How do I deal with this patient's family members?

[morango576]

I am a CNA in FL and would like you nurses opinion on this matter, if you will.

I have been with this Home Health Agency since December, and have had this particular patient for 5 months now. She has Dementia, but mostly independent requiring supervision on a variety of tasks and activities.

We get along REALLY well. She likes me a lot and always tells me "thanks for making my day so bright" everytime I leave her house. I also like her a lot. We have fun together...

Anyway, she lives with her son who is bound to a wheelchair because of a car accident yrs ago. He does mostly everything for himself. At first he didn't bother us at all. But lately he's got into a crazy mood (I think he's jealous of us having too much fun :angryfire), and he's doing everything he can to either slow down my tasks or prevent me from doing it. The other day he said I could not wash her clothes, and she had wet her bed really bed. I stuck R (Refused) on my Daily chart for that day (laundry). Then another day he told me to go easy on the paper towels (he doesn't just say it.. he YELLS at me). Then I started using one of my patient's hand towel as a bib, instead of "wasting" his paper towels. He comes around her and SNATCHES the towel out of her chest... to which my patient turned to me in a desperate face... I told him to leave the towel where it was. He turns to me and yells "WHY?". I told him he had told me to not use the paper towels, he said "for this you can use". I said "I prefer using the towel because it shields it better all the way down to her legs"... because she makes a big mess especially on cereal days! Anyway, another day he came around the table, where my patient was sitting and eating lunch and I was sitting on the chair right next to her, he whams her against the table, trying to push her chair closer to the table (it wasn't that far away)... she screamed in terror! The only thing that came out of my mouth was "OH GOSH!". I could NOT believe what he had done. The way he treats his mom. The way he gets in between us.

Well, I told his sister -- my patient's younger daughter who lives 6 houses away on the same street -- all about this, that her brother is being an old fart, he tells me not to feed her this or that (things that she usually eats but now somehow he forbids her!), and the sister told me "please don't call your agency and tell these things, because if you do, I will have to drop your agency". I had told her I was unhappy with the conditions I was having now, all of a sudden her brother puts on a mood and creates a big problem for us. The one who pays for it is my patient and I'm very concerned. I'm there to do my job, whatever is on my aide Assignment sheet by my RN supervisor, I'm following it to the letter. I'm never late, I never miss work, I take my work very seriously, I enjoy what I do and excuse me -- but I do a DAMN good job! I'm proud of it! But at the same time I don't know how to deal with this old fart that is unhappy about life and is jealous that his mom and I are enjoying the time we have together... we walk, we watch TV, we play games together, we read, we laugh and tell jokes... I don't know why a family member could have a reason for a complaint about this! Anyway, I need the hours too as I am going to start nursing school now in May, and to be honest... I'm not ready to quit my job just yet, because like I said, I'm enjoying it very much. But I don't know how long I can stand this situation with the family members. I don't want to get in their business... the sister keeps telling me that her brother because of the accident, blahblahblah, that I have to have patience with him... I told her "I don't have to have anything for him... he's not my patient... I just want him to leave me alone so I can do my job properly"! Am I asking too much????

Tomorrow I have to go there again in the morning, and after that I'm going to my agency to drop paperwork for the week... but I am very tempted to tell the supervisor there about these things. But at the same time I'm afraid I won't have this patient anymore. I like her and I think she deserves the care I'm giving her. And I count on these weekly hours... I don't know if I can get another patient like her again.

What do you nurses think of my dilemma???? Should I put up with this problem or what?

Thanks a lot for reading... sorry it was too long!

[morango576]

I went by my agency today to drop my paperwork for the week and get my check... everybody was so busy that I did not have a chance to talk to my RN supervisor.

I have really been thinking about what to do... I want to keep this patient because 1-I really like her and she likes me (she's worth every minute of my time and energy) and 2-I need to keep my schedule and hours. I am counting on these hours for my pay, and this is helping me to pay for my nursing school. I am afraid of a big change right now. I will inform my agency but at the same time I'm hoping they will let me keep this patient for the reasons listed above.

[morango576]

thanks Muffin! Yes, I'm definitely documenting everything and keeping my agency informed.

[caliotter3]

If something catastrophic happens with this patient and you are involved, your entire future in nursing could be affected. Ask your staffing coordinator about new cases. Be proactive with your schedule but at the same time you must protect your ability to work. You may leave this case involuntarily and then you will regret not having taken the initiative to go on your own. And just because you report your misgivings to your supervisor does not mean you will be pulled from the case. Whether or not you stay with the case, you are obligated to inform your supervisory staff about what is going on at this home.

[morango576]

I understand what you talking about... I'm scared about something really bad happens with my patient.

My patient keeps having bruises all over her body, especially arms and hands and back, and I have already reported many times. I asked my nurse supervisor if this is common with dementia patients, or what else it could be. (I'm new at this whole CNA thing... learning...) She said it's pretty common, maybe the patient is hurting herself, bumping on walls, etc. When I am with my patient, she points the bruises to me all the time and says "look at these... ".... and I've asked her "How did you get these? Do you remember?". One time we were completely alone and she started saying that "look at these" again and I looked her in the eye and asked "How did you get these? is anyone doing this to you? Or are you bumping on something?". She said "no, no... I don't remember". So this is very frequent, although I've informed my RN and the office manager, have filed paperwork about that, etc. I don't know if they are doing anything about that or what. I know I did my part of informing them. Anyway, one time the agency called Ms. X's daughter, and talked to her about the bruises and told her that I was concerned and that I had to report the bruises to them. Oh that woman was ******!!!!:angryfire She threw a fit when I got there for my shift, I thought about just leaving and calling my agency... but I stayed because I wanted to keep my job. Oh but boy did I hear from her!! Anyway, I don't know if the agency should have told her the way they did, I don't know why they had to call her to let her know I reported the bruises.... naturally the daughter got upset and took it personally, whether if something really happened or not. So the problem started right there. But then time passed a bit and things started getting a little better. Now is Bozo the son making things harder for me to work, creating situations. I used to look forward to going there on Mondays, starting the week with Ms. X and enjoy working for her, but now I dread it. I don't know if the daughter is going to be in a mood, or Ms. X shows up with more bruises, and automatically the daughter keeps giving foolish excuses for it, or Bozo is going to make up something to make my day miserable with Ms. X. Ms. X is worthy of my time and everything good I can give her during the time we spend together, but I don't know if I should just ask the agency to quit going there to avoid further problems... thats my dilemma...thanks everyone for reading and giving your feedback, really appreciate it:up:

[caliotter3]

You are making the mistake of hanging on to this case because you need a job. Go to another agency and sign up for a case that complements your time on this case. If you work five days a week there, then sign on for two days a week at the other agency. Then check with the staffing coordinator at the first agency on a frequent basis, say twice a week minimum. Tell her/him you need to find a new case. Inform your supervisor that you can no longer work on this case and that insert date will be your last day on the case. Let the sister give her excuses and diatribes to another. You take care of you. There are other cases out there if you make the effort to find them.

[morango576]

Callioter, thanks for the wise words... I was already looking online for other agencies in my area. I am concerned that my agency might not be taking my reports seriously... maybe they are? I know that these things don't look normal and things keep happening that make no sense and I get stressed out to the limit. I want the best for my patients and I want to work team work with everybody, agency and family and myself, but I'm not getting it and I get frustrated. I thought about going private duty, what do you think?

[caliotter3]

Private duty is not a good idea overall because you really will have no backup. If I were you I would stick with agencies. It is hard for an outside person to tell whether or not your agency personnel are taking your reports seriously or not. They may be, they may be blowing you off. At this point in time, the important statement you make in your post is that this is causing you undue stress. It seems you are the only one stressed about this. You need your health to continue to work. Many home health workers sign on with multiple agencies, as many as four. You should have no problem keeping working if you sign on with more than one agency. Good luck.

[morango576]

Wow! I did not know people worked for so many agencies!!

Well, I am looking. Most agencies around my city want experienced CNAs... I am close to the 6-month mark of experience. I will keep trying. At least I think my agency can give a good reference about me... (I hope!! )

Thanks so much!!!!!

[morango576]

just another question that just popped into my mind: Don't agencies have kind of a conflict if you work for another one? How does that really work?

[caliotter3]

You can work for as many agencies at one time as you care to. There is no conflict unless two agencies are handling the same case and you are an employee of both. In that case, in order to avoid problems you should not work for the same client with two different agencies. I can assure you there will be problems if you do this. The agencies will not cooperate with each other and the employees are caught in the middle. This situation is highly unlikely and you can avoid such cases.

[nursel56]

Hi Morango! Thanks for keeping us updated on what's going on with your patient. I have just a couple of thoughts on it. First, you have done what is the hardest thing. You informed your supervisor of the situation when you knew it could result in your having to 1) leave a case that you really, really don't want to leave and 2) risk the family being even more angry with you than they already were. Yes, I know that's what we're supposed to do but that doesn't mean it's easy!!

I don't know what exactly the laws are in Florida regarding this, but in my state, the RN supervisor would have to visit the patient once a month, and she would need to authorize a plan of care that covers a three month period that the patient's doctor would have to review and sign. The RN supervisor would need input from the caregivers to make sure the plan of care is accurate. She is the communication link between you and the patient's doctor and would be obligated to inform him/her of what you told her re: bruises, etc. Hopefully she's already done that.

Not a good thing that she told the family it was you who reported it even if they could have figured that out on their own. Put's you on the spot, huh? Oh well, you're pretty brave with that family even though they sound like pain in the ***!!!!:angryfire Good job:up::redpinkhe

[muffin7]

Your nurse supervisor is WRONG!!!!!!!! bruising is not a normal part of dementia. It appears as though your supervisor doesn't want to get involved.

I do think you should find another agency and at the same be a patient advocate. You need to make a report to Adult Protective Services, ASAP!!!!!!!!!