HELP! caregiver causing issues

[WV_heart_RN]

okay, i have a patient with dementia. she is bedridden and contractured at the knees. she can barely lay on her back due to the contractures of her spine.

she developed pressure ulcers on both hips. i brought our wound care nurse in and she did debridement on one hip and made suggestions on the other(which was not bad at the time).

there is a paid caregiver in the home who is there 5 days a week 24 hours. another girl comes in for the weekend. recently the fulltime girl took 5 days off and while she was gone one of the wounds got really bad. it was a tunneling wound and it tunnelled into a sinus cavity. she has pitched a fit and threatened the family she will quit if the other girl isn't fired and states she is doing exactly what she has been instructed to do according to wound care.

today, the patient was taken to the wound care clinic 'cause she said someone has been negligent and if something wasn't done she was going to quit. the wounds were debrided, again. and the wound care nurse called me to map out a plan of care for the patient. after telling me what she sent the patient home with i found that the caregiver had come in and told my nurse manager a whole different story for supplies she needed.:angryfire

this is driving me crazy. this caregiver has some emergency med background but with her it is her way or the highway.

anyone had a situation like this. i am just not sure i can continue being her nurse...

[Demonsthenes]

As with all professional- client and professional- professional relationships, each party has a duty to co-operate and to demonstrate "good will" with regard to the same. If one party refuses to do the same, it is your prerogative to give reasonable notice that you are quiting the patient. Without giving a reasonable period for your notice of quiting the patient, you might be accused of patient abandonment. I would deal with these recalcitrant individuals through a third party, if possible, such that there can be no equivocation about the reasonableness of your difficulties and your possible and/or real intention to quit the patient.

Best of luck!

[Al Stephens]

sounds like it is time for a sit down, with the family, the caregiver, the wound care nurse, you, and the social worker assigned to the family. point blank ask her what she thinks should be done, then what you and the wound care manager think should be done and then let the family be involved in the decision. the main objective is the patient, and it sounds as if the caregiver wants to prove something to either the family or themselves. Time to let everyone in on the work.