I'm a nurse. Not a housekeeper!

missdeevah, NP · Dec 21, 2009

for those nurses that choose to do housework...just realize that you set the precedence and a certain level of expectation by the families for other nurses. i once went to orient at a pediatric patient's house. the nurse there was doing the previous night's dishes, mopping the kitchen, cleaning the patient's little brother's bottles and making formula for the little brother. i knew i would not come back when the dad left the patient's little brother (who was 6months old) with the nurse, along with the patient (who was 2 and vent dependent) while he went to work. i never went back there. i knew that if she did all that, they family would expect me to do the same.

i clean the patient's immediate area, equipment, the little tub after bathing him, utensils that i use for his care. i don't touch anything else in the sink. i clean up after myself, straighten up his room...i don't do his or anyone else's laundry. i'm there to take care of his medical needs as a licensed professional.

Blackcat99 · Dec 21, 2009

I charted the laundry task both to show that I was doing it, but more importantly to document it because to do her laundry, I had to physically leave the apartment and go to the laundry room, out of earshot of the vent alarms. I disagreed with this practice more than I disagreed that licensed nurses should not be doing laundry when predominantly unlicensed persons work the case. I also didn't appreciate having to leave the apartment at night, a personal safety issue. On at least two occasions I returned to find her vent alarming away.

Yikes!!!! :eek: You had to physically leave the apt. to go to the laundry room at night!!! That sounds like a very dangerous situation for both you and the patient. I think it was a good idea that you did chart the laundry task. I am planning to look for a private duty LPN job on night shift. I had thought that since I will be working nights that I wouldn't even have to worry about anyone asking me to do any housework. Now I see from your post that even night shift is not safe from being asked to do housework.

caliotter3 · Dec 21, 2009

Night shift is usually asked to do housework, particularly laundry, because, of course, night shift does nothing, and the other shifts do everything. I am not being facetious with this statement. Both the client and your agency supervisors will say something like this.

Blackcat99 · Dec 21, 2009

Oh no!!!! :eek: I had thought that the other family members would want to sleep at night and would not want me making any noise at night. I guess what I could do is wait until everyone is sound asleep. Then I could get the vacuum cleaner and go vacuum loudly in their bedrooms. Of course, I would have to smash the vacuum cleaner hard against the walls many times while I do it.

No seriously, I hate housework. I thought I would just be taking care of my patient at night and reading a book when my client is asleep.

allnurses Guide · Dec 22, 2009

[missdeevah;4032211]for those nurses that choose to do housework...just realize that you set the precedence and a certain level of expectation by the families for other nurses. i once went to orient at a pediatric patient's house. the nurse there was doing the previous night's dishes, mopping the kitchen, cleaning the patient's little brother's bottles and making formula for the little brother. i knew i would not come back when the dad left the patient's little brother (who was 6months old) with the nurse, along with the patient (who was 2 and vent dependent) while he went to work. i never went back there. i knew that if she did all that, they family would expect me to do the same.

that's just nuts. i would have felt compelled to ask her a question along the lines of, "what the hel l are you doing?" not to mention the fact that she was wasting your time while she continued to do these tasks. maybe it's just me, but i thought the purpose of orientation was to educate the new nurse as to the patient's skilled nursing needs?

that type of behavior is an extreme example of a very common problem- that is the nurse-family relationship superceding the nurse-agency relationship in the case where it's not a direct pay private duty arrangement.

a really good agency will not encourage that behavior. i'm dealing right now with the consequences of what can happen when a toxic, needy nurse crosses the line. this person spent most of the time flattering and kissing up to the family, but repeatedly showed no consideration for the other nurses or the agency in the form of showing up late without calling and giving really lame excuses, not leaving notes in the chart, leaving a mess for the oncoming nurse-- on and on. also a bunch of bizarre stuff like running around barefooted and propping legs up across the the pt's bed but i wasn't going to make a huge scene over that.

naturally, the patient defended this person when everybody else was fed up. why not? as far as they were concerned, the nurse was ms/mr wonderful!! and had convinced the pt that "everybody is just picking on me, why, boo-hoo :crying2:" the nurse also freely shared all of their family dramas, so the pt thought we should all cut them slack in sympathy . i had no idea before this how one person can royally mess up 4 other people's lives.

anyway, the round-about point to this is that even though we are in the patient's home, professional boundaries have to be kept in mind, being part of a team of others has to be kept in mind, and (usually) the patient/client doesn't hand you your paycheck. :oornt: rant switch= off. :nurse:

caliotter3 · Dec 22, 2009

It takes effort on the part of the agency supervisors to insure that nurses don't cross professional boundaries. Most supervisors can't be bothered with the most mundane of matters, so to expect them to act on this level of supervision, is expecting way too much work from them. Families quickly become aware that the agency wants to have little to do with them, so they are free to go hog wild manipulating their nurses.

Chimers · Dec 22, 2009

I would never leave my patient on a vent and not be readily available if the alarm went off. Good grief! There are too many things that can happen, in the flash of a few seconds! What if something physically happened to you while you left the area? Slip in water, break a leg, break your neck? Who would tend to the patient? A disconnect? A mucus plug that needs lavaged? Even if a family member was available would they know what to do?

Leaving the patient to tend to laundry and/or housekeeping out of the patient care area has disaster written all over it. I would gently insist that I am there for the patient and anything that may need to be tended to must be done in the immediate patient care area. SOoooo.. if family insists on laundry I would tell them that I would be happy to fold and put away any of the PATIENT's laundry, but a family member needs to bring it to the patient area. Ditto for patient care supplies.

Too many families can get out of control in their requests on what the nurse should do as far as housekeeping tasks. It also sets a standard of expectation that ALL nurses HAVE to do the same when they visit for patient care, and ergo the domino affect is in motion. Speak to your DON and express your concerns! Safety first! During my time as a DON I have encountered this very same scenario and went to the home and explained to the family the very same thing that I stated above. They understood my concerns about safety and that was that.

caliotter3 · Dec 22, 2009

The nursing supervisor was well aware of the situation in that particular case that I mentioned. I also made her aware that I was entering the home with no caregiver present and that I was expected to leave the patient, alone, in the home, with no relief. When I stayed until relieved, I got yelled at that they weren't going to pay me overtime. It was fine and dandy with the agency that this vent dependent quadriplegic was alone in her apartment. I was told outright that what happened before and after my shift times was not of concern. The patient even knew that I objected to all of this. I don't work on this case anymore and the agency no longer gives me work. I've thought about turning in a complaint to the authorities but probably won't because I don't care to get blacklisted by the employer.

allnurses Guide · Dec 22, 2009

Many factors are at play with issues like this. It makes me crazy to think about leaving a vent patient unattended, and yet if the patient is A & O, they have every right to tell you to get out of their house. We're not supposed to leave them, and they've usually signed paperwork stating that they are responsible to have a designated PCG in the event no nurses are available-- that doesn't always happen in the real world.

I'm glad you dropped that one, Caliotter. Way too much exposure to legal issues. Especially since you were alone with the lady and she was unstable enough to have her alarms going off in the matter of 5 minutes. We use baby monitors if there is more than one person there, give the patient the Life-Alert button if they can use it, or even have them online instant messaging if they can use a computer. No, these things aren't in a textbook, but sometimes you've got to improvise as well as you can!

The one-on-one acute care ventilator patient model is what most people think of when they think "vent". However, there are growing numbers of stable, chronically ill vent patients- now they are in LTC facilities and they do not get 1:1 care. One lady I had was admitted to acute care hospital- the nurse had several other patients and-- her alarms were going off like crazy right there in the hospital! :eek:

caliotter3 · Dec 22, 2009

The lady had a device so that she could call out and speak to a phone operator. But you guessed it. It would slip off her pillow and out of her reach. One time I went into the home and she had been alone for several hours and was choking, needed suctioning, and her phone device was not within reach. She told me that one time she was choking and couldn't speak to the operator, but the operator must have been savvy enough to send an ambulance. I about had a conniption with all of this. I am glad to be not involved with this one any longer. I hate that our agencies put us in these positions and expect us to stand back and do and say nothing just because we need a job.

ArwenEvenstar · Dec 22, 2009

That's just nuts. I would have felt compelled to ask her a question along the lines of, "What the hel l are you doing?" Not to mention the fact that she was wasting your time while she continued to do these tasks. Maybe it's just me, but I thought the purpose of orientation was to educate the new nurse as to the patient's skilled nursing needs?
That type of behavior is an extreme example of a very common problem- that is the nurse-family relationship superceding the nurse-agency relationship in the case where it's not a direct pay private duty arrangement.
A really good agency will not encourage that behavior. I'm dealing right now with the consequences of what can happen when a toxic, needy nurse crosses the line. This person spent most of the time flattering and kissing up to the family, but repeatedly showed no consideration for the other nurses or the agency in the form of showing up late without calling and giving really lame excuses, not leaving notes in the chart, leaving a mess for the oncoming nurse-- on and on. Also a bunch of bizarre stuff like running around barefooted and propping legs up across the the pt's bed but I wasn't going to make a huge scene over that.
Naturally, the patient defended this person when everybody else was fed up. Why not? As far as they were concerned, the nurse was Ms/Mr Wonderful!! And had convinced the pt that "everybody is just picking on me, why, boo-hoo :crying2:" The nurse also freely shared all of their family dramas, so the pt thought we should all cut them slack in sympathy . I had no idea before this how one person can royally mess up 4 other people's lives.
Anyway, the round-about point to this is that even though we are in the patient's home, professional boundaries have to be kept in mind, being part of a team of others has to be kept in mind, and (usually) the patient/client doesn't hand you your paycheck. :oornt: Rant switch= off.

Don't worry about ranting! I feel your frustration! Unfortunately, I found that situations like this were very common. Whether it was a nurse doing all manner of housework and other non-nursing things, socially integrating into the family, or exhibiting other "toxic/needy" behavior. Sigh...it almost seemed "normal". My opinion of other nurses got very low during my 4 years of doing private duty. The total lack of common sense and professionalism was appalling. This is one (of several reasons) I stopped doing private duty a few months back.

Everyone posting on this thread "gets it"...they understand why a professional boundary must be kept or all manner of problems result. Yet, the "boundary crossing nurses" just do not get it. "But I am helping the family..." No, you are not helping!! Once I was asked by my supervisor to speak to one of these problematic nurses, and this nurse told me we were all "cold hearted and cruel" and she was the ONLY nurse who was understanding and helpful to this family! No matter how I explained it, she did not get it. Interestingly...it took awhile, but the situation eventually imploded on itself. This nurse ended up causing a nightmare for this family. Like post above said, "I had no idea before this how one person can royally mess up 4 other people's lives." So accurate! This nurse was fired by the family, and the family begged for the handful of professional nurses to return. Long story...but that is the short of it.

caliotter3 · Dec 22, 2009

Yes, it is quite interesting to see a family turn on their most manipulated/manipulating favorite nurse when it suits them. I have noticed that this type of nurse in home care always seems to think that the patient and patient family will never survive one day without her presence. What a rude awakening when they summarily get rid of her and then she is at the mercy of the agency to place her again.