I need help. I feel as if I am already burning out and I am a new nurse! I am working only one case in Pedi Homehealth. I do 12 hour shifts sometimes 16 depending on moms requests. He has a vent/trach & gtube. I provide all nursing care. I do not mind caring for the child. Mom is constantly wanting to go on outings with the child. I mean ALL DAY I have to carry with the vent machine, suction machine, CPT and cough assist machine. I do it all. I never complain. Even though I wish this mother would recognize that her child ends up sick when he goes out. His HR will increase he will posture so much.
Along with the nursing notes she has a binder where she has us document basically everything we have to document already. She has made little cards posted of checklists of things we have to do around the room. She has a checklist for the diaper bag as well. (sometimes it is so much things I have to carry I end up forgetting something) I just don't know how to address her and let her know that I am not a baby sitter nor am I his mother.
If she doesn't have the time to do everything she asks of me how can she expect me to do it? The child has constant secretions so it's not like I am not doing anything. Sometimes I leave and haven't even had a chance to eat in the 12 hours I am there, documenting is super hard when we go on these all day outings. But I feel as if she is not being realistic based on his conditions. I feel like I am going to have to switch patients even though I have grown to care for my patient but the Mother is just so much of a hand full!
You say you have to carry all that equipment, but the vent, suction machine, Go-Bag, and diaper bag should fit on the wheelchair. (I am assuming a wheelchair, since you refer to posturing.)
Do you actually carry the CoughAssist and CPT machines with you in addition to pushing the wheelchair? If they only have to go in the van, that's doable, although heavy. Please note; heavy machines can become lethal weapons in a roll-over. They should be secured. CPT can be done manually or with a vibrator, which is a far smaller machine.
When I'm not likely to get time to sit down and eat, I bring something like Ensure, Glucerna, or Boost, etc. I can drink one of those down in just 2 or 3 minutes, and they hold me. I prefer Glucerna, as it doesn't have so much sugar. For a 12-hour shift, I would bring 4 drinks. Wear a small knapsack to carry your things if you don't have room to put them with his stuff.
As for the double charting, tell the mom that you need extra time to be able to do extra charting. You should also point out to her that you need time to do your regular charting. Missed charting can cause the insurance company to refuse to pay. Tell her that.
I always check the Go-Bag at the beginning of the shift; it shouldn't take long to do. If mom wants to leave right away, then she gets to see to the diaper bag. If we have time before we leave, I'll do it. At any rate, I'll always make sure that the diaper bag does indeed contain diapers, and whatever else I will need in case clean-ups become necessary (wipes, plastic bag for dirty diaper, chux, spare clothes). If he needs medications while on an outing, you'll need time to set them up.
If mom insists on leaving before you can do these things, have a talk with your supervisor. If mom won't listen to the supervisor, it's time to move to a new client. If your supervisor won't back you up, it's time to move to a new agency.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I've had clients who go on lots of outings, but 12-16 hours every shift sounds very stressful. Under the circumstances, I don't understand the mother's refusal to assist you, as the logistics involved in going anywhere with a trach/vent/g-tube patient can be daunting.
But I'm a big fan of checklists, especially when the consequences of forgetting a suction machine, for example, which happened when an older client found himself at the mall without one....."right before I passed out, I saw..." eek!
Bottom line though, it's very unlikely the mom will change a routine that is well-established. Hope you can find one that works for both you and the client and family.
If the child is too unstable to be away from a CPT machine and cough assist machine for a few hours, he's probably not a good candidate for going on random outings.
The items necessary for diapering the kid are a nursing concern if he isn't a baby/toddler. Incontinence of bowel and bladder is an actual condition. Our go-bag contained diapers, wipes, chux pads, butt balm, and a change of clothing. The go-bag was checked nightly by the evening nurse.
The mom seems a little overbearing and is probably trying to get some level of normalcy in her life. That being said, nothing makes it seem like you are being told to act like the mom or the babysitter. You are there to keep the kid healthy and safe. If the mom wants to go somewhere and take him, you are there to help her do that. A vented child can't be in the car with just a driver so it's not like she can just send you home for the day and go on her merry way.
Kitiger, RN
1,834 Posts
You say you have to carry all that equipment, but the vent, suction machine, Go-Bag, and diaper bag should fit on the wheelchair. (I am assuming a wheelchair, since you refer to posturing.)
Do you actually carry the CoughAssist and CPT machines with you in addition to pushing the wheelchair? If they only have to go in the van, that's doable, although heavy. Please note; heavy machines can become lethal weapons in a roll-over. They should be secured. CPT can be done manually or with a vibrator, which is a far smaller machine.
When I'm not likely to get time to sit down and eat, I bring something like Ensure, Glucerna, or Boost, etc. I can drink one of those down in just 2 or 3 minutes, and they hold me. I prefer Glucerna, as it doesn't have so much sugar. For a 12-hour shift, I would bring 4 drinks. Wear a small knapsack to carry your things if you don't have room to put them with his stuff.
As for the double charting, tell the mom that you need extra time to be able to do extra charting. You should also point out to her that you need time to do your regular charting. Missed charting can cause the insurance company to refuse to pay. Tell her that.
I always check the Go-Bag at the beginning of the shift; it shouldn't take long to do. If mom wants to leave right away, then she gets to see to the diaper bag. If we have time before we leave, I'll do it. At any rate, I'll always make sure that the diaper bag does indeed contain diapers, and whatever else I will need in case clean-ups become necessary (wipes, plastic bag for dirty diaper, chux, spare clothes). If he needs medications while on an outing, you'll need time to set them up.
If mom insists on leaving before you can do these things, have a talk with your supervisor. If mom won't listen to the supervisor, it's time to move to a new client. If your supervisor won't back you up, it's time to move to a new agency.