Feeling beat up in homecare

[CalArmy]

I just need some advice about recent happenings at work. I'm in home care and I feel like the past six weeks have been difficult. I had a patient who wanted labs drawn. I spoke to the MD who didn't feel they were needed. I explained to her what the MD said and she hung up on me. Later that week she called my DON and said all this negative stuff about me. Up until this lab incident she was great calling me honey and giving me hugs. Fast forward to last week I had another patient who was post surgery and very upset with the hospital after we took over post D/C. I helped her with her bill and stitches as well as other things. She signed off our service and we t to the hospital for pain issues several days later. Turns out her surgery did not take and she had a complication. She wants to use a different home care stating someone told her to ignore her pain. Obviously nobody in their right mind would say that to a patient. I know sometimes patients have their own agenda but I just feel like I failed. Should I have done more? Something different? This happened in a short period of time so my confidence is shot. Thx for your feedback.

[nutella, MSN, RN]

Home care can be rough - sorry ...

In home care you meet patients in their territory and to be honest - a lot of patients who require home care have multiple issues including social, mental health problems, multiple chronic illnesses, and so on and forth. The ones who are well off and relatively speaking sane often do not need home care as they have more other resources.

Anyhow - patients can get mad when they do not get what they feel they need or are entitled to. And when it goes through a nurse they might not be too happy with you when you tell them that a doctor does not want this or that.

If you tried your best and did everything "right" you should be able to move on. Not everybody loves us... nurses often want to be liked by all their patients and families, which is unrealistic. People will reject you because they do not like your care or the way you approach them or because they are unhappy for whatever reason.

Think about the many people you help and who are satisfied.

[jadelpn, LPN, EMT-B]

Going forward, if a patient wants labs and the MD says no, be sure that your manager is in on this. That way, everyone is in the loop, even if it is to further explain that "unwarranted" labs are often not covered under insurance, an MD visit if there's new symptoms or not great symptom control, that kind of thing.

There are also patients who believe that they "need to be seen more" or "need more" of just about anything.

Bottom line, any kind of nursing is a team sport. Involve your manager for direction.

[TheCommuter, BSN, RN]

Moved to the Home Health forum.

[danarooo, BSN, RN]

HH can be very brutal. Document Document Document when a pt is demanding something that is not needed/unrealistic and the Doc says no. Patients in HH can be very manipulative at times, and as another person said often you get patients with other issues i.e. psych and that complicates things. Your going to get beat up in HH, but if you do your best and document what you discuss with the patient/Doc then you should be OK. Your management should back you up as well. They should know well how your job goes because they should have plenty of experience having done it, if they are good they will support you and let you know they realize the reality of situations like this.

[Libby1987]

2 patients in 6 weeks. Could either be poor coping reaction to their situation, a pattern of how your communication is perceived or a lack of thoroughness in care.

You state you helped a post op patient with her bill and stitches. I'm curious why you didn't include pain management in your description of the care provided, in hind sight of her seeking medical care for pain.