Help for a new private duty/HH RN. Suggestions, tips, and support all welcomed!

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The question: Should I switch clients? Family is being particularly difficult.

I'm pretty new to my job (only a year of long term care experience), and would like some input on my current situation. I am currently in home health, but was not oriented to the family nor given much information on family expectations. Just primary dx of the pediatric patient.

Client is alert and oriented, and adolescent and dependent of the parents. I am virtually on the verge of switching clients because the parents are not communicating clearly what they want ahead of time for their child.

According to company policy we are to follow care plans, and physician orders, and practice nursing based on best practice.

However, much of the time I find myself sitting back, and doing very little for the client. I feel like I'm stepping on Egg shells around the parents. One of them is very crass, and has sat me aside and stated "You do not tell my son what to do," When I merely suggested that the client may want trach cares while he is up in his chair. Then told me to sit upstairs for nearly two hours until my shift was over.

I've had to reiterate many times that it is their right to refuse cares at anytime and that I just need to document it.

During another day, there was an order where the client needed straight catherization four times. Two scheduled, and the other two are up to the client (if she needs to void).

Mother suggested that perhaps we should wait until next nurse arrives (7-7:30pm). THe last time the client voided was 3pm, and had been spending time with the family until 6. I provided a bedpan for the client, and no avoid so I palpated the bladder to see how distended it was. It was distended, and I asked "Do you feel like you need to use the straight catheter?" At this point, I did tell her that her bladder was a little distended. The response I recieved was "I don't know I think I might, yeah." I attempted to steer her towards her mothers suggestion to wait for next nurse to arrive. However, she promptly told me "Sorry I don't think I can wait." So I initiated the straight catherization, and recieved about 350mL.

The following day, I was pulled aside by one of the parents inquiring why I needed to straight cath the client when the mother strictly communicated that she did not want her daughter cathed. Throughout the shift, the client's family gave me crass remarks about small things and miscommunication, and I felt like I was being treated like a child rather than a professional.

Sometimes I find it difficult to sum up what I'm trying to say. I am told to be quiet even though I have an expounded explanation for the issue at hand. Perhaps even a skilled babysitter. The careplan is rarely followed per client request, and I was asked not to call the doctor for clarification if I can just ask the parent questions.

I am told that my work is appreciated by the family but the way they have lashed out towards me when things do not go a certain way has indicated otherwise...

I've even been compared to other nurses they've had experiences with.

I'm not quite sure how to handle this as a relatively new RN to HH/Private duty industry. I know everyone has told me to chart like there's no tommorow, but should I consider switching clients or will this be the way most clients are in home health?

Edit: The company refers to their company as Home health, but the job is actually Private Duty Nursing.

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Specializes in Complex pedi to LTC/SA & now a manager.

This sounds more like private duty than home health. Traditionally home health is intermittent visits (maybe an hour or so with specific goals) with a discharge date planned from admission. Often post hospitalization.

Private duty is generally shift work skilled nursing in the home (or school). Most commonly with pediatrics and young adults who need long term skilled nursing care. Shifts range from 4-16 hours depending on the case.

That said it sounds like you may want to consider asking to transition to orient on a new case. If the family is interfering in the skilled nursing care for a client who can indicate wants & needs such as asking for a urine cath to relieve bladder distension as ordered something is not right and it sounds like a difficult scenario. Is this your first nursing job?

Check out the private duty nursing forum for some more tips & support.

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The company calls it home health, but yes It was private duty nursing!

They went to my clinical manager and reported me for doing something the child had asked me to do (scheduled cath for urinary retention). It was never indicated that the parents did not want me to do it even if asked twice.

I'm afraid of losing my license over controlling parents, but at the same time...I really need a full time position.

Other clients are approximately an hour away or their schedules conflict each other to the point where I cannot complete my full time hours.

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The question: Should I switch clients? Family is being particularly difficult.

I'm pretty new to my job (only a year of long term care experience), and would like some input on my current situation. I am currently in home health, but was not oriented to the family nor given much information on family expectations. Just primary dx of the pediatric patient.

Client is alert and oriented, and adolescent and dependent of the parents. I am virtually on the verge of switching clients because the parents are not communicating clearly what they want ahead of time for their child.

According to company policy we are to follow care plans, and physician orders, and practice nursing based on best practice.

However, much of the time I find myself sitting back, and doing very little for the client. I feel like I'm stepping on Egg shells around the parents. One of them is very crass, and has sat me aside and stated "You do not tell my son what to do," When I merely suggested that the client may want trach cares while he is up in his chair. Then told me to sit upstairs for nearly two hours until my shift was over.

I've had to reiterate many times that it is their right to refuse cares at anytime and that I just need to document it.

During another day, there was an order where the client needed straight catherization four times. Two scheduled, and the other two are up to the client (if she needs to void).

Mother suggested that perhaps we should wait until next nurse arrives (7-7:30pm). THe last time the client voided was 3pm, and had been spending time with the family until 6. I provided a bedpan for the client, and no avoid so I palpated the bladder to see how distended it was. It was distended, and I asked "Do you feel like you need to use the straight catheter?" At this point, I did tell her that her bladder was a little distended. The response I recieved was "I don't know I think I might, yeah." I attempted to steer her towards her mothers suggestion to wait for next nurse to arrive. However, she promptly told me "Sorry I don't think I can wait." So I initiated the straight catherization, and recieved about 350mL.

The following day, I was pulled aside by one of the parents inquiring why I needed to straight cath the client when the mother strictly communicated that she did not want her daughter cathed. Throughout the shift, the client's family gave me crass remarks about small things and miscommunication, and I felt like I was being treated like a child rather than a professional.

Sometimes I find it difficult to sum up what I'm trying to say. I am told to be quiet even though I have an expounded explanation for the issue at hand. Perhaps even a skilled babysitter. The careplan is rarely followed per client request, and I was asked not to call the doctor for clarification if I can just ask the parent questions.

I am told that my work is appreciated by the family but the way they have lashed out towards me when things do not go a certain way has indicated otherwise...

I've even been compared to other nurses they've had experiences with.

I'm not quite sure how to handle this as a relatively new RN to HH/Private duty industry. I know everyone has told me to chart like there's no tommorow, but should I consider switching clients or will this be the way most clients are in home health?

Edit: The company refers to their company as Home health, but the job is actually Private Duty Nursing.

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I would ask for a new case. I would also document EVERYTHING! and I mean every little thing.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

The above poster is right...home health = visits, PDN = hourly. You will get better answers from nurses in the PDN forum for sure.

My advice...document well, change cases, float to get experience. Its never a good idea to be a new nurse in PDN anyway. You can read why in the PDN forum. Agencies always give the worst cases first because that is all that is usually open. It takes a while to get into "good"cases. Good luck.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Your experience is not unusual, as working in the client"s home and adjusting to family routines (that are often at odds with the written plan of care and yet have become longstanding habit) is quite unique to private duty nursing.

I would really recommend reading through some threads in the PDN forum as a reference to see how others have dealt with similar issues. It may be too late to salvage this case, but you can learn from it and move on...best wishes!

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Personally, the whole "go sit upstairs for two hours" would have been the ledge that I jumped off of. Families can be how they are, but as a mom myself, if the care provider and the family cannot work together as a cohesive unit, the child doesn't get what they need. If you can figure out how to work with them, great. But, if you continue to work against each other perhaps it's time to move on if you can. I have a new family that I am working with and they don't always "tell" me everything (preferences, etc), but they never made it seem like it was MY error. They tell me how or what to do and it's all good and we move forward. I am still learning the ins and outs of the physical therapy and OT so that I can support those efforts. In other words, we are working well together for the good of the children.

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P.S. our agency calls itself "home health" as well, but is really private duty. Funny!

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It sounds like this family does not respect you as a professional. Move on.

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This was my first case with the company, and initially I felt that perhaps I was being 'too whiney,' and that it was my fault for them to talk me down like a child. I've worked at a facility before, and not once was I ever talked down like that (even by moody on call NPs).

I kept telling myself that I need to build thicker skin as a nurse, but this seems to be a vicious cycle with them.

After reading all of the comments, and threads relating to difficult families, I'm going to take it as a learning experience and shoot for another case.

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Specializes in Pediatric Private Duty; Camp Nursing.

I think a lot of us started PDN with a bad case, either psycho moms, difficult clients, hands-y dads, you name it...think of it as hazing! Try to get some other cases, float if you can. I put up w a disrespectful mom at first, it was horrible how she spoke to me. I left after a few weeks because I know I deserve better. And so do you. If somebody banished me to upstairs, I'd be right on the phone w my clinical manager, reporting that I'm being kept from doing my job. It sounds like fraud for them to have nursing care and not using you, just having you sit. An abuse of their benefits.

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