home health to a former primary?

[morebluetiful]

I have been taking care of a baby as his primary nurse for about 7 months. He will eventually be discharged with a trach/g-tube/home vent. I am thinking about offering/trying to get a job with his home health agency so I can take care of him at home part time in addition to my NICU job. I have heard of other NICU nurses who have done this, but I am undecided. Has anyone ever done this? What do you think about it?

[NicuGal, MSN, RN]

Personally I would not do this. I think this crosses some boundaries. Check with your legal department on their thoughts. And if you do this I would work thru an agency so that you are considered an employee and not a babysitter so that if something happens your butt is covered.

[babyNP., APRN]

Nooooooooooooooooo. Run far away.

You can go visit your little primary, but take care of them at home? It just reads as crossing boundaries and a little unsafe.

[denicu]

Years ago as a second income I did homecare and some of the clients were ex premies. I was employed by the agency so legally I was covered by them. There was not a conflict of interest. I just didnt like being in other peoples home so I have not done it in awhile. Recently, i worked in a unit that had many multiples and the parents were well off. The NM was always putting up signs in the lunch room from parents looking for nurses to help them at home.

[Bortaz, MSN, RN]

If the nurse was already working a 2nd job as a HH nurse, and was assigned this infant, would you all still see it as crossing boundaries? Is it just the fact that she's seeking out the contract and contact that you find inappropriate?

I've worked with several NICU nurses who had PT jobs at pedi HH agencies, and they frequently encountered former grads from our NICU.

[NicuGal, MSN, RN]

Our legal department really frowns on it. We just don't do it. Back before this we did have a few who did and found that the families only wanted them and found fault with all the other caregivers. You have to cut the cord somewhere and have the family be able to trust others with the care of their kiddo.

[JustBeachyNurse, LPN]

If the nurse was already working a 2nd job as a HH nurse, and was assigned this infant, would you all still see it as crossing boundaries? Is it just the fact that she's seeking out the contract and contact that you find inappropriate? I've worked with several NICU nurses who had PT jobs at pedi HH agencies, and they frequently encountered former grads from our NICU.

I think of it happens by chance and the NICU nurse happens to already be working PDN/pedi home health it's semi-random.

If a family specifically chooses an agency bedside Nurse Bortaz works there or Nurse Bortaz signs up for super duper pedi agency and requests to be assigned former NICU patient baby X it's a high risk for boundary issues.

I work pedi home health/private duty. Many of my patients are ex-preemies/NICU graduates.

We had one nurse sign up with my main agency to request a particular patient (there were issues at the local maternity ward and baby was transferred to her NICU) she felt bad for what happened and wanted to follow through with child. This did not go well as she had limited full family contact in the tertiary high level NICU as they were 45+ min from baby's home and there were transportation issues. She lasted about 9 months before being pulled from the case.

My primary patient is an ex-30 weeker. Many of the NICU nurses asked mom what agency she planned to use and if her insurance contracted directly with nurses as they wanted to continue working with the child. Mom states this made her very uncomfortable as she felt pressured to take on these nurses and it was all around awkward. It was a non issue as the nurses didn't realize they lived in a different area.

She now (3+ years later) states she almost felt bullied by these nurses who likely thought they were being helpful but mom was stressed. None worked for the agency that the insurance company initially chose and that agency discouraged nurses from "following patients" home post discharge.

[Bortaz, MSN, RN]

I've had several parents ask me about taking care of their kids post-NICU (including a set of parents who were both doctors at my hospital) but I always decline because 1. I only know neonates, not older babies and 2. Well, I'm lazy and don't want to work any more than I have to to stay full time.