I'm on call this weekend and I have a dilemma, please advise.

[Jo Dirt]

This is rambling, I know, but please bear with me. This is the first time I have taken call. Tonight I get a phone call from a patient's sister who is upset because she does not know where her brother's medications are.

He brother is at her house which is about 80 miles from his own home where he was renting a room. He and the other renters had to be evacuated because of a gas leak and that is why he was at his sister's house. She told me her brother had not had any meds all day (he arrived at her house this morning) and this was neglectful on the part of the agency and that furthermore when he came to her house by ambulance he was in a total mess and it hadn't just happened and she was going to find out about filing a lawsuit (the dreaded "L" word, aaarrgh)...I don't know a lot about this patient but I do know he has bowel issues and there is no other way to put it I can think of but he has...perpetual diarrhea...I guess sis will find this out soon enough.

But anyway, I was nice as I could be on the phone, and I told her I would do everything I could and would keep her updated. I call everyone I could think of, including the police department to see about how to get in the patient's former residence to look for the medication because the landlord had locked the place up and no one could locate him to get in (this pt is very sick and takes an awful lot of meds...he is also abusive and noncompliant frequently, he even refused to go to his dialysis appointment today, but this is beside the point now, I understand).

Apparently, the meds were either misplaced by the ambulance crew or they never left the house, even though the nurse who helped evacuate the patient says she loaded the meds on the ambulance. At any rate, pt doesn't have his meds and sister wants something done. I call the doctor to see if we can have his meds called in to a pharmacy close to the sister's house. I can only get an answering service and no doctor ever returns my call. So I call the sister back and tell her that since brother missed his dialysis appointment and he take so many meds, including insulin, blood pressure and kidney meds, that he should really go to the nearest emergency room and I even offered to arrange to have an ambulance pick him up. Sister says brother seems to be doing okay for now and she will call me if anything else happens, she just wants me to make sure I see he gets his meds tomorrow...I would have driven the meds over myself if I knew where they were (even though she is 150 miles away, but there really wasn't anything else I could do except suggest the hospital.

Am I wrong? Can someone please advise?

[suzanne4, RN]

1. It is not your responsibility to drive to get his meds.

2. Contact the ambulance company and see if they were left there. They may not have a phone number for the sister to get them delivered to her.

3. The physican for this patient should have an emergency number to be reached at.

4. If none of the above work, have the sister take him to the ER. There is nothing more that you can do. It sounds like she does not want to take any responsibility for him.

[kids]

I would also call the next person up at your agency. This is the sort of situation my agency Admin wanted to know about ASAP.

[Jo Dirt]

I forgot to mention I called the ambulance service and they said they didn't have the meds.

I tried to called the administrator but she wasn't answering her phone and her answering maching was full.

I just did all I knew to do.

What's worse, is that the company I work for is linked closely with a private duty staffing company and my company is supposed to be for home health (pt's medical issues only) but I have been getting calls from angry nurses who did not have relief come in at the end of their shift. This morning a nurse said "your company keeps telling me I will be abandoning the patient if I leave but I HAVE to go home and this woman can't be alone, she has seizures!" I was totally unequipped to know how do deal with this and I told her so. I told her this was an issue to be handled by the staffing agency but she said they wouldn't help. I told the nurse the only thing I knew to do would be to take the woman to the hospital and leave her....I feel like I'm losing my mind over this. I'm out of my element. I don't think a new grad RN who just started with a home health company three weeks ago should be expected to handle call alone but oh well....

[suzanne4, RN]

And you should not. They need to have someone available to handle issues like this, and if they do not, then look for another postition. It just is not fair to you to have to go thru this. The adminsitrators there need to take some responsiblity for their company, or the company should not be doing what they are doing.

I hope that you have a nice little chat with them first thing on Monday morning.:angryfire

[jnette, ASN, EMT-I]

Wow, MM.... you sure do have your hands full.

Suzanne is right on both counts. Locating the pt's meds is not your or even your agency' responsibility. You all were not involved with that. I can see as his HH nurse you would be concerned about this, but you have no options left but to have his sister take him to the ER, or have her keep trying to contact his MD.

As for the other staffing issue... I wouldn't touch that with a ten foot pole.

That is NOT your resposibility, nor should they be calling YOU as a HH staff nurse.

Shame on your agency for not having a supervisor/mentor on call to help out when you have questions like these. My agency always has either our Nursing Supervisor or the owner herself available at all times on weekends to adresse issues we may have questions about. And we also have 2-3 "back-up" nurses for each weekend call period.

Hope your weekend improves... dang. Not a good experience for your first call. Mine's coming up next weekend... my first one over Easter was pretty busy, but I didn't hesitate to call our supervisor when I needed her assistance in unfamiliar territory, and I had a colleague as my back-up as well.

[renerian, BSN, RN]

Mama that has happened to me over and over/staffing calls. I have had to do agency work when the nurse on call gets staffing calls. If that is the case I am sorry they did not tell you that.

I think with regard to the meds you did all you can do by calling the DR several times. Document, document document. Just let the family know it is out of your scope to prescribe or call in scripts.

Let us know how it turns out and I am sorry your Admin on call did not call you back.

renerian

[EastCoast]

1. If the patient goes to dialysis the center will have a current list of his meds. It's likely he goes either mon/wed/fri or tues/thurs/sat.

Find out first thing tomorrow what center he goes to and where and then call them and make sure they know he is very far from his home as they need to get in touch with another sister agency to make dialysis arrangements at least for the short term.

2. Call the answering service for the doctor again. Who gives a crap if you're a pain in the butt. All answering services are required to keep a record so a second followup to see if they delivered the message won't hurt.

3. The sister herself should be calling the brother's doctor. Sooner or later a family has to also be involved when it is a circumstance like this.

4. It is unlikely there is any litigation involved. Don't panic yourself about this. You advised the sister to go to the hospital. SHe said her brother seemed okay. DOcument that. Therefore, when her brother goes into heart failure you covered your butt.

5. Ask yourself if this is really the job you saw yourself doing when you were in nursing school. I can't think of a salary high enough that would have been worth your aggravation and likely overwhelming sense of responsibility for things beyond your control that you have experienced this weekend.

good luck

[Jo Dirt]

1. If the patient goes to dialysis the center will have a current list of his meds. It's likely he goes either mon/wed/fri or tues/thurs/sat.

2. Call the answering service for the doctor again. Who gives a crap if you're a pain in the butt.

3. The sister herself should be calling the brother's doctor.

4. It is unlikely there is any litigation involved.

5. Ask yourself if this is really the job you saw yourself doing when you were in nursing school....

Heck no, this isn't how I pictured my life as a home health nurse. I pictured driving around in my car and stopping by for nice visits with patients who were happy to see me. Maybe spending a few hours a day on paperwork...well, I guess I was living on Fantasy Island because first of all, I took a job with an agency that was sinking from poor management and this new DON/Admin is from what I understand temporary and just there to help the agency get back on its feet. So they are in the middle of trying to get things straightened out and there is chaos everywhere, and we are having to do and redo things to try to find a system that will work for the company. Orientation for me consisted of ONE recertification visit where I accompanied the part-time HH nurse to a patient's home.

The the next day (my first visit) I was sent to a house where someone screamed "Oh $#%, someone's at the f&^%&%# door!" when I knocked. I had tried to call before coming but could not get an answer so figured I should stop by anyway to see that everything was alright. Apparently the private duty nurse and the screaming owner of the house where the patient rents a room were in lullabye land when I gave them their rude awakening at 11:30am. The patient was a sweet little old lady but I didn't get the same reception from the other two...then one of the only two full time visiting nurses quit so I got all of her patient load. I've got papers everywhere, I wonder if I should stick this out or if it would be any better with another HH agency?

[EastCoast]

hi again,

I also meant to say that the dialysis nurses will likelyl know this patient better than the fmaily does and will be a very good resource for you. There is usually a social worker who should get involved in this as well.

I feel bad for your crappy weekend. The company has clearly taken advantage of your good nature.