In Home Care Working Beside Nurse Who Goes Against Order

[Vee D, ADN]

A nurse I work with goes against orders, continuously breaks respiratory machine, does things without orders. What would you do?

So it's been going on for weeks... a nurse I work beside in home health has been breaking the patient's suction machine over and over and over. I talked to her about it and she denies it yet the family has caught her on tape and complains of the same issue.

We are down to one suction machine that only works when plugged up. If power goes out we are screwed. I reported her to the supervisor. 

The client is on a continuous feed via pump but the nurse takes it upon herself to bolus feed the client. Yes! Without an order.

The client complained to me it made her feel sick, full and has stomach pain. I reported to supervisor. She wrote up the wrong narcotic order higher than the original and gave to client. I reported. 

She removed the client from his ordered in-line suction and now the client has an infection. I reported and documented what she did. Because I documented what she did I had to receive counsel for my notes and signed the sheet. They said we cannot mention another nurse in the notes although I quoted her words verbatim.

I decided to leave the case because I am unable to help the client due to continuously having to fix the problems the nurse created.

[Kitiger, RN]

If the client requires suction, you have to have access to a battery-operated suction machine. You have to be able to safely take the client out of the house. (Fire? Weather disaster? Doctor appointment?) The supply company can bring in a suction machine that runs on battery. Of course, if it is too soon for the insurance to cover the cost, then it falls on the family.

As far as documenting, I would state that the inline suction was switched to open suction on "this date". If the client then showed signs & symptoms of infection, I would document that, along with when the infection started. I would not - in the chart - document who made the change. But I would write up an incident report.

I would also recognize that target on my back. You should leave this case, and possibly leave this agency.

[Vee D, ADN]

On 12/19/2022 at 6:43 PM, Kitiger said:

If the client requires suction, you have to have access to a battery-operated suction machine. You have to be able to safely take the client out of the house. (Fire? Weather disaster? Doctor appointment?) The supply company can bring in a suction machine that runs on battery. Of course, if it is too soon for the insurance to cover the cost, then it falls on the family.

As far as documenting, I would state that the inline suction was switched to open suction on "this date". If the client then showed signs & symptoms of infection, I would document that, along with when the infection started. I would not - in the chart - document who made the change. But I would write up an incident report.

I would also recognize that target on my back. You should leave this case, and possibly leave this agency.

What do you mean by " target on my back?" I've left the case . Also, she damaged the battery operated one plus the filters on the suction cannister to where you cannot suction the client. She damaged 7 suction cannister filters yes 7! 

[Vee D, ADN]

1 hour ago, Kitiger said:

If the client requires suction, you have to have access to a battery-operated suction machine. You have to be able to safely take the client out of the house. (Fire? Weather disaster? Doctor appointment?) The supply company can bring in a suction machine that runs on battery. Of course, if it is too soon for the insurance to cover the cost, then it falls on the family.

As far as documenting, I would state that the inline suction was switched to open suction on "this date". If the client then showed signs & symptoms of infection, I would document that, along with when the infection started. I would not - in the chart - document who made the change. But I would write up an incident report.

I would also recognize that target on my back. You should leave this case, and possibly leave this agency.

Respiratory suppliers are aware and spoke with her about how to operate the machine still she keeps on. As far the clients infection I called EENT set up an appointment , called her gastrointestinal specialist for her stomach to set up an appt  that all documented but I left the case looking for another job too

[JKL33]

2 hours ago, Kitiger said:

You should leave this case, and possibly leave this agency.

Agree.

This is just dumb. Now, OP, you've been written up because you did something wrong as you were trying to clean up all the messes. You don't need that, this is more trouble than it's worth.

I'm sure @Kitiger will clarify what they meant by "target on your back;" which wouldn't be unheard of -- you have a coworker who knows you have been reporting them and also supervisors tend to dislike too much reporting, unfortunately they have been known to act like the reporter is the problem (since the reports mean they have to acknowledge things instead of pretending like everything is fine).

[Vee D, ADN]

On 12/19/2022 at 9:10 PM, JKL33 said:

Agree.

This is just dumb. Now, OP, you've been written up because you did something wrong as you were trying to clean up all the messes. You don't need that, this is more trouble than it's worth.

I'm sure @Kitiger will clarify what they meant by "target on your back;" which wouldn't be unheard of -- you have a coworker who knows you have been reporting them and also supervisors tend to dislike too much reporting, unfortunately they have been known to act like the reporter is the problem (since the reports mean they have to acknowledge things instead of pretending like everything is fine).

Thank you, yes im highly disappointed in this agency as I've spent time trying to rectify the damage the nurse has done. According to the supervisor she said the nurss that I've been reporting seen my nurses note about her and reported it  . The supervisor stated as the supervisor she was just going to advise me next time not to document about her but the nurse I reported is always calling the office and called the director so the director advised her as the supervisor to have me sign a the sheet stating I've been counseled on documenting. The supervisor also said that they've had spoke to that nurse in the office twice and everytime she threatens to quit and that she has told schedulers she doesn't want that nurse on any of her clients cases but due to not having enough nurses they keep her there. She said she's got one more strike until she's done because she's already got another client sent to the hospital.  Despite her saying all that it made me even more upset because why haven't they fired her? She's harming these patients yet they're allowing her to work and because I've been trying to help I get counseled for documenting what she did? So silly and yes I've quit the case and  the director said ," I hope this doesn't deter you from picking up other cases with us". Im not even going to respond. Now looking for another job

[Kitiger, RN]

On 12/19/2022 at 9:10 PM, JKL33 said:

I'm sure @Kitiger will clarify what they meant by "target on your back;" which wouldn't be unheard of -- you have a coworker who knows you have been reporting them and also supervisors tend to dislike too much reporting, unfortunately they have been known to act like the reporter is the problem (since the reports mean they have to acknowledge things instead of pretending like everything is fine).

Yes, that is what I meant. VeeD, you were right to report these things, but some people don't like the reports.

I would at least get off this case - and maybe leave the agency - as the supervisor isn't willing to rein in this nurse.

[kbrn2002, ADN, RN]

That's a scary situation that you work, hopefully no longer work for an agency that allows an employee to put patients in harms way and does essentially nothing. I'd seriously consider contacting the ombudsman for your region and report the entire agency, not just the nurse in question.  Just my opinion but...A place with so little regard for their patient's health and well being shouldn't be allowed to stay in business

[Vee D, ADN]

On 12/22/2022 at 8:44 AM, kbrn2002 said:

That's a scary situation that you work, hopefully no longer work for an agency that allows an employee to put patients in harms way and does essentially nothing. I'd seriously consider contacting the ombudsman for your region and report the entire agency, not just the nurse in question.  Just my opinion but...A place with so little regard for their patient's health and well being shouldn't be allowed to stay in business

I've actually considered that but my concern is it back firing on me. I'm currently hired with another agency on the side now. Plan to slowly maneuver over to another agency.

[Googlenurse, ASN, BSN, RN]

This happens so frequently in home care, esp private duty nursing.

I've known nurses to change settings on a ventilator, change feeding orders, and also give bolus feedings( with no orders)

 

[Vee D, ADN]

23 hours ago, Googlenurse said:

This happens so frequently in home care, esp private duty nursing.

I've known nurses to change settings on a ventilator, change feeding orders, and also give bolus feedings( with no orders)

 

Yes it's absolutely ridiculous.  I left the case and a bunch of nurses just quit the agency. They're losing good nurses. And I've found another agency

[hollyvk, BSN]

Another option is to report the situation to the state agency that licenses the home care agency. They certainly will want to know about the agency putting the client's health at risk.