"I have an ethical problem"

[Emergent]

This was really cute. We have a wonderful young nurse cross training in our ER, she was really helpful yesterday. So she approaches one of us, asking where the charge nurse is. My colleague said ''what do you need, maybe I can help?''

So she says "I have an ethical problem", and proceeds to tell us that she is discharging a patient who is homeless, and doesn't feel comfortable with that, and wanted to find him resources, etc.

Out of the mouths of babes. We told her that we get homeless patients all the time, that we can't solve all their problems for them. If they come to the ER homeless, they leave homeless, that we tell them to go to The Mission for guidance.

She was rather taken aback, I saw shock on her idealistic, fresh young face. I think she was thinking maybe ER is not for her after all.

[weirdscience]

I had one guy, 85 years old, demented (MoCA of

85 years of age,dementia, and homeless? Yikes!

Seriously,someone early in his hospitalizations failed him.

That would make anyone wonder why the hospital kept discharging this elderly,demented man?

That guy should have been placed somewhere(nursing home) the first time it was found he was homeless,esp at that age and with his condition.

Now THAT is heartbreaking. :-(

[weirdscience]

Not sure why that quoted so strangely. Sorry, y'all.

[annabanana2]

Agreed! Horrifying! I think it had something to do with the fact that he was actually quite well-dressed, clean (except for the whole colostomy thing), spoke with a posh-sounding accent and liked to tell very convincing-sounding stories about how he had been a museum anthropologist in a past life. He presented very well, actually, when I met him in the clinic, and it wasn't until I went digging for more information that I actually figured out how demented he was. I can see how an ER nurse, with three patients trying to die keeping them busy, would stick on a new pouch and send him on his way without digging too much into cognitive function.

OH, and I forgot to add that in my region it's actually very difficult to have someone placed in a nursing home from the hospital. I'm in Canada. The current policy is that folks need to be sent home first in order to wait for a bed. Unfortunately the policy doesn't really take into consideration what we do for folks that don't actually have a home.

[kettlecorn60, BSN, RN, EMT-B]

It's so important to not be that typical cynical, UNempathetic caregiver! It makes a huge difference when establishing a good patient rapport. Too often and too early on in their careers many health care professionals become like this. And when I have observed it firsthand, where I work, I feel so frustrated for the patient, (unless they are the overly demanding "frequent flier" drug seeker, of course). As a caregiver myself, I find myself repeatedly asking: "What type of (nurse, doctor...) would I want to have caring for ME?" Or my loved one.......

Obviously it isn't always easy, especially when working in a super busy ED with a surging, relentless acuity, when there's not even time for a break. But I've found that when I've focused on using this perspective, my days have been considerably smoother, even gratifying. More often than not, my patients have been the ones who end up helping/encouraging me, far more than I think I've helped them! It all starts with MY attitude. We have the power to "set the tone" of the visit by building a positive rapport or a negative rapport. Just sayin...Keep Calm and Nurse On!

[Adele_Michal7, ASN, RN]

Are you joking?

They have to be...

[dirtyhippiegirl, BSN, RN]

When I worked on a burn unit, half to almost all of our patients could be homeless at any given time. Even with weeks to find them somewhere to go -- many ended up discharged back to the street. Sometimes by their own preference. Sometimes because they were banned from every shelter in the area. We had a schizophrenic homeless patient that was on our unit for months while social work tried to find a SNF that would take him. Finally get him placed and he ran away a week later.

[imintrouble, BSN, RN]

My "home" is med/surg, but there have been times when I've floated to ER. One of my first discharges was a frequent flyer who called 911 for a free ride to the hospital. They came with no shoes and no coat. I was told to give them socks and a blanket and send them on their way. I was appalled and I'm nowhere near new.

[Kimee129]

I've worked the streets of San Diego not only as an EMT, but as a clinic nurse. 85% of my patient population was homeless. We had amazing resources for all of them. 90% of those homeless were Vets. I had to give up...because no matter what I did...these same people CHOSE to stay homeless on the streets. I made sure they had new socks, donated shoes, and their medication...but I not once bent over backwards again for them. It's a state of mind. Mental illness, alcoholism, drug abuse, and plain simple stubborness keeps these men and women out there.

[JuliaRNMSN]

How out of the box your thinking is. I mean that as a compliment. I'd probably run the idea by Social Services if there were no other community resources to take homeless folks in. I'd have to feel that I had support from other professionals if the going go rough. Many children are homeless along with adults. I certainly would explore the options since they are known to victimized in every way in the first 24 hours they go to the streets.

[Red Kryptonite]

I've worked the streets of San Diego not only as an EMT, but as a clinic nurse. 85% of my patient population was homeless. We had amazing resources for all of them. 90% of those homeless were Vets. I had to give up...because no matter what I did...these same people CHOSE to stay homeless on the streets. I made sure they had new socks, donated shoes, and their medication...but I not once bent over backwards again for them. It's a state of mind. Mental illness, alcoholism, drug abuse, and plain simple stubborness keeps these men and women out there.

My dad was a cop in SoCal for 30 years and he told me the same thing. Long term homeless are that way because it's what they prefer. People who are motivated not to be homeless find and use the services that are out there, and they work their asses off to get off the streets.

The long term homeless people I've met working in health care have only proved him right.

[brownbook]

Great thread...it sure has a lot of interesting off shoots about the homeless population. I am so befuddled about armaniX...was she joking?

Yes it is crazy to send a homeless person back to the street so they will be readmitted two days later....and yes many of the homeless don't want to go to shelters where they can't drink and use drugs.

Kimmee....your thread is great BUT geeze homeless vets...give me a break. My husband saw active duty in Vietnam. He, and consequently I, get so tired of the homeless vet spiel. ANYONE can tell you they were a vet, read about Stolen Valor.

[Red Kryptonite]

Kimmee....your thread is great BUT geeze homeless vets...give me a break. My husband saw active duty in Vietnam. He, and consequently I, get so tired of the homeless vet spiel. ANYONE can tell you they were a vet, read about Stolen Valor.

My husband is an Afghanistan vet, as offended as anyone by stolen valor claims, but that doesn't mean we deny the reality of homeless veterans. Why do you think so many service programs aimed directly at homeless veterans have been set up if they are not real? The people using those programs have to be able to prove their service, and the programs haven't run out of people seeking their services yet.

Undiagnosed, self-medicated PTSD often leads to substance abuse, and substance abuse contributes immensely to homelessness. Which is just one more reason the continuing failures of the VA system needs to be dealt with NOW. But also, being a veteran doesn't preclude just plain character flaws and personality disorders, which could also contribute to homelessness. My own mother is an example of that.