Craziest PDN/PDN Venting Thread

Specialties Private Duty

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I looked in here, and other places, and didn't see a sole thread dedicated to the madness that is PDN. As PDN's we go through... Well, a variety of experiences. Let's just say we could write one heck of a book.

So this thread is for:

1. Your wildest, craziest, saddest, happiest, most psycho private duty nursing/homecare stories (Pedi or Adults)

2. Venting about frustrating parents, cases, patients, etc

3. Advice on "should I stay in this case VS that one, etc."

I hope lots of people participate, I feel this is going to be helpful.... We can feel isolated out there in the field. I personally love sharing stories with other nurses. I'll go first, but I'll wait til I get home and can really type out some doozies. :)

Happy story telling :)

There is absolutely nothing wrong with twiddling your thumbs if the family wants to maintain that level of involvement and have you there as a spare set of hands, but you should draw the line at signing the MAR for meds given that you have no knowledge of. She pours the meds, you write on the MAR "PCG" for caregiver. She gives. You don't initial unless you prepare and administer. If they insist otherwise, and the agency won't back you up, I would definitely leave the case. There is a limit to how far you should allow the family to paint you into a corner. It is unacceptable that the agency supervisor is telling you to give substances that you did not prepare and can not identify. Documenting does not protect you in this case. Tell the supervisor to put her instructions in writing for liability reasons and see what happens.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

Not all agencies use "pcg". Some write "f"for family or write "mom" if they witness the parent give the med and pour it. Each agency policy is different.

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Specializes in Complex pedi to LTC/SA & now a manager.
Not all agencies use "pcg". Some write "f"for family or write "mom" if they witness the parent give the med and pour it. Each agency policy is different.

Exactly. My agency we circle our initials and document in the narrative since we did not give the med but witnessed the parent giving the med. if we don't witness then it's "parent/mom/family/pcg reports admin 180mg acetaminophen via GT at 8:55". The only parent prepared substance we can administer is GT feeds and only if in the 485. Some kids have specific formulas that parent prepares for the day or specific blenderized diets. The clinical manager verifies competency and there is specific verbiage in the 485. It's considered no different than if parent prepares a meal and we assist a PO feeder. I even have trach/vent clients that are PO feeders supplemented by GT

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Thank you guys for the advice because to be honest, I never really thought about it that way since I'm new to home health/private duty. I have a few more questions about this, so I'm going to start a new thread.

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Specializes in Peds(PICU, NICU float), PDN, ICU.
Exactly. My agency we circle our initials and document in the narrative since we did not give the med but witnessed the parent giving the med. if we don't witness then it's "parent/mom/family/pcg reports admin 180mg acetaminophen via GT at 8:55". The only parent prepared substance we can administer is GT feeds and only if in the 485. Some kids have specific formulas that parent prepares for the day or specific blenderized diets. The clinical manager verifies competency and there is specific verbiage in the 485. It's considered no different than if parent prepares a meal and we assist a PO feeder. I even have trach/vent clients that are PO feeders supplemented by GT

Initial and circle means the med wasn't given...period. That's different. And yep, we always document when another person gives meds or something.

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Quibbling over using this initial over that initial is detracting from the point, which is documenting who actually gave the medication. It is common sense that the nurse follows the employer's policy, but it is apparent that this particular agency has not provided a policy. Writing your own initials instead of the indicator for the person actually giving the medication is dangerous false documentation and is the point that the individual nurse in this case should be aware of. Heaven knows her supervisor isn't making her aware of correct procedure.

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Specializes in Peds(PICU, NICU float), PDN, ICU.
Quibbling over using this initial over that initial is detracting from the point, which is documenting who actually gave the medication. It is common sense that the nurse follows the employer's policy, but it is apparent that this particular agency has not provided a policy. Writing your own initials instead of the indicator for the person actually giving the medication is dangerous false documentation and is the point that the individual nurse in this case should be aware of. Heaven knows her supervisor isn't making her aware of correct procedure.

How to document initials correctly could be the difference between winning or losing a lawsuit/license.

I can see it now. A nurse in court getting questioned. The nurse is asked why they initialed and circled saying the need wasn't given, but in their notes they wrote it was given. The nurse loses credibility and shows inconsistency and creates doubt in the minds of the jury. They lawyers have a field day. Mommy and daddy, while wrong, win the case.

Correct documentation and handling the situation correctly is key. However, getting away from this case would be the best option.

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Specializes in Complex pedi to LTC/SA & now a manager.
Initial and circle means the med wasn't given...period. That's different. And yep, we always document when another person gives meds or something.

It's what came down from corporate compliance post audit. The premise of the rationale provided is that the nurses are documenting that you, the nurse, did not give a particular med scheduled during your shift which always redirects to the narrative for clarification. The narrative will clarify if you did not give the drug because it was held per parameters (such as a BP med when hypotensive) or if parent administered. If you did not witness the parent prepare the med then how can you document what was given. (And yes there was an issue. Child with acetaminophen OD as parent was double dosing 360mg q4hrs but telling the nurse she was given the scheduled 180mg. Since the nurse indicated in the MAR & narrative essentially that she witnessed the parent administer the right drug & dose she was held partly responsible. The issue wasn't caught because it was thought the nurse's documentation was accurate). Either way I document medications & treatments completed by parents/caregivers as per the company policy in effect at the time.

We are not to document in the MAR drugs given or not when no nurse is scheduled. How can you document if you weren't working? Yet in my other job there are MAR's filled with "P" 24/7 even though nursing only accompanies child to school 6.5hd/5 week and only gives one scheduled med.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

I've seen where nurses document when they aren't there. Yep, that's crazy.

And just because something is policy doesn't make it right. My company (and others) say they won't pay until they get nursing notes per policy. However, the state I'm in says they can't trump the states laws with their policy. Same goes for state board of nursing. Facilities/agencies can't change how we do things if its how the BON states something must be done. I'm thinking we may be with the same agency and some supervisors will come up with stuff that isn't true. On the other side of that, my agency has outdated policies on things like equipment. But since policy hasn't changed to keep up with the times, they want us to do damage to new equipment by following old policies. So policy isn't everything. Ultimately we can all get another job, but we can't get another license. So I'll follow BON rules and state/federal laws over a workplace policy any day.

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Specializes in Pediatric.

Ohhhhh honey, I'm sorry you're going through a case like this. Talk about micromanaging! Yikes. I absolutely believe that if this patient is indeed having legitimate seizure activity, it could be being triggered by grandma. It may be what you said though- the patient "spazzing" out. Sigh. I'm so sorry.

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Love your posts ! I have done private duty for 25 years..worked with wonderful patients and families , I still enjoy hearing the families point of view !

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On 3/7/2014 at 3:50 AM, 2ndcareerchange said:

I have the same problem, but instead of talking about it they put all the paper towels away before I arrive. So now I either bring a hand cloth from home or uses the patient's, he has a lot of them in his drawers due to his drooling at night. I understand people are on a budget, but you would think they would be glad we wash our hands so much.

THIS!!!

There is a running joke about the fact the parents never address anything. We find out they don't want us to use, touch etc something when we go back and it has mysteriously disappeared. It can be a sofa pillow, paper towels, baby blankets he'll I even had a table top lamp disappear from a pt room! And when you ask they suddenly have no idea.

They really don't handle any type of conflict well.

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