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Home health pediatric...demanding parent tips??

Private Duty   (11,080 Views 27 Comments)
by CrazyCatNurse CrazyCatNurse (New) New

917 Profile Views; 7 Posts

I am full time on a home health pediatric case. It's physically demanding--there are frequent dirty diapers and the kid weighs 150 pounds or so. So it's transfer him to bed, change him, back to wheelchair--five times in five hours yesterday.

Anyways, the family expects the nurses to be always interacting with their child. I understand their point of view--they want maximum stimulation with this child so hopefully the comatose state goes away.

But they want me massaging, doing range of motion, talking, reading to, rubbing the head of, singing to, stretching...something all the time. For 12 hrs. Yes, they let me eat and have bathroom breaks but that's about it.

I'd just transferred the patient to bed, undressed him, inserted suppository, started tube feeding, put splints on feet... And I sat down and was catching my breath. Mom comes in with a fat stack of papers for me to read to her kid, "instead of sitting idle" because "nurse so and so would do this!" she cheerily suggested. She demanded my cell number. She didn't even ask if I was comfortable with it. Since she will get it anyway--I'll have to call her on my cell sometime, I gave it to her. And I read to her kid.

I don't want to tick her off, but I can't do this all day. I feel the family has unreasonable expectations; plus I'm not good at one-sided conversations. And my throat gets sore talking so much.

How can I tactfully set boundaries and appropriate expectations?

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systoly has 23 years experience and specializes in LTC, Memory loss, PDN.

1,756 Posts; 12,250 Profile Views

you don't have to give out your cell number

and you don't have to call anyone other than your employer from your personal cell

if there's no land line at the residence and you need to communicate with the pcg

call your agency and have them contact the pcg

if mom wants you to contact her directly, she is free to install a landline or provide

nurses with a phone

as far as activities are concerned, that should be spelled put in the 485

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,281 Profile Views

I am full time on a home health pediatric case. It's physically demanding--there are frequent dirty diapers and the kid weighs 150 pounds or so. So it's transfer him to bed, change him, back to wheelchair--five times in five hours yesterday.

Anyways, the family expects the nurses to be always interacting with their child. I understand their point of view--they want maximum stimulation with this child so hopefully the comatose state goes away.

But they want me massaging, doing range of motion, talking, reading to, rubbing the head of, singing to, stretching...something all the time. For 12 hrs. Yes, they let me eat and have bathroom breaks but that's about it.

I'd just transferred the patient to bed, undressed him, inserted suppository, started tube feeding, put splints on feet... And I sat down and was catching my breath. Mom comes in with a fat stack of papers for me to read to her kid, "instead of sitting idle" because "nurse so and so would do this!" she cheerily suggested. She demanded my cell number. She didn't even ask if I was comfortable with it. Since she will get it anyway--I'll have to call her on my cell sometime, I gave it to her. And I read to her kid.

I don't want to tick her off, but I can't do this all day. I feel the family has unreasonable expectations; plus I'm not good at one-sided conversations. And my throat gets sore talking so much.

How can I tactfully set boundaries and appropriate expectations?

Oh wow, where to start. I've dealt with this type plenty of times. The family is being unrealistic in their expectations. They are probably doing it because it's the only control they have. The agency failed in explaining to the family that we are there to do nursing. Any time I hear the words "the other nurse does it", it is a red flag. That is manipulation and a parent that will play nurse vs nurse. All the nurses and the agency will need to create a boundary wall so the parent won't continue to cross the line. You should inform your agency that you were pressured to give your number out. Communication should be between the office and you or the parent and the office. That is an important boundary when dealing with this type of parent. I have an option on my phone to block my number when I must call a parent like this. Talk to your agency about changing cases or cutting back on this case or you will be burned out fast! Or the family will complain to the agency and it will look bad on you even if you did no wrong. I'm sure this family has had a high turnover. Don't feel guilty or feel like you aren't being loyal. The family has done this to themselves and it probably was an easy case to get on to...another sign something is wrong. Good luck and take care of yourself!

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NottaSpringChik has 7 years experience as a BSN, RN.

183 Posts; 9,282 Profile Views

Great advice and information, SDALPN!! I am fairly new to PDN and my first case was, well, as SDALPN described, "easy to get on...." I did my best but the woman ended up saying she didn't want me. What I had done right was to let my agency know what the situation was there and I told them I would continue the job but wanted them to know what was going on. They told me the problems I was having were not new ones or unique to me. So, when the client kicked me off of the case, they put me on another one and it is great!! Easier care, nice, nice family. So the client did me a great favor by kicking me off of her case, actually. I'm sure the agency would have left me there because they often don't have nurses for this case. Many nurses won't stay on it. I guess I was just stubborn enough the woman ended up asking me to leave instead of me quitting her. She has a few nurses she does like, and as SDALPN mentioned, she plays nurses against each other. It's quite the little clique, which isn't helpful in the least.

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Adele_Michal7 has 5 years experience as a ASN, RN and specializes in Pediatric.

893 Posts; 8,322 Profile Views

Ugh that sounds like a nightmare! As a 3 year "veteran" in pedi private duty, I've run across or heard of a few cases like this. I kind of find it ludicrous. I mean really? Of course you need to provide all care required: all meds, all treatments, reposition, etc. a fair amount of stimulation is good and expected. But to expect a nurse to provide constant mental stimulation to a comatose patient is, IMO, crazy.

As far as the parent saying "Nurse so and so did it". Hate that crap. I would def talk to your agency and use them as a mediator. If guidelines aren't spelled out from the get go things wont improve.

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7 Posts; 917 Profile Views

Talked to DON. Turns out they promised the family we would read/provide stimulation to the kid during down times. Great. There is no other case at this agency. I'm looking elsewhere, but what they're hiring for out here is LTC, case mngt, or nights.

DON suggested I take breaks by going outside. This kid's head flops out of headrest in 5 minutes, and he randomly vomits and aspirates. No, I will not be going outside.

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,281 Profile Views

Talked to DON. Turns out they promised the family we would read/provide stimulation to the kid during down times. Great. There is no other case at this agency. I'm looking elsewhere, but what they're hiring for out here is LTC, case mngt, or nights.

DON suggested I take breaks by going outside. This kid's head flops out of headrest in 5 minutes, and he randomly vomits and aspirates. No, I will not be going outside.

Sounds like you are cornered. And sounds like the agency really can't afford to lose the case and has no backbone. They are they type to put the families first and the nurses last. I would keep my foot in the door with that agency and find another agency. But if you must keep a steady income I'd stay on the case and look for work in spare time. If the family has that much time to keep that close of an eye on you, they have time to take care of the kid.

If you choose or are forced to fight the battle, you could mention it to the Dr. Sometimes the Dr can intervene by giving the family a reality check or by discussing the families control issues. Either way the Dr will be aware of the family dynamics which could be helpful in the future.

Good luck! We've all been there. It's them, not you :-)

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NyteshiftLVN has 7 years experience and specializes in Lvn to RN, new grad med/surg.

70 Posts; 4,297 Profile Views

I know the feeling, but in my own mind... I didn't go to clown college. Although I'm sure it would have been a lot less expensive. I would have told them well if you promised to do it... be my guest (okay probably not, but I would have thought it!). Realistically 12 hours is a lot on the voice and sounds really absurd to me. Like as suggested if the parents have so much time to be watching you every second, why don't they read to the kid? I agree with the looking elsewhere because this sounds drastically miserable.

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systoly has 23 years experience and specializes in LTC, Memory loss, PDN.

1,756 Posts; 12,250 Profile Views

if i had to play nice, i'd say i'll be happy to use books on tapes

you can get them at the library

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,281 Profile Views

if i had to play nice, i'd say i'll be happy to use books on tapes

you can get them at the library

Well played! I must remember that one! That made me smile!

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PerfectlyPlump is a ADN, RN and specializes in Peds, developmental disability.

181 Posts; 5,665 Profile Views

Books on tape would be perfect, and age-appropriate music also would be fine stimulation. A fair expectation would be to sing as and converse with the child while you do ROM, oral care, bathe and peri care, let's say, for ten minutes every hour. But continuous talk would not be possible, even if he were responsive! No parent and no teacher would ever do that. Any child needs some quiet time, and time to rest!

Sometimes parents are in major denial about the recovery potential that their child has.

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Adele_Michal7 has 5 years experience as a ASN, RN and specializes in Pediatric.

893 Posts; 8,322 Profile Views

The books on tape is a great suggestion. You cant be expected to do active entertaining through your entire shift. You also need time to eat, use restroom, CHART.... And the patient needs downtime as well. Some of those parents are honestly just ridiculous

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