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am I a nurse or home maker???

jack1339 jack1339 (New) New

I have been a lpn for 16 years now, and have worked in many facets of the induatry. I am curently a home health nurse for a private duty agency. Is it me or do these insurance companies, and employers expect us nurses to become home makers while on duty for the families. I had one case with a 2 year old vent patient, his single mother brought in 2 bags of laundry and said they needed put away as if I were to do it. I said to her "you'll get to it soon" and jokingly told my case manager. I was told sometimes as nurses we are to take over parental duties also. Also, when did I go to school to be a dietician or chef? I am expected to prepare all meals while on duty. Should the meal prep not fall on the family and as a nurse I have no problem warming a meal, but to plan and prepare the meals are not my responsibility. As nurses we have set guidelines as to what we are permitted to do by law. And as nurses we shiuld set our own guidelines in the home setting as to what we will not be made to do that we wouldn't do in othwr settings. I barely cook at my home. I also am expected to vacuum my patients room and wash the dishes I use to feed the patient. I am sorry, but this is not my job. If a patient requires meal prep and skilled nursing caee it is time we, as nurses make a statement to our employers and these insurance companies that want to skimp and save money, that we have specific training and skills for nursing care. And if meal prep and cleaning need done that it falls on the family, or a homemaker that be paid by the insurance instead of them expecting and forcing us to do it while attending to medical needs. I thought that's what we did, nursing care. Thanks for readung and hope to read some responses.

nursel56 specializes in Peds/outpatient FP,derm,allergy/private duty.

While you are waiting for more replies you might get an idea from this thread...


I don't believe keeping a clean and organized environment around the patient or washing the dishes I use to prepare their meals is somebody else's job though. Perhaps you can review the legal agreement signed by the client and the agency that would specify the duties of the skilled nurse. I frequently see that at the front of the chart.

Usually, there are homemakers who would come in and do a great deal of those things. A company can get paid for the certain number of hours that these tasks are being done. With that being said, I would be clearer on what my role is. If you are finding you are cooking and cleaning more than taking care of the patient, I would bring it to your company, and ask that a homemaker be added a certain number hours a week/day. I would also do this if I was spending considerable time on PT/OT or any other non-nursing discipline--yes, nurses do ROM and assisted ambulation that type of thing, however, if I were doing what a PT person does for lengths of time, that would become an issue, as I am a nurse, not PT.

Another aspect of this is that you could "educate" the mother about how to take care of her childs' needs as far as food, cleaning, laundry and such. Education is also a huge part of what nursing is about.

I am curious if you have a case manager, and if you have meetings regarding your cases. If so, I would most definetely advocate for the child to have as much help in the house as possible. You are one person, you can't be everywhere at once, and although I think that keeping your patient's area clean and tidy is part of it, folding the family laundry and preparing meals and cleaning the house may not be.

I would have conversation about this with your manager. If the patient's insurance company is being billed for multiple disciplines that you are completing yourself, I would have to weigh what I am making for a wage against what I am tasked to do and see if it is worth it, or perhaps a job that has more boundries.

And I agree with the PP--I would review what it is that you are bound to do by the agreement signed,

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

Its is in our job duties per medicare/medicaid to clean the things the pt uses. But not to clean the other areas.

I find it funny that nurses get so worked up over this, but they have no problem doing RT tasks like suctioning, neb txs, and vent related talks. They don't mind doing CNA tasks...except for cleaning up after a pt.

I will fight the battle when it comes to a parent wanting me to clean their home or do their laundry. But as long as priorities are taken care of, putting away laundry and cleaning the dishes you use for the pt are part of caring for that pts needs. Its part of caring for a pt in the home. You are the aide, the nurse, transport, lab/phlebotomy, RT, babysitter, teacher, code team etc.

JustBeachyNurse specializes in Complex pediatrics turned LTC/subacute geriatrics.

Ensuring the patients basic ADLs are met and the patient & supplies are neat & clean are part of basic skilled nursing. It is not unrealistic for a skilled nurse to wash the dishes used to feed the patient. Would you not wash enteral feeding supplies if this patient had intermittent or bolus GT feeds? Cooking for the family and washing a sink of dishes is not.

meanmaryjean specializes in NICU, ICU, PICU, Academia.

I also care for a vent-dependent toddler as my second job. I have no problem with doing his laundry or washing up the supplies (including dishes) I've used with him. I dust his room, and have been known to push a vacuum around it as well.

What is the big deal here? All of the above activities take less than 15-20 minutes of my time. And as another poster so astutely noted, I also do RT/PT/OT tasks as well.

And yes, I am a nurse. A masters-prepared one at that. I do not consider anything that my patient needs to be 'below' me. To be blunt- get over it. there are plenty of nurses willing to take your place right now.

I think this would be case by case, is the op talking about a single one of only that child? or several others? if one child and no job, I am not going to be doing any house keeping! several children/job...then I would help out, in the patient realm.

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

I think this would be case by case' date=' is the op talking about a single one of only that child? or several others? if one child and no job, I am not going to be doing any house keeping! several children/job...then I would help out, in the patient realm.[/quote']

Its not up to us to make that decision. Medicare/medicaid states that it is part of our job. If we aren't following our job description as requested by the parents, we aren't doing what we are getting paid to do. I have a case with 2 working parents and they insist on letting their other kids do their chores which include helping keep the pts rm clean. The parents also pitch in and insist on cleaning. It has nothing to do with the situation. Its not up to us to alter the job description as we see fit. I can think of many parents who I think need more hours and other parents who get too many hours. But that's not up to me either.

As I said earlier, if a parent wants things cleaned that are unrelated to pt care then they are abusing us. If my pt crashes, I guarantee that I won't be doing laundry for my pt that day. But on a typical day, its not unreasonable to do these tasks.

Think of it as infection control if you need to. On the cleaning sheet my agency provides, I write in cleaning equipment weekly, wipe down bed weekly (think bed rails lifted back up after changing a dirty diaper), etc. I clean up the mess I make. What is the point of us helping the parent if we leave them a mess to clean up when they take over? There is a line between deep spring cleaning and light cleaning as we are required to do. Scrubbing entire walls is excessive, but wiping a spill off of the wall isn't. When I do the cleaning sheet, I split tasks equally over the week so its not put on one nurse or shift. If a little bit is done each day, its really not so bad.

JustBeachyNurse specializes in Complex pediatrics turned LTC/subacute geriatrics.

The only thing I don't do is load/run the dishwasher. The world is a better place if I stay away from dishwashers. Lol. ;) I will rinse or hand wash with hot soapy water and dry/put away as appropriate. My patients' parents are fine with this as either way the dishes & supplies have been appropriately cleaned & put away.

I will pretreat & soak dirty laundry as most of my clients either 1.do not have a washer /dryer or 2. have specifically asked nurses to not operate the W/D (issues in past with others). But if needed I have no issue washing /folding/putting away my patients clothing.

I also work exclusively pediatrics.

I agree that sometimes people go a little overboard in thinking we are to do their chores. At one time when I was bouncing from place to place before I found a permanent home to work in, I was sent out to care for a 9 year old who had absolutely no medical needs aside from two breathing treatments per shift. I was shocked when the mother came in with my list of duties which included hand washing an entire weeks worth of the child's clothes, and hanging them on the line to dry, followed by cleaning her room, running the vaccuum, straightening her drawers etc and of course, keeping her entertained for the whole shift. I did not return there. It just felt like abuse of the system.

I now work exclusively with a 9 month old trach baby whose family is not very well off with young overwhelmed parents. And for this child, there is absolutely nothing I would not do. I go in early, stay late, do all of the things I'm required to do and frequently do a little extra for "my baby". I draw the line at doing anything related to their other child, but they have never asked me to do anything in regard to him. It was understood when I came in that I was the baby's nurse and nothing else.

I feel like deep down we know when what they ask of us crosses the line and becomes abuse of the system. The bigger question, though, is how to broach the subject when you feel you've been violated.

Good luck to you. I would say ultimately if it is something that bothers you to the point that your resentment gets in the way of care of the patient, then politely bow out and find another assignment where you can feel respected and valued.

I'm still new to nursing, but each client that I've oriented to so far needs meals prepped if they are PO and the nurse is responsible for cleaning equipment and maintaining a neat and tidy patient area. Including patient laundry if the family doesn't take care of it. Some families do, many families do not. I view it as something that is unique to this realm of nursing. I don't get to delegate changing the soiled briefs to the CNA, RT isn't going to give my patient their 1300 neb, nutrition isn't going to bring up a supper tray and there is no housekeeping department that is going to magically restock the patient's towels and linens if I think I'm above throwing a load of my patient's laundry in the washing machine. Things have to get washed and reused, unlike the hospital setting where everything is disposable or gets sent to the laundry/kitchen after as single use. If the cleaning duties are interfering the the ability to complete all cares and treatments, that would be one thing. But most of the cleaning duties I've been responsible for take just a few minutes and can easily be completed between meds, treatments, and charting.

imintrouble specializes in LTC Rehab Med/Surg.

For almost 3 yrs I worked as a private duty nurse. I worked mostly nights. Days about once a week. I never saw any kind of contract. I was oriented by the nurse who'd been there 10 yrs. I didn't know anything about contracts until today. I just did what the nurse told me to do. Any mess I made, I cleaned. I changed linens, but I didn't wash them.

I stopped working private duty because after 3 yrs I started to feel like a servant. How is it possible that you DON'T see yourself that way?

Maybe it was just the child I cared for, who couldn't control anything in his environment but me.

Edited by imintrouble

nursel56 specializes in Peds/outpatient FP,derm,allergy/private duty.

Imintrouble I suspect a copy of a signed agreement may not always be included in the client's home chart, especially with the trend toward EMR. Generally they contain a section identifying the PCG who must agree to be responsible for covering hours in the event the agency can't staff the case and a section stating that the nurse isn't responsible for family housework or babysitting siblings.

As far as doing "CNA tasks" or "RT tasks" I had a real 'you know you're old school when...' moment as I've never considered either anything but a subset of nursing tasks even though hospitals now split the care into different job categories.

So much of this is dependent on the characteristics of the family and their relationship with the nurse. I've gladly washed dishes in the sink if they are there, folded a basket of family towels etc but leaving a kitchen full of mess and being expected to clean up after able-bodied relatives is a different story.

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

The problem with doing the family dishes is that they quickly tend to expect it. It also makes the family resent nurses that stick to their job description. Plus doing anything outside of what insurance is paying you for can get you in to trouble if something happens. Or if you got injured doing the dishes...maybe a broken glass or something. If you slice your wrist with a broken glass on the job, I'd wonder if you would still be covered since its not a job you are supposed to be doing. Then they would ask why you weren't caring for the pt. Of course we are capable of watching a stable child and listening to a monitor while washing dishes...I don't want it to come across the wrong way. But it could lead to being questioned about neglect. These agencies are too quick to throw us under the bus. It feels good to go above and beyond for an appreciative family. But as a nurse who has come behind nurses that have allowed themselves to be a servant instead of a nurse, its not fair to the next nurse.

If we all went in and did the same job within the same parameters, the families wouldn't push us to do more. But when they see one nurse do one thing and another nurse doing smoother thing, they learn to play nurses and get as much as they can out of us.

nursel56 specializes in Peds/outpatient FP,derm,allergy/private duty.

SDA I actually agree with you and caught a fair amount of flak for it in the "nurses aren't maids" thread I linked to.

An example of what I mean would be a grandpa carrying his dinner dishes in while I'm washing the patient's things and looking hopeful.. I'll say 'give 'em here..' He appreciates it and it adds very little time. I don't use baby monitors very often. I get nervous when I don't have eyes on the patient.

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

SDA I actually agree with you and caught a fair amount of flak for it in the "nurses aren't maids" thread I linked to.

An example of what I mean would be a grandpa carrying his dinner dishes in while I'm washing the patient's things and looking hopeful.. I'll say 'give 'em here..' He appreciates it and it adds very little time. I don't use baby monitors very often. I get nervous when I don't have eyes on the patient.

Its such a fine line. I wish there was a PDN certification and classes so we could all be in the same page. But these agencies don't want us to know much except what they tell us. They don't tell us up front what the ins companies want. And they don't help us by telling the family we can't do certain things. I think that would solve many of our problems.

From the parent side, the agencies promised us everything except for unicorns, rainbows and our child waking up and talking. They told us that the nurses prepare the formula, wash all the bottles/syringes/extensions/neb sets/equipment/laundry, order supplies, check supplies, put supplies away, vacuum, clean the room, take out the garbage, keep the "nurses" bathroom clean....

Not_A_Hat_Person specializes in Geriatrics, Home Health.

I worked very briefly on a case where the nurse washed, dried, and folded the laundry for the entire family, which included 4 children under 12. I have no problem doing client laundry or preparing client meals, but I won't do it for the rest of the family. I'm a nurse, not a maid.

sharpeimom specializes in ortho, hospice volunteer, psych,.

When my mom was dying of breast ca with mets to her brain, pancreas, and liver we had hospice nurses and a few aides to take care of her. All went smoothly until about six weeks before she died. As the ca in her brain progressed, her whole attitude toward me changed drastically. I had quit my job and was there most of the time until it became impossible. I never knew when she saw me if she'd greet me as she aways had, with a cheery 'hiya Babe! Tell me all about your day." or whether she'd scream "Don't hurt me again!" or ask me coldly "What have you come to steal this time?" It just about broke my heart.

The Amish girl (unmarried Amish women are referred to as girls whether they're 2 or 102.) who had worked for my mom came in 3x a week as always an did cleaning, laundry, etc. Then the day came when my mom was afraid of her too. At that point, the nurses and aides just began doing may of the tasks without my asking ad it made me feel awkward but I wasn't quite sure what to do. I was reluctant to bring anyone new into that situation. I filled in as much as I could behind the scenes but my mom got so upset eventually

I almost hated to be there.

I told the nun who ran the hospice that I hadn't asked them to do household tasks and she said not to worry about it, but I did anyway.


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