What can I do?

[wonderbee, BSN, RN]

We have a patient who requires vac dressing changes 3x weekly. The house is dark and cluttered so much that the admitting nurse had to do her admission standing up. No effort was made by the caregiver sister to move anything so she could sit down. The patient has a hostile attitude but is not overtly threatening. He refuses to do his own simple heel dressing changes which are to be done daily. He waits for us. The windows are kept closed and there is no AC running. Both the caregiver and the patient smoke and the smoke hangs heavy all through the house. It takes an hour to complete his dressing changes. One step forward and one step back is just about the only room we have to work with. Twice nurses have left the house wretching from having to stand for so long and the poor air circulation. I was one of them. Every time I go in there, I perspire to the point of dripping. It's embarrassing and terribly uncomfortable.

I know we have to put up with some skanky conditions in HH. Is there anything can be done to make this a healthier situation for us nurses? What about the responsibilities of patients to provide a safe work situation?

[cookie102]

the conditions we go into sometimes i think we need battle pay....right now i don't have alot to offer but ,,,,,,,i would definetly bring in the MSW, for one thing patient safety is at risk...second is i would not be doing a daily dressing on the heel, get something that can be used 3 times a week and change it when you do the vac dressing,,,there are soooooooooo many new products out there that daily dressing have gone by the wayside....

[caliotter3]

You need to speak with the supervisor, case manager, or DOCS concerning getting the social worker involved for some help with this situation. Sometimes a supervising nurse with a strong personality can present possible courses of change to a client and family and achieve results. Sometimes it takes a concerted effort over a period of years. In the short time, about all you can do, whether or not you make a case to get other involvement, is to document your concerns. If you decide that the conditions are too much for you, then you must decide if you want to be taken off the case. If enough nurses refuse to work the case, then change will occur, or the agency won't be able to staff the case and will discharge the client and he can try to find another agency to deal with. I have worked with at least one client that went through at least 12 agencies in only 10 years (although in one case the agency closed). This case was so well known in the nursing community that nurses had built up a network to warn their friends not to go there or what to expect if they did. Eventually, there were no more agencies to take the case, and the client had to go to an institution. Sad, but probably could have been avoided. Good luck.