Is this legal?

WoosahRN, MSN, RN · Dec 21, 2015

There's a lot of things wrong here. I'm not sure who to escalate it to. One would be to your employer. They should handle it and address that nurse's employer. I'm not sure how to advise you on how to escalate to contacting her hospital. Technically this could be many violations. This patient is not hers anymore so her being involved in medical care should be at least a HIPAA violation. And it's completely out of bounds to be making medical changes or even to be touching the patients line when she is not the paid caregiver. Not to mention the unprofessional attitude of trashing you and your company.

I understand we can get attached and territorial with patients we take care of for a long time. This nurse was primary nurse for a year. That's hard to break but doesn't excuse being unprofessional.

The parents you need to understand are going to be nervous. This is the first time being home with their child in their live and after a very tumultuous year I'm sure. So being able to deal with these parents is a tricky step but made worse because you are being undermined by someone they trust. Overall it's a disservice to the child.

Keep us updated.

Horseshoe, BSN, RN · Dec 21, 2015

How could it be a HIPAA violation if the parents have willingly shared the info with her?

There may well be some violations of some sort here, but I don't see HIPAA being one of them.

TheCommuter, BSN, RN · Dec 21, 2015

If someone is talking down to me or being condescending in front of others, it is time to dictate how that person will treat you right then and there.

"I feel as if you are talking down to me. This is inappropriate and it needs to stop. You weren't there and you wouldn't know."

elkpark · Dec 21, 2015

I would just like to point out that this kind of scenario is one example of why so many of us here advise against disclosing any contact information, or encouraging/enabling clients to maintain any contact with you once they've left the hospital, because it's considered a professional boundary violation. And, whenever this topic comes up on AN, invariably, some NICU nurse(s) will post and say something like, but you don't understand, we form relationships with our patients and their families, many of us keep in touch with our families and there's nothing wrong with that. Wellllll, here's the flip side of that, and an illustration of why it's a bad idea.

I agree with the OP that I would refuse to return to the home and provide care under these circumstances. If I ran the home health company, I would refuse to have any further contact with the family, or provide any further care, unless/until the family agrees to not bring in other healthcare providers to interfere in the treatment. If they feel more comfortable with the NICU nurse caring for their child, good for them, maybe they can get her to come provide all the home healthcare.

I would also seriously consider reporting this RN to the BON for serious professional boundary violations, and/or any other aspects of the situation that might interest the BON.

xoemmylouox, ASN, RN · Dec 21, 2015

What a mess. You will find that PDN is full of messes like this. I would cut your losses at keep looking..

JustBeachyNurse, LPN · Dec 21, 2015

Major boundary and ethical issues. Go through your clinical manager who should be contacting the NICU manager. You are right to reconsider working this case. I really hope you documented all the changes to the settings the NICU nurse made in contradiction to physician prescription and the plan of care. Write up an incident report ASAP

CryssyD · Dec 21, 2015

Many years in pediatric ICU and sub-acute care taught me how easy it is to get over-involved with your clients. I have been the nurse on the other end of the phone, listening to distraught parents tell me how the hospital or home health nurses are not providing appropriate care. But the thing to do is not to throw your fellow professionals under the bus, especially when you are going on the biased, unprofessional opinions of the parents; they love their kid, of course, and seeing things they aren't used to or comfortable with is distressing to them. But to run over to the unit or the house and take over care yourself is the craziest thing I've heard today--if I had done that, and my boss had caught wind of it, I would have been fired so fast my head would still be spinning. Sheesh.

At the very least, the case manager should report the NICU nurse to her boss--she had no business even talking to the parents after the baby was discharged, let alone going to the house. Her behavior with the other nurses was totally inexcusable. I suppose you could report her for unprofessional behavior. But I think this was really a boundary issue and she mainly needs a good lecture about maintaining those boundaries in NICU, because it can be hard.

caliotter3 · Dec 21, 2015

Let your employer handle it and thank your lucky stars that you got out of that nasty situation. When the family turns to a former caregiver to validate every breath the patient takes, you will never get a nursing action in edgewise. If that other nurse wants to run the show, she has the option to go to work for your agency and I am certain they will be only too happy to appoint her the primary nurse for this case.

Horseshoe, BSN, RN · Dec 21, 2015

Many years in pediatric ICU and sub-acute care taught me how easy it is to get over-involved with your clients. I have been the nurse on the other end of the phone, listening to distraught parents tell me how the hospital or home health nurses are not providing appropriate care. But the thing to do is not to throw your fellow professionals under the bus, especially when you are going on the biased, unprofessional opinions of the parents; they love their kid, of course, and seeing things they aren't used to or comfortable with is distressing to them. But to run over to the unit or the house and take over care yourself is the craziest thing I've heard today--if I had done that, and my boss had caught wind of it, I would have been fired so fast my head would still be spinning. Sheesh.
At the very least, the case manager should report the NICU nurse to her boss--she had no business even talking to the parents after the baby was discharged, let alone going to the house. Her behavior with the other nurses was totally inexcusable. I suppose you could report her for unprofessional behavior. But I think this was really a boundary issue and she mainly needs a good lecture about maintaining those boundaries in NICU, because it can be hard.

Emphasis is mine. I would hope your boss wouldn't really do that.

People are so quick to advocate someone be fired for making mistakes. This nurse needs some education pronto about boundaries, professionalism, etc. Maybe even a "time out" while she gets said education. But she may be a really good nurse whose contributions to her unit are very valuable, and that is something worth holding onto if possible. I'd rather have an over involved nurse I have to reign in than someone who doesn't give a rat's patoot.

CBlover, BSN, RN · Dec 21, 2015

How could it be a HIPAA violation if the parents have willingly shared the info with her?
There may well be some violations of some sort here, but I don't see HIPAA being one of them.

That's exactly what I was thinking. What a interesting scenario. It makes me wonder really. I can totally understand why the parents are flipping especially after a year in NICU and now are home with their little one. I can't imagine the stress. They trust the NICU nurse. But as others mentioned he/she really has no business coming to the patients home IMO. What if all NICU nurses followed their pt's home? After all many NICU babies need special care after going home. That's what the HH nurse is for and should be left at that. If the competency of the HH nurse is in question find one who is competent.

Emergent, RN · Dec 21, 2015

This is why I disliked home care. Many of the families are difficult. You're on their turf, and people get crazy and micromanaging with caregivers of a loved one with a chronic condition.