Home health nurses rights...

[TaylorMaidRn]

Today I conducted a HH visit on a patient I had not previously seen before. While assessing this patient I noticed that the patient was OBVIOUSLY under the influence of drugs. Having made myself familiar with this patient's med list in preparation for the visit, I knew that the patient was not taking any medications that would account for this behavior, and the pt denied any new medications. The pt also did not have any medical diagnoses that would account for this behavior either. Also, I am a former ER/Trauma nurse that has a sixth sense for identifying drug abusers.

Then, during the visit, another individual came to his door and what I suspect was a drug deal occurred (I could not adequately see/identify the substance that was exchanged for money).

I gave report to my boss and explained what I had seen later in the day and the response I received was that it was basically well-known and that the patient had been doing this through the entire time as a pt with our company. It was also noted that the nurse admitting the patient had the same experience and reported it, but the hh agency admitted him anyway. I also found this person's arrest history on a public database and he has been convicted of 9 felonies and several misdemeanors ranging from hit and run to assault to drug possession and intent to deliver.

I told my boss that I do not feel comfortable going to the patient's home again, and the response I got was basically "too bad".

I have looked all over and cannot find any literature detailing what nurses rights are in a situation like this. So my questions are:

1. Did the hh agency have the right to send me into what I call an unsafe situation without warning me?

2. Do I have the right to refuse being put into this unsafe situation again?

3. What are my duties in reporting this to police or sbon?

Any info would be greatly appreciated as I'm truly perplexed on how to deal with this!

[homehealth_rn]

I would absolutely REFUSE to go back!!! Your agency should put your safety first! I had a situation in which I suspected a patient's son was running a meth lab in her home. I spoke with management and we reported it to the sheriff's office and did not return to the home. We also called APS. You should d/c due to unsafe home environment and your agency should back you up on this.

[caliotter3]

I believe I have read somewhere that you have no duty to report lawbreaking (with the exception of abuse reporting, of course). Don't quote me on that one, my recollections are not clear. As for the other questions, I have experience. My employer did not give me any warning. Par for the course. It turned out that I had the right to look for new employment with the added employer-provided assistance of being blacklisted. If I were you, based on the information you posted, I would find a new agency. These people have no concern for you and they are telling you so. Forewarned is forearmed.

[KateRN1]

Check with your state board of nursing, but as a general rule, nurses are not obligated to report any behavior other than abuse/neglect. However, you do have a right to be reasonably safe in your work environment. Your first steps should be to review your employee handbook, the patient rights and responsbilities, and your agency's policies and procedures. Our agency has a statement in each of those places that indicates that we will not take any patient under care who is knowingly engaging in illegal behavior. If you can find this "ammunition" in the agency's documents, you have cause to refuse to continue to see this patient. If your supervisor continues to insist that you go and you have a corporate office or a compliance officer, that is your next possible option. After that, you may want to consider discussing the situation with a law enforcement officer being careful not to violate HIPAA regulations.

For what it's worth, I have had this situation and promptly discharged the patient.

[TaylorMaidRn]

Thanks for all of your replies and support! I actually had another talk with my boss today at work and kindly reviewed the situation with her and told her I absolutely would not go back to the home and that I would inform all of the nurses working for the company of the situation and I'm sure none of them will be willing to go either (I wasn't going to let them walk into that situation unknowingly). He will be discharged next week! Wheeew!