Do you feel like this sometimes?

I'm sorry you're having a hard time. It is discouraging when a patient comes and goes from the hospital, especially when while they were at the hospital no treatments changed and they come home to the same predicament and back to the hospital a week or three later with the same or a related problem. Such is the nature of our health care system passing the buck. It is aggravating when as a HH nurse you are providing the PCP with updates on the patient condition and even may provide your opinion as to what could improve the condition/complication and the PCP too passes the buck and just says, "Send 'em to ER." In this manner, nobody is addressing the underlying problems, only patching a band-aid for the acute condition and not looking at the bigger picture.

Or, sometimes it's more a matter of a very sick person on a chronic disease pathway who will continue to decline or have exacerbations no matter what you do/teach/assess as a home health nurse. I have found that some of these patients are just not appropriate for home care, but there are no other alternatives for them (financially or otherwise for SNF or ALF placement). We cannot cure diseases, only educate, treat, advocate, assess and report. Many chronic diseases there are no cures for and really, truly no hope for getting the patient better. Sad, but true.

Don't beat yourself up about it. Your inclination may also be correct, they may not be compliant when you're away.

When a patient has to go to the hospital, it is never the home health nurses fault. That mentality makes me nuts and I know the agencies harp on it. 'Tell the patient/cg to call us first". Sorry, I tell the patient/CG to call MD, then let us know about it. I was once asked to make an extra visit to see a patient who was having chest pain, sob. I refused, telling the DON that there was nothing I could do and had no way to diagnose the problem, that these symptoms require MD evaluation. Further, precious time would be wasted while the patient waited for me. The patient went to the ER and died the same night.