Can anyone insert a foley? Inject IMs?

[sandera]

Tell me if this is weird.

I'm a new home health nurse and I have an end-stage heart failure, copd, renal insufficient 100 year old pt who refuses hospice, wants to avoid the hospital, and stays at home with two unlicensed caregivers.

The first time I saw him 3 weeks ago, he was alert & oriented x3, sitting in a wc. Now he's in bed, screaming, moaning, can't get up, his skin is breaking down. The md thought it was a UTI. Since pt was already on macrobid, the doc decided to have the unlicensed caregivers start giving him daily ceftriaxone IM. And the the caregiver, a bookkeeper, inserted a foley over the weekend. No one is concerned about screaming/moaning. The doc said, "oh he moaned when I just touched him, so I don't think it's pain."

Does this situation seem strange to anyone else? I don't even know why they have me doing visits. And the caregiver is so hostile to me. Can doctors give just anyone orders to give IMs and foleys?

Any help would be appreciated.

[Valerie Salva, BSN, RN]

Sounds like adult protective services should be notified.

[ChristineN, BSN, RN]

I see alot of chronic pts that get homecare (I see them when they are admitted). Alot of them are cared for by unlisenced family members that doesn't think twice of putting a foley in, doing trach care, giving injections, G tube meds, hell, some even give IV medications. Assuming the caregiver recieved some sort of informal training from the doctor, a nurse, someone on proper technique, I don't see an issue.

[RNsRWe, ASN, RN]

Sounds like adult protective services should be notified.

Ditto!

This is ready for the national news. Someone needs to intervene, and fast. Being cared for at home by people who have been appropriately taught is one thing. They also should know the signs and symptoms of something that needs an EDUCATED person to further assess, to see what's WRONG. And this isn't happening, as evidenced by the patient's current status, so I have a real issue with it.

[SuesquatchRN, BSN, RN]

Poor old guy. Yeah, he moans when you touch him because he doesn't hurt. Idiot doctor.

[Neveranurseagain, RN]

Happens in schools all the time--unlicensed personnel doing caths, g tube feedings, trach care, Valium for seizures and im/sq injections in CHILDREN! They receive some training just like a monkey does!

[sandera]

I'm relieved that the foleys and IMs are okay. I didn't know anyone could do them.

But I'm still uncomfortable with the caregiver's and Dr's pain assessment of 0/10 in a screaming, moaning pt. He was pleasant, oriented and chatting the week before.

I'm going to meet with our social worker tomorrow.

thanks everyone for the input.

[Dolce, RN]

In my experience doing home health we could instruct the family to provide certain services for the patient. For example, family could be taught how to flush out a PICC line, or how to administer a SQ shot. Paid, unlicensed caregivers fall under a different umbrella. They are not family members. They are being paid to provide a service which they are not qualified or licensed to perform. This is not good at all.

[Simba&NalasMom, LPN]

In my state, unlicensed caregivers who work for homecare agencies (but not home HEALTH agencies) can indeed do things like insert foleys, give shots, check blood sugars, and even hang IV fluids to PICC lines. By law the task must be delegated by a registered nurse, which technically means that the unlicensed caregiver must give a return demonstration of competency before the RN signs off. I was fortunate enough to work for a homecare agency that actually followed up on all of its delegations and I felt very comfortable with the caregivers doing nursing tasks. I am guessing that somewhere within your agency there is an RN who is ultimately responsible for the outcomes of said tasks. If I were you, I would check to see if YOU are the RN whose license is on the line.

Scary? Yep. But sadly, in my state, it is also legal in homecare.

[BradleyRN]

In my state, unlicensed caregivers who work for homecare agencies can insert foleys, give shots, check blood sugars, and even hang IV fluids to PICC lines.

That is insane. It is one thing to teach a family member to do nursing skills for their loved ones for free, but it is quite another if someone is getting paid (and much less) to do our job. It seems that all of the nurses' organizations that are suppose to protect our profession are in a coma to allow these types of practices!

[sandera]

The caregivers in this case are paid by pt, unlicensed and I have never seen them demonstrate competency. I'm new to HH, the case mgr of this pt, and I feel completely out of the loop with the Dr giving orders to caregivers and accepting their pain assessments over mine. I don't want my license on the line, and I'm not getting a lot of guidance at work. The caregiver didn't want me to bother taking pt pulse because "it's always 40-50." And, I don't have to look at his bottom, his "skin is fine." :icon_roll I have to push and push to get anything done. Then it isn't taken seriously.

If the Dr prefers the CGs to carry out tasks and perform assessments, he shouldn't have ordered an RN case mgr. I'm worried that somehow I'll be held responsible for this mess.

[racing-mom4, BSN, RN]

If the Dr prefers the CGs to carry out tasks and perform assessments, he shouldn't have ordered an RN case mgr. I'm worried that somehow I'll be held responsible for this mess.

So true, I do not envy your posistion at all right now, it is a lose lose. Worst of all the Patient suffers. Your between a rock and a hard place.

More than the foley and IMs I am worried about his pain....can Doc at least order something more for that??