Advice needed r/t job

[kwagner_51]

Hi y'all,

I have a question and would like your help sorting it out.

Here is the situation:

I work in home health, doing shift work. Pt 1 is constantly getting sick with pneumonia and strep throat. He is very hand fixated and has scratched/clawed my hands, to the point that I have bled. [it is not done on purpose.]

Pt 2 has severely diminished lung capacity and has requested that if I am sick to please not come to her house.

I was with pt 1 two weeks ago when he got sick again. Monday and Tuesday of this week I was sick. I was running a fever and felt like I had a URI. I no longer have a fever but do have a deep cough.

I was asked if I wanted to work with pt 2 this Friday for 8 hrs and then work pt 1 for 4 hrs. I was going to do it. I need the $$$ due to the fact that I didn't work my 12 hr on Tuesday. While I was at pt 1's house last noc, I realized that I couldn't work at pt 2's house d/t the possiblity that 1. I have a cough and think it might be r/t the fever and 2. I might carry something from pt 1 to pt 2 or vice versa.

I called my boss and tried to explain it to her, but she said I couldn't let that stop me. After all, nurses care for sick people in hospitals going from one to another. I do NOT think it is the same thing.

For one, pt 2 is in her home environment and has asked me not to come in sick. PERIOD!! My boss pointed out that she has 24 hr care and that any one of the care givers could make her sick. I understand that point. However, if a pt requests that we not come in sick, shouldn't we listen??

What are the chances of me carrying pt 1's illness's to pt 2?

Please give me some advice!!

Am I being stupid?

Thanks!!

[Altra, BSN, RN]

My

As a nurse you need to assess yourself - are you febrile? Can your s/s be controlled with OTC meds so that you're not coughing/sneezing while at work? That's an assessment you need to make - whether or not you should stay home from work.

If patient #2 is immunosuppressed then I would think that that would be addressed in her plan of care and perhaps the situation does warrant a change in caregivers for a day or 2. But if you have a garden-variety URI or virus (like I have right now ... ) then you were likely "sick" before you were symptomatic. Vigilance is important but has its practical limits.

If it were me ... unless patient #2 requires special considerations r/t immunosuppression, I would go to work unless my s/s could not be controlled w/OTC meds.

As for patient #1's propensity for behaviors which result in injury to you and/or other caregivers -- this is unacceptable and needs to be addressed. The patient may very well be unable to control his/her behavior, but that doesn't mean that you all continue to be subjected to injuries. What does the patient's plan of care say? My first thought would be to utilize mittens or something similar on the patient while you provide hands-on care.