew and I'm assuming you documented it.

I took care of a little girl who had a very rare 'orphan' disease for many years. She had a horrible time with constipation no matter what we did. She regularly had tennis ball sized stools. It honestly looked like she was birthing (crowning) when she had a stool. It was very uncomfortable for her and I often put a glove on and helped to break it up so it wasn't so uncomfortable for her. Sometimes they don't pay us enough money for what we do!

Kyasi

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Specializes in peds palliative care and hospice.

sorry guys. "said event" was constipation and yes, it really was baseball sized following a dose of miralax. The fact that she had bloody stool (regardless if it is expected or not) in the past was never reported to mom, the casemanager nor was it documented anywhere... which was my issue with the day nurse...

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The day nurse is not doing her job, so that means you must be very careful to take proper care of the patient and to insure the agency supervisors don't paint you with the other nurse's brush. Those mischaracterizations have a bad habit of coming to light at performance appraisal time.

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Specializes in peds palliative care and hospice.

They were made aware of the situation. I asked them to gently remind everyone on the case of the importance of telling mom when these things happen. As far as my note that night, it was 3 pages long as I documented every phone call that occured before we took her to the ER (for a different reason) and some after.

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Nurses that don't notify me of things that are on my list of things or nurses that don't document or nurses that don't let me know when something is off, do not last long in my home nor long at the agency we use.

I also do not allow nurses to call my child's doctors. I am the parent. I am to be notified and I will handle it.

The nurse before you acted inappropriately and would never again be allowed in my home.

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Since it is my job to call the patient's doctor, a parent who will not allow me to do my job causes me to leave the case when I find out about this detail. I really do not like being put in a position where my hands are tied and my license is at stake.

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It is our policy also to call the MD for any problems we find. However, we do allow the parents who say they will do it the chance to call first. We follow up with the parent to see if there were any medication changes and to see if they actually called within a reasonable time. If they didn't, then we do. But I have found the parents who are on top of things and say they will do it actually do. And they also understand our agency requirements for follow up on a problem and don't get angry when we call them to see if there are any new orders.

Ventmommy, you sound like the kind of parent I would love to work with in my agency. I can't say that about many of our pediatric parents.

Kyasi

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Specializes in LTC, Memory loss, PDN.
Nurses that don't notify me of things that are on my list of things or nurses that don't document or nurses that don't let me know when something is off, do not last long in my home nor long at the agency we use.

I also do not allow nurses to call my child's doctors. I am the parent. I am to be notified and I will handle it.

The nurse before you acted inappropriately and would never again be allowed in my home.

This is an interesting issue. I can fully understand ventmommy's position, but there are laws and guidelines the nurses have to follow as well. It probably depends on what state you're in as well as on the urgency of the situation.

To be in compliance with delivering prudent care, in my state, I'd have to contact the Dr.'s office myself. This doesn't mean I couldn't contact the parent first if time wasn't critical, but I cannot act on directions, orders or instructions not received first hand from the Dr. Fortunately, in my area, the Dr.s are very cooperative and I seldom have any trouble getting the doc on the phone himself. I cannot even take an order off a Rx label anymore.

Now, if there's a fax machine in the home, and the Dr. writes an order that expressively states all nursing staff is to contact mom only and not the Dr. or any other care provider or emergency service it gets interesting again.

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