I know I have no buisness being there, but I need the Money

Specialties Home Health

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I'm an inexperienced nurse. My agency recently sent me on a case where I am taking vitals and arranging medications for a couple: The female has CHF along with other medical issues and her spouse has Parkinsons with a history of heart problems (coronary bypass surgery a few years back). Although I am there to ONLY take vitals and prepare their meds (as the agency would put it), as a nurse I know better-it's not that cut and dry. When I enter the clients home I am there to assess and implement. If something goes wrong, it's clearly on me. I've been reading up on all their meds and conditions since I have to be there weekly. I don't want my inexperience to cause harm to these patients. The other day I called the doctor because my clients' Blood pressure was 110/50 and he had an irregular heart beat. The doctor SCREAMED at me and said NEVER to call him again with a reading as such, because it's a normal BP....:uhoh3: I wanted to know if I should hold his next dose of BP meds (safety first) instead I got an earful.....oh well, that won't stop me from calling whenever I'm not sure about something, so, here's to you doc :p

My question is, what advise can you give me to provide the best care for my patient?? I already brushed up on my CPR, and read the S/S to look for regarding there conditions. Anything else I should be doing (besides the obvious, leaving the case :confused:). I'm in a bind. Help!

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I would have a serious talk with your nursing supervisor. Ask her/him to explain to you better the parameters for calling doctors, so that you have a better understanding of what is expected of you. And you are right, better to call and get yelled at, than the opposite.

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Specializes in ICU, Home Health, Camp, Travel, L&D.

The whole first year after graduation, where-ever-in-the-world you are, except for maybe at your 2nd job as a bartender, you're going to feel like you have no business being there. That's standard. You are doing what a reasonably prudent nursing with your experience would do. Congratulations. Review parameters for calling, but NEVER let a doc yell at you again! I don't care if you've been a nurse for 5.6 minutes, and you butt dialed him, DON'T allow that disrespect. Let them walk over you once, and they'll wipe their feet on you time and again.

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The whole first year after graduation, where-ever-in-the-world you are, except for maybe at your 2nd job as a bartender, you're going to feel like you have no business being there. That's standard. You are doing what a reasonably prudent nursing with your experience would do. Congratulations. Review parameters for calling, but NEVER let a doc yell at you again! I don't care if you've been a nurse for 5.6 minutes, and you butt dialed him, DON'T allow that disrespect. Let them walk over you once, and they'll wipe their feet on you time and again.

Thank You both for your response.:) Keep the suggestions coming, I need all the advice I can get!

Although I feel taking on these clients may be over my head (especially with limited experience) I'm grateful for the opportunity to learn. The medications they are on (a total of 30 combined) has definitely been a learning experience for me. I have studied the normals of all the vitals, so I won't have to call the doctor (which by the way wasn't my clients' primary doctor, he was a fill in..:rolleyes:)

Your post has boost my confidence. I will NOT allow a doctor to scream at me like that again. As a matter of fact I dismissed him and he kept on going on with his rant of never calling him for vitals within normal parameters. At that point I had no choice but to hang up on him..:D

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Specializes in ICU, Home Health, Camp, Travel, L&D.
:cool: Atta girl!
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Specializes in Pediatric Private Duty; Camp Nursing.

Have you ANY professional experience, or are you a fresh graduate? I was under the impression that home health agencies only hire nurses with experience, preferably 1 year minimum. There is so much to know and working a year in an LTC or med/surg floor in a hospital will get you enough basic knowledge to feel comfortable on your own in clients' homes. I, too, had the questions about when to hold bp meds, but in my LTC facility, I had lots of people I could go to for questions. Out in the field, you are on your own. If you have no experience, your agency did you a terrible disservice by throwing you in cold. I recently left an agency who threw me in cold on a vent case, saying my nursing school experience was enough. I had no business being on that case because I never worked in a professional setting long enough to understand the whole shebang of vents. So I left the case, to protect my client AND my license.

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Have you ANY professional experience, or are you a fresh graduate? I was under the impression that home health agencies only hire nurses with experience, preferably 1 year minimum. There is so much to know and working a year in an LTC or med/surg floor in a hospital will get you enough basic knowledge to feel comfortable on your own in clients' homes. I, too, had the questions about when to hold bp meds, but in my LTC facility, I had lots of people I could go to for questions. Out in the field, you are on your own. If you have no experience, your agency did you a terrible disservice by throwing you in cold. I recently left an agency who threw me in cold on a vent case, saying my nursing school experience was enough. I had no business being on that case because I never worked in a professional setting long enough to understand the whole shebang of vents. So I left the case, to protect my client AND my license.

I have no intentions on being there much longer. My agency doesn't care about me nor my license, I have to care. Most likely this will be my last week working with these clients. I'm learning a lot but I know having been in home care for less than a year isn't enough to handle these situations. For myself and for my client I won't be retuning after this week. I already have a job this was just extra money, I realized I can do without it.

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Specializes in ER,Neurology, Endocrinology, Pulmonology.

It could be really good for you to have a goto person, a friend you can call with questions before calling the doc.

I know that we should be able to call a doctor any time we feel like it, but sometimes they are just jerks and there is nothing you can do about it.

Sometimes it is learning how to ask questions that can help too. For example, if I know a doctor is a jerk and the pt's BP is marginal I would call and say : " this pt is on 4 medications for blood pressure. I have no parameters for any one of them. I need some numbers. He BP is 110/50 and she is symptomatic but I need to know what her target range is "

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Specializes in Transplant.

You are responsible for your actions. You are really putting your clients at risk. You need to get some additional experience because in homecare you are out there alone and if something happens, they are going to hold you responsible because you know you are now qualified to work in this capacity. This is your duty as a home care nurse to NOT perform a service if you are not capable.

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Specializes in Home Health.

I would recommend that report that physician's actions to the Medical Board. Joint Commission has been in the process of encouraging action in hospitals to reduce the number of MD's from bullying nurses, because of the risk of the nurse becoming upset to the point of making mistakes, and worse, nurses afraid to call MD's. Never, ever be afraid to call and MD. You are first and foremost a Patient Advocate! The MDs temper tantrum is his problem. I don't put up with that and I tell it like it is!

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