Advice on Home Health Boundaries

[JaneDoeDoe, LPN, LVN]

Hi, I am a home health nurse and have been working with a family for a couple of years. The family and I have grown very comfortable with each other over the years. But lately, I feel as if more is being required from me than nursing. Recently, the caregiver has put all of the responsibility of doing my patient's laundry onto me. Whenever I do not get around to doing it, I can tell that they are upset with me. One time they had made a complaint about not being able to find something that is only used by them at night when I am not on shift, and made a comment about laundry being piled up and seemed pretty annoyed. I did not get to laundry that day as I was busy and the next day, they had made the same complaint. When I do laundry on Friday and it is in the dryer whenever I leave shift that day, I come back on Monday and the same clothes are in a big pile sitting there waiting for me right when I walk in the door. I do not mind doing the patient's laundry at times but the responsibility is solely on me now and if I don't do it, it doesn't get done. I am also expected to feed their pets during the day. They ask me to do different tasks for them. And sometimes when I am asked these things, it's in a demanding way. More of a statement than a question, no please or thank you. Sometimes I feel like I am a maid/housekeeper/personal assistant rather than a nurse. I want to try to handle this conflict on my own first but how the caregiver responds to a lot of things isn't always the best. We used to bump heads a lot when I first started working with them. I would like to talk to my supervisor about it but again, I know it would make things uncomfortable between me and the caregiver as they will know it is me making the complaint. I love my job and working with my patient, but I just don't know how much more I can take. I have held my tongue back a lot over the years and have been professional. I am just unsure how to go about things. Any advice would be greatly appreciated!

[lifelearningrn, BSN, RN]

You're a skilled nurse, not a housemaid. Unless it's in the plan of care that you're responsible for laundry (other than changing linens and patient related things) than you shouldn't be doing it. Feeding pets? Not in any care plan I've ever seen. Are they paying you directly as a private duty, or is insurance/home health company footing the bill? 

[Crystal-Wings, LVN]

F that. That's part of the reason I left private duty, not to mention it was boring. I'm not a maid, I'm not a chef, I'm not an entertainer, I'm not PT or OT, I'm not going to watch your other children, and I'm not a school teacher. I didn't put myself through nursing school to do ANY of those things. If those people want those services they need to hire them. I noticed about 90% of the families I worked for totally abused the system. 

[Davey Do]

"Boundaries" is a good germ to use, Jane Doe, and those we serve, their families, need to be given guidelines.

When I worked in HH 30 years ago, the patient or guardian signed a contract which specifically stipulated the services to be rendered. The contract also stated that if the agency did not hold up their end of the contract, e.g. staffing according to that which was promised, the client could end the contract due to breach.

A contract is legal and binding, and if either side does not fulfill their end of it, or steps out of reasonable boundaries, they are in breach.

[JKL33]

There is likely not a totally comfortable way to put a stop to this; it's probably more a matter of deciding what would be least uncomfortable, which is kind of an individual thing. For me the viable options would be 1) Do the work the agency is contracted to perform and ignore their complaints/snide comments about household chores not being done until they get the drift or 2) Kindly address it head-on. At least then there isn't the added discomfort of them being upset about being reported to the agency.  To do this, you could take the approach of waiting until you notice that they seem annoyed and then ask about it: "Is everything okay/Is there a concern with [so-and-so's] care?" They have to either say no and stop acting all annoyed, or they have to say yes and admit they are ticked because you are not performing services that they KNOW FULL WELL that they are not supposed to be asking of you.   You could reassure them that you really enjoy caring for so-and-so, but were really never supposed to be doing the other duties and can't continue doing them.

Another head-on option: "I was hoping we could talk about the household chores...I feel like expectations involving extra tasks and housework are increasing. As it is, I was not supposed to be doing those things. When there was an occasional extra thing it didn't seem like a big deal, but now it is getting very awkward and I feel bad about that because I do very much enjoy providing nursing care for [so-and-so]. It's really best if I stay focused on that...." etc.