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

[Stressismyname]

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.

[Kooky Korky, BSN, RN]

I think the family is just nervous because you are new to them.

If they don't begin to trust you, move on.

[CloudySue]

Make sure you have the client's clinical manager's name and have the best phone number ready to call her. (Some give out their cell numbers but many want you to call the office, which is the standard procedure usually.) Call her if you have any concerns. Let her know regularly if you are being kept from following the MAR. Document when the family is noncompliant. If you have regular documentation that you did the best you could, you are protecting yourself. I don't see you losing your license over this. If you do a straight cath, and the client requests it, and the care plan allows it, and you document well, you are good.

Why didn't you just have your client ask her mom directly? Just be like, "Well, I think we should check w mom, she said to wait, so let's just keep her in the loop and let her know you want to be cathed now. OK?" If this mom is like this with every nurse, the client knows all too well that mom is touchy and would probably like to help you sidestep any problems as well. I'm sure she'd be willing to help be a buffer between you and the mom.

[KATRN78]

Do you get the switch or sent to the corner when Mom disapproves of you too?

[Stressismyname]

The thing is...I did tell her what her mom wanted, and that perhaps "we should wait for the NOC nurse to come on for this." She speaks in a very soft tone, but the parents heard me ask about the straight cath, but did not intervene.

In a way yes, the mom does the same thing (corner sit), but she tells her husband to sit me down on her behalf. Sometimes she is comfortable with telling nurses what she wants directly, and sometimes she does not. Some cares they allow me to do without having to triple check every time (check mom, dad, and then client). Some cares they don't but aren't necessarily always clear about it. Father told me the client "directs her cares at all times."

[eeffoc_emmig]

It doesn't sound like they really need nursing services. What they DO need is family therapy.

[CloudySue]

Some families can handle having nurses in their home. These families embrace them, make them comfortable, and treat them like family. They appreciate the extra pair of eyeballs, place trust in their professional abilities, and sleep soundly, knowing they can "check out" for a full 8 hours for some well-deserved respite. They would rather things be perfect, but realize that this is the hand they were dealt in life, and try and make the best of it. They appreciate the nursing services that help put some normalcy back into their lives. So they are kind to their nurses. They say "thank you". They make the workspace comfortable. They give you some "privileges" like microwave and refrigerator use, and if you're really lucky, you can use their Keurig, wifi password, and massage chair. These are the types of families for whom I would drive through a snowstorm.

Other families experience great anxiety having a stranger invading their personal space. They have trust issues. They feel guilt in not being "supermom" able to do it all. They resent nurses being the one to comfort their crying baby in the middle of the night. They have control issues, they must be in charge of every move made. They have anger issues, and there's no one to be angry at, so they focus it all on the nurse, who is the outsider who would not be there at all if things went the way they had planned in life. So they make things worse for the nurse. They restrict a nurse's actions, belittle their work, criticize, hover, spy. Refuse to provide basic things like a chair or a light. The problem with this treatment is that they don't realize they chase good nurses away. No self-respecting nurse puts up with that. So they end up with an endless parade of new and/or mediocre nurses and the family becomes even more unhappy and unbearable. You cannot educate these people, cannot change them. The only thing you can do is have the self-respect to refuse the case, and move on.

[eeffoc_emmig]

Some families can handle having nurses in their home. These families embrace them, make them comfortable, and treat them like family. They appreciate the extra pair of eyeballs, place trust in their professional abilities, and sleep soundly, knowing they can "check out" for a full 8 hours for some well-deserved respite. They would rather things be perfect, but realize that this is the hand they were dealt in life, and try and make the best of it. They appreciate the nursing services that help put some normalcy back into their lives. So they are kind to their nurses. They say "thank you". They make the workspace comfortable. They give you some "privileges" like microwave and refrigerator use, and if you're really lucky, you can use their Keurig, wifi password, and massage chair. These are the types of families for whom I would drive through a snowstorm.

Other families experience great anxiety having a stranger invading their personal space. They have trust issues. They feel guilt in not being "supermom" able to do it all. They resent nurses being the one to comfort their crying baby in the middle of the night. They have control issues, they must be in charge of every move made. They have anger issues, and there's no one to be angry at, so they focus it all on the nurse, who is the outsider who would not be there at all if things went the way they had planned in life. So they make things worse for the nurse. They restrict a nurse's actions, belittle their work, criticize, hover, spy. Refuse to provide basic things like a chair or a light. The problem with this treatment is that they don't realize they chase good nurses away. No self-respecting nurse puts up with that. So they end up with an endless parade of new and/or mediocre nurses and the family becomes even more unhappy and unbearable. You cannot educate these people, cannot change them. The only thing you can do is have the self-respect to refuse the case, and move on.

^^^ Perfectly stated! ^^^