Background checks for parents

[SDALPN]

So tonight there was a series of events at the home I was working in that led me to this thought. I'm working in a home where the parents are pretty out there. One of the parents has been "brainwashing" the family to believe that women are inferior to men (along with quite a few other odd beliefs). I strongly believe that it is their home and their choice to raise their family the way they want even if I disagree with their beliefs. In the past the one parent has been pushy with me and even told me he was jealous of me giving report or receiving report from his wife because he wants all of his wifes attention constantly. He has told me he doesn't want me talking to her except at certain times that he has allowed. Recently he has become even more unstable. One day hes telling me I'm the best nurse they've ever had and do more than any of the other nurses ever have. The next day hes telling me what he has to tell his wife is more important than me discussing important info about their special needs child.

Tonight he stepped over me 3 times. The 3rd time was the final straw. He yelled at me telling me the scheduling mistake by the office was my fault. But that was after yelling at me for talking to his wife about what had happened with scheduling. He demanded to see my cell phone with texts to the office about the scheduling. He also acted very aggressive to the point I felt threatened. I called my office and was able to leave early. I let him know in a professional way that I would not be talked to or treated like he was treating me. So it led me to wonder why the agencies don't check the parents background to make sure the nurse is in a safe working environment. I've been around unsafe parents in the home before. While I can understand the agency not completely disclosing a parents background check, shouldn't the agency be concerned that they are placing the nurse in a possibly dangerous environment where the nurse can be by themselves with a possibly dangerous person? I just did a little research for my safety and found out that the parent has been arrested many times for violence.

In just a couple of years this family has been through almost every agency in this area. That usually says a lot in itself. They are extremists. They are also very picky about their nurses to the point that after the agency filters their nurses to the families demands there are no nurses left to send to the home. They accused one nurse of being a witch and casting spells on them and let the nurse go. They won't allow overweight nurses. The nurses must be Christian. They won't allow a Muslim in their home for any reason. The nurse must be a non-smoker and can't wear any perfumes or scented products. The nurse must be conservative. If they are liberal the family won't allow them there. This family digs and digs to find out personal beliefs too. There are other requirements for the nurses too that I can't think of right now.

So what do you think about the parents having their background checked by the agency before the agency can start the case? Not to be used to deny care. Only to be used for the nurses safety in the home. I know the "what ifs" could be a mile long. But what if the parent is a sex offender? Isn't that something that we need to know for our safety? We are taught not to accept an unsafe assignment in nursing school. But how do we know we are in an unsafe environment before its too late?

[kids]

Most of your points of concern would be discovered in a routine background check.

And it's doubtful at least in my area of experience that a RSO would be in a household with a child, Level 2 & 3 offenders aren't even allowed to live with their own minor children.

[applewhitern, BSN, RN]

Wow. No way I would go to this house, period. Your agency should consider sending two people out to this house together, instead of just one of you. He sounds like a ticking bomb. To answer your question, a background check might, or might not, reveal anything. Many unstable people go for years without doing anything serious enough to have a criminal background. Then one day they just go off the deep end. I wish there was some other option for this situation; maybe DHR or someone like that could get involved and have the child placed outside their home. Scary. Wonder what he has to hide, since he doesn't want you talking to his wife.

[amoLucia]

Uh..... for what other reason/purpose would a background check be done if not to make a decision to provide care? If the agency learned a prospective client family had issues, what are its options? Firstly, to NOT ACCEPT the case (this could possibly open them up to discrimination charges), or secondly, to ACCEPT the case (what do they do with the info they learn?). Remember, it's the child who's the pt here.

There's no predictor to tell who will or will not go off the deep end, WITH or WITHOUT, a backgound check. This family is well known to the HomeCare community. They've got psych issues, discriminatory sexual/ethnic issues, and/or domestic abuse issues, etc. I hope you've provided documentation to your agency re: his behaviors.

My recommendation --- GET OUT FAST!!! Your safety comes first. Your agency should be handling this better because it sounds like a time bomb waiting .... Your original query of doing checks on all pt families is just opening a can of worms with just too many what if's that you yourself can see.. Too bad it's a child who's the pt here here.

[JustBeachyNurse, LPN]

Background checks may not be a realistic expectation. My agency sent the nurse case manager to this home. It was a bit of an odd experience but it was state ordered in home skilled nursing, so there was more obligation than a typical case. Each nurse came back with a different but related conflict. Ian's a new nurse with this agency I went to the home as it was a potential full time case, however there were a lot of red flags from mom not wanting the nurses to do ANY of the skilled care but sit and watch TV with this older child, accusations of improper care and actions from nurses who were there before me (things that could not possibly be true based upon what I observed), caregiver was a heavy smoker with an O2 dependent patient (major safety issue), very odd comments form the caregiver trying to solicit a reaction. wanting the nurses to work odd hours (but it was okay as she'd sign outer time sheet for the full shirt)

As I was a new nurse and new to the agency I was afraid to decline the case until mom admitted to the chain smoking and lit one up. That was my easy out as I have a history of asthma. Ultimately the agency declined the case as when the case manager went for the visit her spidey senses were up but nothing glaringly obvious but the reports from the four or five nurses sent the cases gave them the documentation to decline the case from the state. Plus it gave the state more concrete evidence to more actively intervene.

Fortunately for you your agency made it possible for you to leave early. Remember if there is any possibility of abuse (verbal, emotional, or physical) abuse or neglect to a minor child we have a moral and a legal obligation to report our observations to management and appropriate authorities. Good luck

[SDALPN]

There is no real abuse to the child. The only thing I've seen is an occasional missed feed by the family....bolus feeds every hour. The kid is an active toddler and all toddlers have days where they eat less. The child doesn't lose weight and is at a healthy weight. Also the family has some bizarre beliefs about healthcare. They are the type to read a sentence of an article about a subject and claim they are experts. The beliefs they have hold the patient back from taking steps forward as fast, but the patient is making progress. So even though what they do effects the child, its not abuse.

The family just doesn't know how to treat the nurses right. They look at us as the "help". Report was always a minute or so after the time to clock out and then lasted 15-20 min. I caught on quick and stopped clocking out at report and waited til I was walking out the door to clock out. They changed the schedule daily to fit their needs, expecting the nurses to change with them. They have no microwave (they are scared of the health damage it causes...however they have cell phones glued to their heads!!) They expect the nurses to bring food that doesn't require cooking. Not easy to do and it gets old quick! They would order pizza and not ask the nurses if they wanted to place an order. They did provide bags of chips and juice boxes for the nurses though. They have cameras pointing at the nurses all day so they can watch the nurses. The cameras are connected to Skype so they can watch from anywhere. The family claimed their a/c didn't keep up with the house. But they would keep the downstairs around 80 degrees and the upstairs was around 90 degrees. I would keep a fan on the patient and myself and they would come up and turn it off every time they came up there. The nurses weren't allowed to do real nursing without asking the parents first. They felt they could do everything better than us. Even changing a trach tie or giving a bath was out of the question. However I was able to get them to trust me to give a bath and to do a few other things. But they wouldn't trust the other nurses to do it. We are basically there to babysit and clean. If we tried to teach the parents or explain what something meant they would tell us we were wrong. Then turn around and ask everyone they could about what we tried to explain to them to see if anyone gave them a different answer (major trust issues). They homeschool their many kids (they are extremists for anti-abortion) and they have the older kids raising the younger kids stating they don't have time to raise the kids. So the older kids don't have a chance to be kids themselves. Its not just the nurses getting used/mistreated.

[SDALPN]

I found out the dad told the office "I needed to be put in my place as a nurse" and that I needed to be "submissive". He told the office that they had to write me up and he wanted to see the papertrail. I don't think that its any of his business and that he is still way out of line. I stepped down from the case. I need the work, but that guy is just too unstable to be around. So the office "counseled" me....which I think is BS. Even though I did everything they asked when they asked. Then my boss talked to me privately and said as a friend instead of a boss that I should go back to school and that I function at a much higher level than the job I'm doing. They are looking for another case for me. My old boss contacted me a few weeks before this offering me a new case coming home from the hospital in about another week or so. Luckily, I have options!! My other agency I'm with also just emailed me days before this happened offering me a case that came home last week. I did find it odd that when I asked for a copy of the counseling that I signed along with my comments that the agency said they had to finish their investigation and would mail me a copy afterwards. Any opinions?

[applewhitern, BSN, RN]

I am just glad you are out of that nuthouse!

[amoLucia]

Be cautious about the friendly 'pat on the back' type approach by your boss. She may truely be giving friendlly advice but I see that she is trying to direct you to look on further. I felt there was something wrong with that family esp now with the 'submissive' and 'put in her place' remarks. Something's NOT right here!!!

The agency has a vested interest to receive payment/reimbursement for services provided with the least amount of problems. They don't want to 'make waves' and they will probably give the guy your disciplinary paperwork. It'll look good on paper if you're no longer wilth them! Your agency may be trying to ward off any further problems at your expense.

Keep after them for your paperwork. I think your time with them is limited, esp if they are slow to provide another case for you. If you have your own private malpractice insurance carrier, I'd contact them and ask for their advice. Good luck.

[SDALPN]

I kinda wondered about the "pat on the back" approach too. They do still have work available. But another agency I'm with contacted me about a week before this happened asking me to work a case for them with my choice of hours and days.

I won't ask for legal advice here. But seems like the family may want a papertrail for a lawsuit. I'm a little concerned. But I never did anything wrong on the case. I was extra cautious since there were cameras in the home. I got concerned while working for them when they were upset with someone doing maintenance on an appliance in their home. They were made because they called them out 5 times to their home. So the last time the mom told me they were going to use their business to put the maintenance people in the news for what had happened. She said it like she was being very revengeful for not getting her way. It made me see real quick how she would turn against someone.

[Blackcat99]

Glad to hear you got out of that assignment alive. I think it would be nice if all nursing agencies would do "background checks" on the parents. However, most of the agencies I have worked at could care less about the safety of their nurses. They just want the money period and really don't want to hear about any concerns from their nurses.

[SDALPN]

Now I just wish there was a way to warn other nurses about a family. Too bad HIPPA keeps us from doing that. The patients and families are more protected than we are