how can i stay focused?

[HHNurse<3]

hi,

im relatively new to home health and have been having a hard time staying focused on my role as an RN in situations when a patient has complex psychosocial issues, for example, pt. needs a higher level of care, or has anxiety/psych issues with no local agencies with psych rns, etc. it's hard not to get caught up in all these issues even though i want to help. i know the msw's are supposed to help, and i am supposed to defer to them, but as a case manager i am responsible if referals don't get made, or if the needs are not met appropriately. i think i need to stay more focused on the more easily attainable goals like bowel care, dyspnea, etc. but am having a hard time with this. how can i help in these areas if there are larger underlying problems? our agency says discharge with aps referal if a patient needs a higher level of care and refuses to go/accept help. i hate this philosophy and at least want to do as much good as i can with these patients in the short time i get with them.

any pointers?

thanks!!!!

[caliotter3]

You need to come to terms with the fact that you can't fix everything all the time for everyone. You must do the best that you can under the parameters set by your supervisors and put it aside when it is time to go home. I can assure you that if you continue to get too emotionally involved with those who have psychosoc issues, you will get burned and burned out. Do your referrals and teaching. At some point, the client must take responsibility for follow through. You can't do it for them.