Boundaries in Private Duty Nursing

[MTRNlove, BSN]

Hi nurses, I'm looking to build my boundaries as I got burned at my last assignment. I wanted to see about collaborating with you all in order to gain more insight into this important life skill. 

My last assignment was a bust. The family was always asking me personal questions and then they would judge me on my answers. The mother kept pressing me on my political views and when I finally gave them an inkling into my leanings, the father told me I should be ashamed of myself! 

Another thing about this case (I'm a fairly new nurse) was that I didn't understand much about what duties were really not mine. For instance the daughter I was caring for didn't need much nursing care and all I needed to do was take her vitals once a shift, the rest of the time I cleaned the house, laundry, and cook. Looking back I was asked to do household chores that didn't seem that related to my client. The father became very demanding after awhile and started writing down lists of chores as well as mistakes I made from the week before. That's when I decided to vacate this case. 

Wanted to know your thoughts and opinions on how you maintain good boundaries with clients?

I'm on a new case now, family seems much more appropriate with me. However I notice other nurses on this case are going above and beyond the call of duty and cleaning the house as well as bathing their elderly Mother in law (whose not the client)!

[caliotter3]

You need to have a sit down with your clinical supervisor or the director of patient care services.  Ask the questions you have posed here.  Schedule this meeting for a time when they can spend some time with you.  Meanwhile, the topic of being the household maid has been covered many times on the site.  You can find threads with many posts that pretty much cover the topic of boundaries and what is, and is not, within your responsibilities.

[MTRNlove, BSN]

I dis speak to the CM and told her everything. No advice was given other than, "I understand" and that I'm not the first nurse that had a problem on this case.

[caliotter3]

Problems with specific clients and how many nurses have those problems might be the pat answer to you, however, it does not take care of your knowledge needs.  It is your supervisor's job to make certain you understand your job responsibilities.  Hold them to it.  Or, read all of the advice you can find here, and there is a lot of it, and implement what you need to keep yourself out of hot water. 

In short, when you are doing a shift of extended care, your cleaning responsibilities cover any messes you create during your shift, as well as the immediate area where the client spends their time, generally, their bedroom.  Nothing is to be done for the rest of the family.  Do not allow them to coerce you into doing those chores.  "I am here to perform professional nursing services for (patient).  I am only responsible for cleaning up after myself and keeping the patient area neat and tidy.  If you have questions, please direct them to my supervisor."  That is your standard response to their demands.  If they insist, well, go on to the next case, but be certain that management knows why. 

[amoLucia]

There's also the consideration that there's an abuse of reimbursement for services NOT covered by providers' R&R.  That borders on fraud. And when HH agencies knowingly allow it to occur, that contributes to the fraud.

I did HH waaaaaay back in the Dark Ages. Many of my clients didn't need (or really want) skilled nsg. They needed the major domestic chores which at the time, were NOT  covered under any insurance program. I had tremendous guilt because I was charged with decreasing services in prep for discharge.

I didn't last in HH very long for those reasons - my sickest pts were my poorest, and my poorest pts were my sickest.

[MCCARTHY 123]

On 5/11/2021 at 10:05 AM, MTRNlove said:

I dis speak to the CM and told her everything. No advice was given other than, "I understand" and that I'm not the first nurse that had a problem on this case.

I work home health.  Very hard job. We not only care for the sick but also have “ walking wounded” parents.  I have been through it all.  Nurse bullying, sexual harassment, your not like nurse xyz….  Be polite, smile and have humor.  You keep a boundary.  If you do get too close and personal with the family they will 100% turn on you.   The agencies make money when it is staffed.  They will mislead you about cases as well.  Took me years to learn this. 

[soontoretire2020, BSN]

If your client is on Medicaid, which they usually are, Medicaid pays nurses to do nursing, not housework. Management needs to explain that to the clients. 

You are in the wrong forum.