Did I do the wrong thing?

[glycerine418]

Hello everyone! I know this is a forum for nurses, but if anyone (especially CNAs and HHAs out there) could take the time to read all this and offer any insight, I'd really appreciate it.

I'm a brand new CNA. I was eligible to take the exam only because I had completed a semester as an LPN student. I was recently hired by an agency (independent contractor). I do not have my HHA certificate...never took any courses. However, on my very first case, my coordinator sent me to someone's home, not as a fill in, but she would be my client 3 times a week until further notice. When I met with the coordinator, he didn't brief me well on the client. In fact, I had to inquire about the patient's diagnosis. He couldn't even tell me about her level of mobility.

I wasn't sure what tasks I was going to perform, so naturally I prepared myself to be faced with CNA work. The coordinator added that I would take part in light housekeeping, keeping the area near the patient's bed tidy, reminding her to take meds, stuff like that...and I expected that.

So I basically went to the patient's home with very little knowledge about her...I also have generalized anxiety, mind you, so this didn't help at all.

She opened the door and what do you know...she's fully ambulatory. She asked me to have a seat with her and asked me flat out how long I've been doing this. My coordinator told me to say "I've been doing this for a while" because no one likes a newbie. When asked what I'll do for her, of course I started describing all the tasks I've been trained for. I felt like such a fool. She was like "I can walk fine and I don't need any help with feeding or going to the bathroom! I need you to do my laundry, cook all my meals, and drive me to wherever I need to go."

I felt so uncomfortable because I haven't had any training whatsoever as a home health aide. I was a little upset because the agency I work for also has escorts for transportation/HHA/homemakers/companions...and they sent me...and unexperienced CNA. I was so grateful for the opportunity to work but I was expecting to put what I learned into practice.

So okay...

As for the cooking...I can't even cook well...and what do I even cook for the client? I have to take into consideration if she has a certain diet (NAS, whatever) to follow. (Any advice on this, you guys?)

As for the driving...my biggest issue was safety. God forbid we get into an accident. Then there's mileage (no compensation), which makes the $9 I would make slowly deplete anyway

I asked if I could call my agency to voice my concerns and she said that it's fine. I call my agency, he tells me to just flow with it. (not reassuring). But I decided I would stick it out and try. I didn't want to disappoint her. I come back into the house and she tells me she called her daughter and that this isn't going to work out and she wants someone else. I didn't even get to explain myself. She told me to leave. I was crushed.

I would have done the job to the best of my ability to satisfy the client, but I just wasn't prepared.

My coordinator told me he would call the client and try to convince her to let me back. But knowing her daughter doesn't even want me (because my inexperience showed), I felt extremely uncomfortable. I voiced my concerns and asked if I could have a different case, and so it looks like I'll be waiting for another case.

In the meantime, I'm communicating with another agency for other opportunities. I'm so grateful that even with my lack of experience, they're willing to see me and possibly register me. They seem more organized too. I don't know if I like the current agency I'm with now or if I should even stay with them...besides it's a 1 hour commute to their office.

Okay I know I wrote a book and I'm sorry, but bottom line...did I completely screw up?? I feel so bad about this. My mother, who is a nurse, said I shouldn't be so down on myself, that the agency should have gathered more information about the client in order to send the right person for the job. My CNA training alone didn't prepare me for her requests.

If I'm asked to do another HHA case, I'll be willing to take it on for experience. But can anyone here fill me in on how they handle the driving/cooking aspect of it? lol

[Woodenpug, BSN]

I was a CNA for a few years and I've worked in home health. The interesting thing is that you should be able to get work doing what you described without any certification or license. The usual rate is $10.00 per hour. Just advertise on CL. For experience r/t nursing, skip the agencies and find something in a LTC. You did fine and there is never a percentage in deceiving a patient/ client for any reason. What ever the coordinator tells you, complete honesty always works best in the long run.

[CABG patch kid, BSN, RN]

First of all, it seems like you were unprepared because the agency didn't brief you enough on what to expect. I think they should have gone into more details about what your job duties include, and when they send you out to a client's house, they should tell you more details about the person!

Not to pry, but is home health really where you want to end up? You mentioned being in LPN school, why not get a job in an acute care setting? Even if you want to go into home health as an LPN, you will need some acute care experience to sharpen your assessment skills and technical skills. Many hospitals are needing CNAs, if I were you, that's where I'd go, just my

[Blee O'Myacin, BSN, RN]

Sounds to me like:

The patient was looking for a housekeeper that would be paid for by medicare.

The HHA was not clear on your duties, was not forthcoming on the condition of the patient and when you called with questions, you were blown off.

I think that you should be grateful that you were asked to leave.

You should never take on the liability of driving a patient. Or cooking meals either. What if there is an undisclosed allergy? What if the lady gets a stomachache or indigestion? Are you at fault then?

My 2 cents worth is that you should find a job where the duties are clearly defined by written policy and procedure and you are given a proper orientation.

Take Care,

Blee

[EmmaG, RN]

Sounds to me like:

The patient was looking for a housekeeper that would be paid for by medicare.

And if the agency was aware of this (which they seem to be) they are going to get in some damned hot water. You don't want to mess with the Feds; they tend to take Medicare fraud pretty seriously...

I agree you should find another job. What you were asked to do here put you at risk. It's not worth it.

[bollweevil]

I think you were lucky she "fired" you, as someone already stated.

Never drive a patient around unless you know exactly what insurance is in effect and you are satisfied with its provisions.

Best to find another employer. This one sounds dangerous and underhanded and could get you in trouble with Medicare regulators and inspectors.

[leslie :-D]

you didn't do the wrong thing.

your employer did.

and your boss would probably try and drop the dime on you in a minute.

please, go elsewhere.

best of everything.

leslie

[Batman24]

Be grateful she let you go. You did nothing wrong. She wants a maid, cook, and driver not medical assistance. She as well as your agency could get in big trouble for this as has already been pointed out above.

Never drive a patient. If you God forbid crash and you aren't insured as a driver through your agency they will sue you directly. Your agency doesn't seem very on the ball. I would seek employment through someone else.

[nursemary9, BSN, RN]

Hi

As everyone else has said--find a new agency! You did NOTHING wrong--they did, in not telling you exactly what you're duties were.

When I did Home Health & evaluated a patient for a HHA, we had to write up an assignment for the HHA & leave it in the Home. We had to sign it & go over it with the client & then they had to sign that they agreed with the assignment.

Moreover, Medicare rules say a person MUST be Home-bound to qualify--at least that's what we were told.

Find a New Employer!!

[pepperann35]

First of all, it seems like you were unprepared because the agency didn't brief you enough on what to expect. I think they should have gone into more details about what your job duties include, and when they send you out to a client's house, they should tell you more details about the person!

Not to pry, but is home health really where you want to end up? You mentioned being in LPN school, why not get a job in an acute care setting? Even if you want to go into home health as an LPN, you will need some acute care experience to sharpen your assessment skills and technical skills. Many hospitals are needing CNAs, if I were you, that's where I'd go, just my [/qu I agree with this advice. Try working in LTC or as a NA in an ALF. I am glad you got out of that home care case. Sounds like she wanted a maid and someone to pay for her gas. It did not sound as if she had a very nice attitude anyway. Good luck!

[CritterLover, BSN, RN]

i'm going to disagree with what many here are saying.

i worked for a hha while i was in nursing school.

there were two levels of assignments: home health aide, and companion.

in addition, it could be private pay or through medicare.

in both cases of private pay (aide and companion) we were exptected to to light housekeeping, cooking, grocery shopping, and transportation. in addition, aides were expected to do the assistance with bathing/dressing/ambulation. aides were paid more.

medicare only paid for home health aide services (not companion services), and you had to be certified. (however, some medicaid waiver programs will pay for companion services).

it sounds like she might have been private pay, or on the medicaid waiver service. in either of theses cases, she doesn't have to be homebound.

driving a patient around is acceptable, though your agency should have pulled your driving record and checked on your insurance status. (though that is more for their liability than yours). i would insist on mileage reimbursement, too. gas costs too much right now not to get reimburesed for that. if she is private pay, they will just bill her for it. however, if you arn't comfortable driving patients around, you need to let them know.

i always hated the meal prep part, too, and tended to decline assignments that were heavy on the cooking. (i'm actually a pretty good cook, but i'm good at cooking what i like, not necessarily what is traditional).

if, on the other hand, she is a medicare patient, then your agency is being dishonest on at least two counts:

first, they are asking for services that arn't covered by medicare; second, they are sending a non-certified aide (unless that has changed, though i don't think it has).

a word about those coordiantors: they need a body to fill a time slot, and mine (more than once) sent me to homes to do things i was not prepared for. for me, it was even a little worse because i worked nights, so there really wasn't anyone to call and discuss it with when i realized i was in over my head. be a little more assertive in the assignments you are willing to accept.

however, don't be afraid to try new things -- that is the only way you will get experienced. going into someones home and providing care can be intimidating. make sure you get training for any type of nursing task that you are allowed to do (colosotmy care comes to mind. we were allowed to do that as hhas where i was. they didn't tell me my new patient had one. she (the patient) had to teach me how to do it, when the rn supervisor should have either met me there the first time, or at least gone over it with me in the office).

all that said, working as an aide or companion while in school is a pretty good deal. i mostly did nights, and got to study while my patient slept. i did do quite a bit of transportation, though, so if you arn't comfortable with driving the patients in your car, you need to clarify that with your agency with each assignment, since it is expected on the private-pay side of things.

[Nursebarebari]

That HHA job is unrelated to nursing, it is more like housekeeping or a maids job. As others suggest, why don't you look for a CNA job in LTC or hospital. That will really help you in the long run when you become a nurse. Trust me, you will learn a lot as a CNA in hospital or LTC, and that will help you in school and on the job as a nurse. I was a CNA before becoming a nurse, so I have that experience. And one more thing, don't be hard on yourself about that job, you did nothing wrong. If you had taken that job and drove the client out and accident happened, how would you explain yourself.

Take it easy and good luck.