All kinds of issues

[NightNurseRN13]

New grad (RN) here and have been working for a home health agency for almost 5 months. Let me first say that I love what I do and I adore my patients, however there are a few things that have been bothering me.

1. One house I work at there are always two nurses (either LPN or RN), when I'm there 50% of the time the other nurse nods off and takes a nice 3-6 hour nap. I debated on how to handle this and decided to drop off an anon letter at work since that is an option in our handbook. I decided to go with the anon letter, because I know certain co-workers are close with our boss and I didn't want to put myself in the middle of who knows what. Problem is, nothing has been done.

2. Had a nurse speak very unprofessionally to me because her patient was de-sating while she was out of the room and I didn't suction. I tried explaining to the nurse that I assessed her patient while she was gone and the patient was fine, that it was probably the patients pulse ox was disturbed by their chest PT, but she didn't want to hear any of it. I shut my mouth and listened to her blast me out for 10 minutes. I never reported that because I figured she was just cranky after waking up from her nap.

3. When I go long periods of not being at a certain patients house and I assume care, the patient is down right dirty. I was told the patient had bad breath and to please do really good oral care my shift (which I always do), turns out I discovered the patient has thrush... who knows how long that has been going on. I did report it to the oncoming nurse. Another time, I was doing my assessment and the bedding was completely soaked and spelled of old urine.

Anyway... I'm looking at this situation as a way to improve the quality of care for these patients and be an advocate, but I think I have the "new nurse mentality" and think it's not my place or that maybe I'm not seeing the whole picture (which down deep I don't think there there is any other way to see this but patient neglect).... so it would be great to hear your opinion on the situations posted above.

[nurseprnRN, BSN, RN]

Perhaps a care management re-evaluation conference with all the nurses involved in these patients' care (and perhaps all patients of a certain age? duration of service? diagnoses?, so nobody feels singled out) to get re-focused would be helpful to all. Sometimes something like thrush or worsening incontinence can sneak up and gets ignored precisely because of the chronicity of the caregiving.

It's a little like my old housekeeping ladies who grew to ignore the cobwebs in the corners and the oh-so-gradual accumulation of dust on the knick-knacks; when they retired the new gal swept them away immediately.

The naps, though, that's gotta stop. If someone is sick enough to need two caregivers onsite, then s/he needs two awake caregivers. Perhaps, though, a re-eval would determine that only one at a time is enough, and then whoever is there would have to be, like, awake.

[NightNurseRN13]

That is a very good point, thank you for your response. How would I go about making this happen though?

[jadelpn, LPN, EMT-B]

Writing anonymous notes, even if it is an option in your handbook, and passive-agressive reactions will not get you very far.

This is all about patient safety. If a patient needs 2 nurses to assume care, then I would assume that it is a critical patient who needs interventions and monitoring.

Protect yourself, and report this to your boss. If, in fact, the second nurse can sleep (and although highly unlikely, could be feasible--if the second nurse can be called if needed) then you need to know that. There is absolutely no excuse for leaving a patient in a wet bed. That the nurse spoke harshly to you regarding suctioning--cover yourself with this one--if you know that the patient needs 2 nurses to monitor and care for them, one of them is sleeping--you can not justify that on paper. Thinking that a fellow nurse is "cranky after nap" is outrageous!

If you do not feel comfortable going to your boss, then I would report to the state licensing agency, the omsbudsman, have discussion with the case manager--I would go so far as to say that you have a duty to act in these instances.

I get that you are a new nurse and you need a job. But this particular job is putting you at risk--along with the patient that you are caring for.

[NightNurseRN13]

I want to clarify that the house with two nurses, there are two patients in the same house. 1 nurse for each patient.

[nurseprnRN, BSN, RN]

Ah, then one patient's account is being billed for ... naps? This now becomes fraud as well as lousy care and unethical behavior. Time to tell your management, for sure, and line up another job for yourself because your next move is gonna make you personal non grata there: to report it to the state and the BoN so you don't look complicit when the excrement hits the impeller (as it doubtless will someday).

[NightNurseRN13]

You guys have said exactly what I was thinking. I've put more thought to it since this post and if my boss doesn't accept my complaints then do I really want to work for this company?

I guess I'm going to have to do more than an anon letter.

[xoemmylouox, ASN, RN]

Just ensure you CYA with everything. Don't be surprised if they push you out instead of dealing with the problem.

[NightNurseRN13]

Just ensure you CYA with everything. Don't be surprised if they push you out instead of dealing with the problem.

You called it. I was removed from that case and placed with another one.