Been asked to do home wound care after patient is discharged

[Cbailey75]

Hello all. I am an RN and one of my elderly pts that I've been caring for is soon to discharge home after several months of hospitalization. I've gotten to know her and her family very well. She will be discharged home with her also elderly husband and she has a large pressure wound on her buttocks with a wound VAC. I'm the main one that does her dressing changes at the hospital, because it causes her so much pain. This wound is FINALLY getting better, but we constantly battle keeping suction on the machine due to location. The patient is very worried she won't get good care at home or won't be able to fix the VAC when there is a leak. Her family has offered to pay me to come do her wound care at home. Is this ok? We have CNAs that sit for patients after discharge. Normally I wouldn't even give this request any consideration, but I do worry about her wound; and wouldn't want to see her have a set back after finally moving the right direction.... Has anyone done home care for a patient once discharged?

[elkpark]

I've given her all the #s at the hospital and my email address and told her she can call anyone of us if she has any questions or concerns and could email me directly anytime, and asked her to come visit at the hospital as soon as the wound is healed enough and the VAC comes off.

I understand that, since my specialty is psych, I'm more persnickety about boundaries than lots of nurses in other specialties are, but I would consider even this "too much," and an unhealthy boundary violation. You are encouraging her to remain dependent on the hospital nursing staff, and maintain a relationship with you (all) when that relationship has reach its natural end and she should be moving on.

[JustBeachyNurse, LPN]

I understand that, since my specialty is psych, I'm more persnickety about boundaries than lots of nurses in other specialties are, but I would consider even this "too much," and an unhealthy boundary violation. You are encouraging her to remain dependent on the hospital nursing staff, and maintain a relationship with you (all) when that relationship has reach its natural end and she should be moving on.

Agreed. Giving out personal contact info is crossing the line and creating dependency on you where the nursing resource should be the home care team. Asking to visit or telling her to even call the unit may be construed that you don't trust the home care nursing team before she's even discharged.

[Mom2boysRN]

Home health is covered under medicare 100% and there could be problems with billing for a home wound vac if there's no documentation of a home nurse doing vac changes and evaluating the wound. By having home health she will have someone that can be available to teach the family and maintain the vac. If she needs therapy services that will also be available to her.

[KelRN215, BSN, RN]

For some reason the quote function isn't working for me. OP, in your role as a staff nurse, giving your email address to a patient is unwise. What happens when she emails you at a time you are away from the computer about an issue that requires immediate attention? An issue that she should really be paging the on-call MD for or even calling 911. People do it and it's a huge risk for you and the hospital. You are not her nurse in the community, you are her nurse while she is hospitalized. Don't overstep your boundaries.

[canigraduate]

You've already crossed too many professional boundaries. You are playing into this patient's fears and are doing her a disservice.

Let it go. It's time for you to move on.

Also, now it's going to be really awkward when the patient calls you and you can't do anything for her. You've set yourself up for failure.

[bloatedputti, MSN, RN]

No way can you provide nursing care on a patient independently. Nursing (incl Nurse Practitioners) is an interdependent profession, which must function be under laws and regulations (Nurse Practice Act, Title 22, etc). Briefly, this includes protocols, policies and procedures, Liability Insurance,documentation, and supervision by an MD in some capacity. This is also the case with dental hygienists, and why you don't see freestanding cleaning clinics. It would be foolish to administer any medical care, except in emergencies, to anybody, other than say, family members.

[Ruby Vee, BSN]

Boundaries! Unless you are already working for a Home Health Agency and THEY assign you, let it go and move on.

[iluvivt, BSN, RN]

Oh dear, you should not have given the patient your phone number and e mail address.This interfere with the process fir home care.Lets just say for example home care opens the case and the patient has concerns about a change in her wound.Now the patient is calling you, instead of the nurse to come out and evaluate it.It is the home care agency that now assumes care with MD orders and they device a plan of treatment.You really do not be in the middle of this! If you give any advice over the phone or by e mail you are putting yourself at risk for a lawsuit.Do you understand what everyone is saying.You should not be giving advice even if she calls up to the unit! You need to direct her to care team , MD or LP.