Advocating for my pt.

[buggybum96]

As a pediatric home health nurse with 5 years experience in the home, plus hospital experience on the medical oncology floor, I am having trouble coping with the lack of attentiveness to little details on the care of this patient by other nurses.

As a hospital nurse, everything had to be dated....IV tubing, dressings...you know the drill... But in my current pediatric home I just can't seem to get anyone to understand that things should be dated. There is one night per week that all respiratory equipment gets changed out, i.e. suction cannister, tubing, yankaeur, trach mask, drain bag and corrugated tubing. Every time I come back after my 1 night off....NOTHING is dated. Not even the 250ml bottle of NACL that is used to irrigated her bladder after cathing.

My other issue....particularly the 2 male nurses that work seem to ignore oral care. I beat my head against the wall during my 7 nights to get her lips nice and soft again and all the crap off her tongue then I go on my week off and I come back to dry/cracked lips and a slimy tongue and greasy hair (supposed to be washed twice a week on day shift)

And my third thing....and it's been said out loud by one male nurse....I don't fold laundry.

All but the laundry issue has been conveyed to the case manager... I've even brought these issues up with the family so the mom is aware but nothing happens.

Who else has come across something like this and what did you do? I'm really ready to contact the "higher-ups" but worried about backlash.

I've brought this up several times to the case mgr but it seems to falls on deaf ears.

[CloudySue]

My case I'm on right now, the mom gets furious if dates are on things. I mean stark lunatic furious.

She probably gets mad when they're dated because then it can be proven that she's using the equipment longer than prescribed. Her insurance might not be so great, or she's not prescribed enough every month, or maybe she's trying to stockpile some supplies by getting more use out of what she has. Some items, I believe, can have a much longer life in private homes if they are washed well and washed frequently. Cross contamination isn't much of an issue in the home setting. I often think these medical companies really have a sweet thing going, with all the frequent changing of items.

Incidentally, I'm the same way with contact lenses. I wear them longer than the directions say to make my supply last longer. I'm convinced that they tell you to throw them away so frequently so you'll buy more. I know they warn you of eye infections, but I sterilize them every night, and haven't had a problem my entire adult life. (Knock wood, of course!)

[brillohead, ADN, RN]

I have a client who asks that the HME on his portable/wheelchair ventilator not be dated. This isn't because of stockpiling or anything -- they get enough to change it daily -- but rather an attempt to minimize things that might draw attention to him.

It can be kinda cool to look Cyborg-ish with the machinery.... not so cool when there's a piece of tape with today's date handwritten on it.

Instead, we have it listed as a task in the MAR -- you can tell when it was last changed by looking at the initials in the MAR.

[Gooselady, BSN, RN]

She probably gets mad when they're dated because then it can be proven that she's using the equipment longer than prescribed. Her insurance might not be so great, or she's not prescribed enough every month, or maybe she's trying to stockpile some supplies by getting more use out of what she has. Some items, I believe, can have a much longer life in private homes if they are washed well and washed frequently. Cross contamination isn't much of an issue in the home setting. I often think these medical companies really have a sweet thing going, with all the frequent changing of items.

Incidentally, I'm the same way with contact lenses. I wear them longer than the directions say to make my supply last longer. I'm convinced that they tell you to throw them away so frequently so you'll buy more. I know they warn you of eye infections, but I sterilize them every night, and haven't had a problem my entire adult life. (Knock wood, of course!)

See, now that makes sense, and is a lot more 'generous' than concluding this mother is starkers. I admit I was snorting quietly to myself during my very first orientation in private duty. The nurse orienting me was vigilant about how I screwed the caps back on the liquid meds and how many Q tips I got out in preparation for a trach and GT dressing change. I remember mentioning something about a 'chart Nazi' and she didn't laugh (looked kinda guilty, actually). Yesterday I got a small manifesto in a note from her about things I missed putting my initials on, etc.

She's right, and I wrote back (I won't see her) my thanks and to please feel free to be a total chart Nazi I mean, leave me notes if she finds anything else, I appreciate the feedback, I want my charting to be complete :) She used different colored pens, different colored plastic 'flags' and sticky notes. I was hot pink, the day nurse was aqua blue

I noticed both moms of my kids look uncomfortable if I offer alternate explanations for a symptom their child is having. Unless it's important (which it hasn't been), I keep my lip zipped now. There is SO MUCH out of their control that however OCD they go on supplies or 'how to do ____ in Johnny's case' aren't just suggestions to me, they mean A LOT to the mom and/or dad And they come to mean a lot for the nurses who have been there for years (like the chart Nazi).

Even I found myself bounding into the house and making a beeline for the little boy patient, after not seeing him for four days, and first thing trying to make him smile. How I position him over night is . . . very important, and I do it just so. So there.

When both the family and he nurse are advocating for a patient is conflicting ways now that's a problem. Especially when we nurses can fall back on evidence and all that other stuff. Maybe if we can keep in mind that there are GOOD reasons (however unfounded) for whatever the family is doing, and those reasons are intense bonding, love, affection and fear for their sick loved one. It might be easier to convince them otherwise by respecting WHY they get so OCD -- their love and concern.

[caliotter3]

I like the nurse who initials the change in the MAR while the equipment has the same crusted over crud on it that was there the day before. Even better than that is the nurse who ignores doing the change due on their shift and the entry on the MAR. When I worked in the facility nurses got called in to fill in holes on the MAR. In hh, they ignore the MAR at will with no consequences. Some even will not chart all of the meds that were supposedly given on their shift. Most of the time my clients wouldn't notice if you put stickers of the Latvian flag on each piece of equipment, that was how out of touch they were with the care their family member is receiving. As they say, if it doesn't involve the babysitter, you, being present for duty, it is of no concern to them.