Home Health Boundaries Advice

[JaneDoeDoe, LPN, LVN]

Hi, I am a home health nurse and have been working with a family for a couple of years. The family and I have grown very comfortable with each other over the years. But lately, I feel as if more is being required from me than nursing. Recently, the caregiver has put all of the responsibility of doing my patient's laundry onto me. Whenever I do not get around to doing it, I can tell that they are upset with me. One time they had made a complaint about not being able to find something that is only used by them at night when I am not on shift, and made a comment about laundry being piled up and seemed pretty annoyed. I did not get to laundry that day as I was busy and the next day, they had made the same complaint. When I do laundry on Friday and it is in the dryer whenever I leave shift that day, I come back on Monday and the same clothes are in a big pile sitting there waiting for me right when I walk in the door. I do not mind doing the patient's laundry at times but the responsibility is solely on me now and if I don't do it, it doesn't get done. I am also expected to feed their pets during the day. They ask me to do different tasks for them. And sometimes when I am asked these things, it's in a demanding way. More of a statement than a question, no please or thank you. Sometimes I feel like I am a maid/housekeeper/personal assistant rather than a nurse. I want to try to handle this conflict on my own first but how the caregiver responds to a lot of things isn't always the best. We used to bump heads a lot when I first started working with them. I would like to talk to my supervisor about it but again, I know it would make things uncomfortable between me and the caregiver as they will know it is me making the complaint. I love my job and working with my patient, but I just don't know how much more I can take. I have held my tongue back a lot over the years and have been professional. I am just unsure how to go about things. Any advice would be greatly appreciated!

[Julia Liou, RN]

It sounds like you're in a tough spot, feeling stretched beyond your professional duties. It's important to remember that your primary role is a nurse, not a housekeeper or personal assistant. Addressing this issue directly with the family may seem daunting, but setting clear boundaries is essential for your job satisfaction and mental well-being.

A good first step might be to have a calm and honest conversation with the caregiver. Clearly outline your responsibilities as defined by your job description, and politely but firmly explain that your nursing duties must take priority. It could be helpful to prepare a list of typical nursing tasks and non-nursing tasks that have been added to your workload, so you can clearly demonstrate how the additional responsibilities are affecting your ability to perform your primary role effectively.

If the conversation doesn't lead to a change, or if you feel it might jeopardize your relationship with the caregiver, it might be necessary to involve your supervisor. It's part of their role to ensure that work conditions allow you to perform your job effectively. Although it might be uncomfortable, your supervisor can help mediate and set clear boundaries with the family.

Remember, it's important to maintain professional boundaries to prevent burnout and ensure you can provide the best care to your patient. You deserve to work in an environment that respects your expertise and limits as a healthcare professional.

[beachynurse, ASN, BSN]

I used to manage a Home Care department in a Home Health agency. I don't know how long you are there, but we always prepared a care plan for our home care patients which did include any household responsibilities. You would be responsible for the patients area only, unless you prepare meals for her/him. You would need to keep their room tidy, prepare meals, patient laundry- no family laundry, change bed linens, clean up the kitchen after you prepare the patients meal, and patient's meals only. You would never be responsible for a family pet. 

In my years at that position, I always found that families will take a mile if you give them a couple of inches. They will ask for a favor and then it becomes expected. The easiest way to not have to deal with this is to tell the family that you are only able to follow the care plan that your supervisor developed, and do just that. Because you have been doing this for a while, you might need to have your supervisor help extract you from doing the extra work. Good luck!