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Discussion

declining a pt assignment

I have had 4 cases total since I started this job a few months ago ... one just ended so I currently have 3. I have accepted all my cases with minimum orientation and have not given my agency any trouble. Well, there is a patient assignment I have now that I want to decline. I tried to give it a chance ... I requested an extra orientation day because I wasn't comfortable with transfers yet .... anyways, after two shifts now with an orienter I am positive I don't want this patient case. Here's why: I'm a bit more comfortable with transfers but they are still extremely more difficult than any other patients...but that's not what pushed me to my decision. It's mainly the fact that the majority of this 5 1/2 hour shift is spent COOKING DINNER for the client!!!! And then you spend time cleaning up the mess you made making dinner and doing dishes ofcourse. I don't know how to cook well and my orienter literally just gave me a cooking lesson both times I visited this clients house... she basically made the meals and i helped both times...am i in a cooking class? I'm seriously kitchen challenged and I'd prefer to hone that skill at home and not practice on a client's meal at work. she whips up these awesome meals and is a great cook and tells me you don't "need a recipe" because you can just smell and taste things to know if they'll be a good edition to the meal ...cooking comes naturally to her ... not me. And the point is, I didn't know upon hire that I'm expected to be a chef for most of my shift ... I am an RN and I don't feel comfortable TRYING to cook and I want to spend my time actually being/ a nurse. Is this understandable? I am actually looking for a new job because most of my cases seem more fit for a cna or caretaker and I'm not utilizing many nursing skills ...for example... another client I have I literally just drive to an adult day care. The list goes on for reasons I'm unhappy with this job but I won't list those.

Anyways, is it understandable in the meantime for me to turn down this client because I don't feel comfortable or like it's reasonable for me to cook and clean dishes for most of my shift? I can hardly cook for myself!

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    This doesn't sound legit. Cooking for a patient is not a reimbursable nursing activity and nurses should not be doing that. This client needs a HHA or PCA.

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    • Experts

    Many years ago I had an assignment similar to that. The client had pureed foods frozen in meal-sized portions that I was to defrost and reheat, then feed to her. Once she was finished eating I was to wash her hands and face, the tray of her wheelchair, then her dishes... in that exact order. One day after I scooped the last spoonful of food into her mouth I went to wash the dishes while she finished up. I could see her from the sink and did not turn my back to her. Her mother flew into the kitchen and then into a rage that I was doing things out of order. I didn't stay there long after that.

    Another assignment was a brother and sister who had juvenile Huntington's. They'd been abandoned by their family and were basically wards of the HHA. The one day I was there as a substitute for regular staff (RN...) I was tasked with all client care PLUS cleaning the bathroom and kitchen and mopping the floors. When I got paid I found out that I hadn't been paid as an RN but as an LPN. I quit the agency very soon after that.

    I can see where you're coming from and I think you would be totally within your rights to decline the assignment.

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    • Author

    I got my paycheck for last week and it says LPN by each assignment I had last week. I too am being paid wrongly .... I work today and honestly I've lost all motivation for this job. Paychecks should never be the reason you work but oh don't worry ... the pay is horrible and not keeping me here either. I have a job interview this week for another job and I'm hoping I'll get it or another one on the spot so I can quit asap.... I feel bad for the families but I cannot stay.

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    • Author

    Update below

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    • Author

    Update.

    I try to decline the case and they tell me I can just microwave a meal. But uh, I'm still cooking for a client and feeding him and doing transfers to and from the toilet. They wouldn't let me decline! They even had the audacity to ask me to pick up an extra shift with this client. Really? The only nursing care I do is flushing a peg tube twice and giving ONE med. I feel like a home health aid can do most of this and if they can't do peg tubes, the family is always around when I'm there so they could do that.

    It's just that both my other clients aren't nursing material either .... one I literally change their brief, dress them, and drive them to an adult day care. She has a peg tube but the feeding and flush is done when I arrive. My third client has a trach, vent (very stable though, can go without it) and a mickey but I spend most of my time just helping her find movies to watch and watching kids shows on repeat. And she pinches and hits if she's in a bad mood! I do like her family though.

    Point is I feel under challenged and bored and not like an RN. Also, turns out I'm getting LPN pay for all 3 clients!! Is this even legal?!

    Thoughts guys??

    I'm leaving this agency asap!!

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    Update.

    I try to decline the case and they tell me I can just microwave a meal. But uh, I'm still cooking for a client and feeding him and doing transfers to and from the toilet. They wouldn't let me decline! They even had the audacity to ask me to pick up an extra shift with this client. Really? The only nursing care I do is flushing a peg tube twice and giving ONE med. I feel like a home health aid can do most of this and if they can't do peg tubes, the family is always around when I'm there so they could do that.

    It's just that both my other clients aren't nursing material either .... one I literally change their brief, dress them, and drive them to an adult day care. She has a peg tube but the feeding and flush is done when I arrive. My third client has a trach, vent (very stable though, can go without it) and a mickey but I spend most of my time just helping her find movies to watch and watching kids shows on repeat. And she pinches and hits if she's in a bad mood! I do like her family though.

    Point is I feel under challenged and bored and not like an RN. Also, turns out I'm getting LPN pay for all 3 clients!! Is this even legal?!

    Thoughts guys??

    I'm leaving this agency asap!!

    There's nothing illegal about it generally. Unless you have a contract (ie job description) that says you can't be asked to take responsibilities designated as LPN, or cook for that matter, they can require that you do it as part of the job and fire you for declining to take that assignment. Ensuring that you will always be paid at the same RN rate is something you needed to specify when taking the job.

    Reimbursing is another matter, it's typically not allowed to bill insurance, medicare, etc for nursing services that include cooking or housekeeping. If these patients are paying out of pocket then that's fine, otherwise they should probably be in a more appropriate setting for having these services provided.

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    • Author

    Medicare pays for all of the services for the clients I work with. I'm thinking cooking is not a part of the bargain ...this has been the straw that broke the camel's back. I'm looking forward to my job interview ... may even see if I can move it up a day or two because I forgot I'm off early enough tomorrow!

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    This sounds like long term private duty nursing care in the home as these are not skilled nursing tasks covered by Medicare home health. Private duty shift work in home or school is often paid by Medicaid, community care waivers, or occasionally private insurance or private pay.

    Cooking meals & companionship are most definitely not skilled home health nursing. Many agencies pay the lowest rate as reimbursement is low. I've known RNs to like a case so much they accept the LPN rate (often30% or more lower) to stay on a lower skill case that they like the family

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    • Author

    It just bothers me that they kind of didnt take no for an answer when upon hire we were told if a case wasn't working out for us we could just let them know. I guess I should've put my foot down more. They have such a high turn over of nurses (clearly, as I'm trying to leave too) that they are desperate. My client's families.. all of them ... hsve expressed to me multiple times their anger with the agency ... they feel like they don't actually care and just place bodies in a home to cover their own butts so they can say someone's there even if it's not the appropriate assignment for they appropriate person. When both the family and nurse are dissatisfied the agency is not doing something right.

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    Ok yeah this sounds like private duty not home health. Home health is intermittent care and you are in then out and on to the next patient. In private duty you can be asked to cook/clean and do laundry etc...which is why I no longer do private duty but home health. Since you are likely private duty then you are likely also not getting insurance or benefits and are PRN, which means you are a contractor and you just need to put your foot down and not let them try to keep you on a case. Be straight up, tell them you are not a good fit you don't want the case and they have x amount of time to get someone else in to replace you end of story. With these agencies that do private duty they like to try to wheel and deal and make it seem like you have to stay or whatever and you don't. Switch to home health, you make a lot more money and your not stuck in one spot for hours and hours. You also get to use your actual nursing skills instead of being paid virtually nothing and being treated like a maid/nanny etc...

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    (Just for the record, I can't cook either and would feel very uncomfortable trying to do so.)

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