Help

caliotter3 · Jan 22, 2008

If you feel uncomfortable about talking to the client about this or do not think that asserting yourself in this manner would cause any change and the situation is just getting to you, then go to your supervisor and staffing coordinators and arrange to be removed from the case. Hopefully, the agency will have other openings on other cases to keep you employed. Let them know the reason why so they will be aware of how you wish to be treated and why they are having problems keeping nurses on this particular case. You should have heard how a wealthy very sick man talked to me one time when I was new to hh. As I left for the last time, I complimented the housekeeper at the door on her ability to accept verbal abuse.

caliotter3 · Jan 22, 2008

Oh, I forgot to address "light housekeeping". You can set the parameters here also. You are only responsible for the immediate area that the patient occupies and only for any laundry that is only the patient's. How much you want to get into the chore of cleaning is up to you. Always tell the client at the beginning that you are there to perform skilled nursing tasks first and housekeeping is last on your list of priorities and gets done by you only if you have completed everything else, to include the cleaning of patient medical equipment (like vent circuits). If a place is deplorable, I might get involved to a degree. But it would be better to notify your agency of the need for a social worker or agency supervisor to intervene for housekeeping services.

Southernurse · Jan 23, 2008

thank you! it makes me feel so bad that i am feeling sub-par in my skills.

caliotter3 · Jan 23, 2008

You're not sup par in your skills. You are just not used to the sense of entitlement and sense of being in total control that many housebound patients develop over the years of being catered to in their own homes. I doubt that this patient would be this demanding if he were on a short stay in an acute setting. You only have to learn how to be assertive, preferably tactfully, without angering the patient. He will learn that he can't walk all over you, or he will get a nurse that he can walk all over. The same goes for the family members. It's all part of hh.

jnette, ASN, EMT-I · Jan 23, 2008

hmm.. never thought of this aspect of it. I guess in "case" work, one might run into this. In HH where you simply do so many "visits" per day, this is never an issue as we are only there for half hour several x/wk.

I guess for those pts. who have a nurse in the home daily for alloted hours per day, it might be easy to become "somewhat spoiled" and begin seeing the nurse as the all around "everything" person.

momof4ndocswife · Jan 25, 2008

Interesting.... I'm a 52 yr old "new grad" with my 2nd college degree (BSN), earned 30 years after earning a BS in Biology in 1977. I decided to go into nursing so I could spend time with patients, etc. but found the only jobs really open to "new grads" are in the hospital. I've mostly been doing volunteer work in recent years, while raising 4 children, so returning to the work force has been a rude awakening. I'm finding that hospital patients ALSO demonstrate a real attitude of entitlement. Whenever I'm in their room to change a dressing, give meds, etc. they ask me to clean up their room, adjust the lights "7 thermostat, get items from their drawers and personal clothing, take out the trash, etc. I came into the profession to serve patients, but I often wish they'd just give me a chance to do that before they start ordering me about. Before I finish my nursing skills, they are already making other demands.

I'm wondering if this is simply the nature of human nature... no matter where the patient is located.

jnette, ASN, EMT-I · Jan 25, 2008

Jeanie.. I suppose a lot depends on geographical location, too. I am just fortunate enough to live in a part of the country where this sense of "entitlement" is not prevalent, but where patients are still kind, thoughtful, and grateful for what we do for them. So refreshing. :)

I, too, was a "late bloomer" as far as finally persuing my RN.. graduated at 52 myself like you....and HH is really nursing's best kept secret!

I hear a lot about "shift" or "case" work, but I don't think I'd care for that. I do enjoy my 5-7 visits per day, however. Half hour visits, nice folks who are genuinely pleased to see you. Love it.

Wish you the best!

momof4ndocswife · Jan 25, 2008

Jnette,

How log have you been in HH? I really do think that's where I'll more than likely find my niche. I hate all of this racing about in the hospital, although I'm grateful for the "hands-on" nursing skill experience I'm gaining on the floor. 'Have to admit that I really didn't get a lot of variety of nursing skill experience during school clinicals. 'Seemed like we did the same thing day after day. I'd definitely being challenged... stretched.

I interned on this general surgical floor and also on a cardiac PCU floor. There were no job openings on the PCU and this general surgical floor had a position come open during my last week of internship. I accepted the offer, although I could tell the nurse manager was "concerned" about my age and stamina. I felt a little defensive and was determined to prove my worth. I also wanted to learn all I could on this floor. I just had no idea how challenging it would be... or the pace! My, oh my!

Some friends from PCU called and told me they might have an available opening soon and want me to consider a transfer. IT's tempting b/c I think my values more resonate with the staff on that floor, and the pace isn't has hectic... unless someone goes down the tubes. It's a critical care floor, so it can still become quite tense.

After reading through some of the postings, however, it looks like this gen surg floor may provide the best training for a future in HH. PCU does get a variety of patients since anyone from the hospital with heart issues is sent there short term. THe PCU floor isn't as large, so I felt more efficient with time use since I didn't have such long/wide hallways to traverse from one end of the floor to the other. The staff was closer and more personable on PCU, too. There seemed to be more mature nurses on PCU, but even the younger nurses were more interested in the patients than procedures. I find on the surgical floor, nurses often mirror the personality of the attending surgeons. They often tell me the goal is to get in and out of pt's rooms as quickly as possible. That's not what I thought was a nursing goal . Interesting. Real world nursing is definitely different from school!

Congratulations for succeeding at late-life transitions. Thanks for sharing. Gives me encouragement and impetus to hang tough!

Any advice?

jnette, ASN, EMT-I · Jan 25, 2008

I'm with you... no way would I consider hospital nursing in this day and age of staffing ratios, and all the demands made on nurses. There simply isn't enough time in your day to do what we all went to school for thinking we would want to (and hoped we WOULD ) DO as a nurse.

I worked in dialysis for nearly ten years.. first as a PCT while I went to school and persued my nursing degree, then as staff nurse at the same dialysis facility.

Two years ago I moved on to HH, and it was the best decision I have made for myself.. (besides finally going after my degree!)

At least in HH I can feel like a NURSE in so many more ways than simply pushing meds. I can spend all the time I want with my patients, have plenty of time to do all the teaching I want..you can joke and laugh and carry on with them.. weep with them, too.

Being on their turf is special..and knowing they graciously welcome you into their home makes it even more so. You get to see each patient as an individual.. each as different and unique as thier home decor. Not merely another "face" or "room # in a johnny coat" as in the hospital setting.

Between visits you have the freedom of the backroads, your choice of music in your car, your coffee, stash of chocolates ..or whatever. No one breathing down your neck, no maddening, crazy pace to keep up with, no "attitudes" to deal with. The autonomy is so liberating.. as is taking in the scenery as you go from one home setting to the next. :up:

And if you need to run in to the grocery store or post office between visits, that's just fine, too. Want to stop for a burger or frozen yogurt along the way? No problem.

And still get home before two pm and have the rest of the day to yourself.

Just can't beat it ! :w00t:

Southernurse · Jan 27, 2008

i spend 12 hrs a day in the client's home, tending to all the needs. i guess when there is a nurse there 7 days a week, 12 hours a day, one can get used to their demands being met. i have no issue with doing anything for a client...actually i agree with jeanette that you can actually do all of the things you are taught to do at school because you have the luxury of time. i am referring to the ones who are giving up coughing because you are there and ready with the suction machine. (of course, it is encouraged while the machine is turned on and prep is done.) i am referring to the ones that though they are capable of getting oob for brp just go all over themselves because you are there to clean them up. for a nurse like me to finally say, "hey! you're taking advantage of me!" is huge. is this my life lesson to get out of the evil habit of being a doormat?