Is this normal? Am I over reacting or just new with nerves? New HHA on Hospice case

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It's 2:30 am and I'm awake, literally losing sleep over a case I was sent on to cover for another Home Health Aide who called out today.

I'm a very new Home Health Aide, I've been working for a month at a small healthcare system and just became CNA certified last week. (I'm also a pre-nursing student.)

I'm extremely nervous in general because patient care is all new to me but I'm eager to learn and willing to help when I can. I'm uncomfortable with the situation I was put into today and I'm wondering if this is just how it is in home health and I have to get used to it or is this not a scenario I should have been dealing with?

My two usual clients are located in an assisted living facility run by the healthcare system I work for. This morning I was working an unusual shift today because my client had a special occasion to attend to and I had been there extra early in the morning. As I was leaving I received a phone call from the scheduler at my office asking me if I could possibly help out on a case right down the street from where I was until 4pm because the aide had an emergency and couldn't stay or called out. I was hesitant because it was a longer day than Im used to and then she said it's a new hospice patient. The scheduler was desperate because the case was 24hr around the clock care and aide already there was waiting to go. She described the case and said this client just became a Hospice and Home Health client as of Monday. She said that she needed food prep, personal care, light house work the typical duties that I already do, she made it seem like this client can talk, eat, swallow, potentially get up and use a commode, no big deal. The only out of the ordinary thing she mentioned was I am not allowed to leave until the next aide comes, even if they are late. She said oh the aide there will tell you what to do......so that didn't happen and this client ended up declining in the last two days and I was blind sided with little to no information.

1.) Report from aide desperate to walk out the door was vague. She didn't properly show me around the clients condo and I didn't know where anything was other than depends as far as supplies etc. She informed me the client declined in the last two days and can no longer, eat, speak or swallow, she said a delivery was coming and the granddaughter might show up and that's about it. She said she just sleeps and you go in and check on her here and there and make sure she is dry, put Vaseline on her lips and ask her if she is in pain or ok. That's it no info about anything else.

2.) I get bombarded non stop from that moment on with people and questions that I could not answer for hours.

3.) I was there for 40mins, then the Visiting Hospice Aide and Visiting Hospice Nurse came at the same time, they didnt identify themselves to me properly to me with titles just first names. I thought the Nurse (male in plain clothes no badge) was a relative at first. I was unsure of what I was supposed to do so I just stood in the room with them and tried to figure out what was going on. They said she had a fever and they worked to bring her temp down. They asked me repeatedly where different things were after I explained I just got there and it's my first time there and I was covering for the girl familiar with the case and the aide before didn't show me where those things were, such as OTC meds, linens, basin, hidden second bathroom that I didn't know existed etc. I said sorry I will help you find what you need but I don't know where that is.

3.) Nurse leaves after vitals, giving Tylenol suppository and morphine and speaking with Hospice Aide. Again says nothing to me about meds or anything new to do except to tell the daughter he was there and gave her grandmother pain medication.

4.) Hospice Aide stays longer and tells me that hospital bed is being delivered, I will be here alone when that happens and I'm responsible for signing for it and coordinating with delivery man and teaching family members later how to use the bed since they didn't schedule to be there when all of the supplies are coming. OH and after that, I'm responsible for TRANSFERRING the patient from her gigantic bed to the new hospital bed with her already grieving granddaughter later and no one else will available to assist. ( small room, large furniture will be filling the room, she offered no advice on how to safely handle the transfer). THEN SHE SAYS," she is declining quickly, this is happening fast, did your office tell you what to do if she passes?" Me: "Nooo, no one has told me or trained me for anything like that." She says to just call the triage nurse number and please stay calm and do not call 911. (I thought this women was eating, talking and able to ambulated when I offered to cover this case, now I'm being told I'm left alone with a women hours away from death and to play soothing music for her.) I just feel inadequately trained for this and I was so freaked out.

5.) Once delivery guy got there, he said there was no room for hospital bed to fit in the space the family requested, I then had to help delivery guy PUSH client's bed, with client in it over to get the new hospital bed. I freaked out when I realized I had to transfer this poor woman in this awkward configuration of furniture.

6.) granddaughter comes back and we did the transfer, we got it done and everything was OK but it could have gone better. I feel like she loses confidence in me after this.

7.) granddaughter begins to ask me about changing morphine dosing times since she just gave her morphine to help cope with the transfer. I told her HHA/CNA's can't answer questions about medication dosing and I suggested she call the nurse if she isn't sure. She looked at me like I had three heads and said "WHY did the other aides help me administer and answer questions about morphine then? Maybe they were just more comfortable than you?" I said maybe the Hospice Aide is allowed to but I as a regular Home Aide I cant. Instead of calling anyone she writes down a note for her sister for later about skipping a morphine dose. (Um Am I wrong here? Have you EVER got involved with Morphine as an aide?!)

8.) client is on oxygen and they were using Vaseline which I though was a no no. Also it was 80 degrees in there and I hadn't eaten in hours and was so hot. Isn't it also a no no to have oxygen in such a high heat environment? Granddaughter acknowledged how hot it was but didn't adjust the thermostat or open windows.

Is all this normal? Why can't Hospice Aides stay longer? What would you do in this situation? What do I need to know or do differently with Hospice clients/families. Should I just decline, taking those cases until I have more experience? Was the scheduler wrong for putting a new aide with no experience on that case or is it my call to say I'm not experienced enough for Hospice cases?

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Hospice has a lot of dynamics. You did the best you could under the circumstances presented to you.

If there's medication questions, you could offer to call the hospice nurse to either come and speak to the granddaughter as to the changes that have occurred and the medication schedule, or have the hospice nurse have phone conversation regarding the same.

Oxygen--I don't think that 80 degree temps are contraindicated, just uncomfortable I am sure. Along with the soothing music, I would see about turning the heat down a bit, or opening the window for some fresh air. And I would ask the nurse about the Vaseline--I have not heard that it is contraindicated in patient's on O2, however, ask if you need to.

Going forward, if you are asked to do something new, I would be clear on who you can call if there's a question, a change in condition requiring more pain medication, that type of thing.

Hospice is a specialty that either one loves or not so much, and it may not be your "thing". And that's ok.

I would however, be very wary if the scheduler says that I have to stay at a clients house until someone else shows up EVEN IF THEY ARE LATE.....Seriously? That would be when I would think that one would say "I can not".

So in other words, I would be more apt to decline the visits to the 24 hour care clients with no real end in sight. Seems like they are sticking you there with no direction for endless amounts of time. Easy way to burn out quickly...

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According to the NIH, petroleum-based products such as vasoline, chaptstick etc should not be used when on oxygen.

As for the temp in the room, it has no bearing on oxygen.

Oxygen safety: MedlinePlus Medical Encyclopedia (last updated 4/24/14)

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You ask, "Is this normal?"

in many cases and situations, yes, you are asked to go beyond your scope or comfort level. It is up to you to learn to say no. It is not easy, but it is definitely my experience

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Specializes in Med nurse in med-surg., float, HH, and PDN.

EGADS! I would have called your agency and told them to get someone else over there STAT, even if it is the supervisor or DON.

They had no business sticking you in there in the first place. When they want a warm body in place they don't seem to care who it is or for how long.

It has happened to me, though not as bad as what you went through, and I have had quite a bit more experience than you.

I can't help but wonder if you actually work for my agency, except I know you don't, because I am not in Philly.

It sounds like you did the best you could, though. I hate it for you that you were stuck there with no report and drastically changing conditions..

No, it is not 'normal'. Sounds to me like your CSR was dumping on you so SHE could get out of the office that day.

BAH!

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EGADS! I would have called your agency and told them to get someone else over there STAT, even if it is the supervisor or DON.

They had no business sticking you in there in the first place. When they want a warm body in place they don't seem to care who it is or for how long.

It has happened to me, though not as bad as what you went through, and I have had quite a bit more experience than you.

I can't help but wonder if you actually work for my agency, except I know you don't, because I am not in Philly.

It sounds like you did the best you could, though. I hate it for you that you were stuck there with no report and drastically changing conditions..

No, it is not 'normal'. Sounds to me like your CSR was dumping on you so SHE could get out of the office that day.

BAH!

Thank you! I knew something was not right about it. I left out the part where the scheduler called me back AGAIN because the over night girl called out as well. Really, BOTH the regular aides called out the same day and no one informed my office that this client was rapidly declining, had a fever or had multiple deliveries with no family members present to handle it all? I said NO to the over night shift and she said I can't leave until they find someone else but they are doing everything they can to get someone in there as close to 4 as possible. The next girl they suckered came in for the overnight shift at 4:45 and told me they got her to come the next day as well. She said she was told this woman was still functioning on some level and was shocked when I told her what went on. she has worked for the company for 4 years and only taken one other hospice case. I beleive the way they coordinate visiting Hospice and Visiting Home Care is not beneficial to the client or grieving family. I guess I felt that once they are that close to death, the hospice department should be more involved, not just make a 15 min visit and let Home Health Aides handle it. Honestly I lost sleep over it because I felt like we (the healthcare system) as a team could have done a better job for that family if people would just take a little time to properly communicate with and train their employees!

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Hospice has strict regulations about what it can and cannot do and we don't provide 24/7 care in the home where I live. There are no local (only) hospice inpatient facilities. We can help with inpatient's but they have to be admitted LTC; not an acute admit. There is also a 5-day respite available but the patient has to be admitted to the hospital's LTC unit.

Family's can hire Home Health Aides but that's a separate issue from hospice. At least in my understanding.

I am appalled that your HHA Department/Agency sent you out like this. Totally unprofessional and yes, I would have done as NSIME stated and called for help STAT!

No, you can't make decisions about the medications on your own. I would leave teaching and changing things to hospice. There is always a hospice nurse on call for triage questions. They can help over the phone or make a visit.

I wish you the best and hope you don't let anyone take advantage of you like this again. You need to have a meeting with your supervisor and discuss this. You have legitimate concerns.

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Hospice has strict regulations about what it can and cannot do and we don't provide 24/7 care in the home where I live. There are no local (only) hospice inpatient facilities. We can help with inpatient's but they have to be admitted LTC; not an acute admit. There is also a 5-day respite available but the patient has to be admitted to the hospital's LTC unit.

Family's can hire Home Health Aides but that's a separate issue from hospice. At least in my understanding.

I am appalled that your HHA Department/Agency sent you out like this. Totally unprofessional and yes, I would have done as NSIME stated and called for help STAT!

No, you can't make decisions about the medications on your own. I would leave teaching and changing things to hospice. There is always a hospice nurse on call for triage questions. They can help over the phone or make a visit.

I wish you the best and hope you don't let anyone take advantage of you like this again. You need to have a meeting with your supervisor and discuss this. You have legitimate concerns.

Thank you! The Hospice Aide asked me how long I have worked for the company. I told her I am brand new and that I was just certified a week ago, I also told her I am a pre-nursing student so I'm eager to watch and learn and I will try to be as helpful as I can. I guess this is where I went wrong, she told me she has been a Hospice Aide for almost 30 years and then she started to tell me what to do and what I should be able to handle. She said, "Oh you're certified now and a nursing student, you should be able to handle a transfer." If she would have stayed another 15 minutes she would have been there with me when the hospital bed came and could have made sure her "rapidly declining " client was transferred safely given the circumstances and set up if the room. I also wished she would have given me a brief description of the Hospice Nurse and Aide roles and how HHAs work with them since we discussed this is my first encounter with hospice and the only reason I was there was to help out and cover a shift.

I followed her lead since I didn't get the impression from anyone involved that any of this was a concern or a big deal.

The grandaughter was always in a hurry, popping in an out for 10mins here and then 20mins there and had no interest in waiting to call anyone. She said her sister was coming later and she would just leave her a note about Morphine and she can make the call.

At one point I actually did call my office after the Hospice Aide told me that if the client dies on my shift I have to call the number for the triage nurse on the table and that's it. I spoke to the head scheduler and told her what the Hospice Aide said. The scheduler said,"well that would be terrible if that happens when you are there. Let's just hope it doesn't happen but don't call the number she gave you I will give you the direct number instead." I said, as far as OUR office is concerned, is there anything else I need to do or need to know. She said, "well obviously if that happens just call us after you speak to the triage nurse, OK? Is that it?" I just gave up at that point because no one seemed to want to provide me with the support I needed. I decided to just do the best I can to help this family and went back into the clients room, sat next to her bed and played some Frank Sinatra and various other soothing songs for her and hoped that it would all work out.

Never again!

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Instructions are left with the family and usually posted on the refrigerator where I live and work.

If you are the only one in the house when a patient dies, YES, you call the number that hospice gives the family. We teach the family that when the patient dies, they only have to call the hospice nurse. Not her personal phone number (that should never be shared with family) but the number given to the family on the instruction sheet on the refrigerator. The hospice nurse will come out as soon as possible and legally pronounce death. We assist the family about notifying their choice of funeral home and we can stay with the family as long as necessary. There are rules and regs to follow as hospice and people can get into trouble deviating from those.

If the family is there while you are there, they should call the hospice nurse. If they are too distraught, you can call for them. But that's all you need to do.

We do post-mortem care as well and I have had families assist me; I'm assuming if the HHA was still in the home and wanted to assist with this, they could do so. But wait for the hospice nurse to arrive before doing anything with the body.

Your employer needs to do an in-service on hospice rules and regs and what your responsibilities will be. They have short-shrifted you big time.

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Specializes in Med nurse in med-surg., float, HH, and PDN.

Well, look at it this way: Trial be Fire ! I've been through a lot of those kinds of shifts, not with Hospice, but with my agency. I've been with them some ungodly number of years, like literally half my age. (Oooh that's scary!) and sometimes it still shocks me when the BS starts getting high and deep.

But, I swear that there is a GREAT similarity between our agencies! They must be first cousins!

Edited to add: You sound like a smart cookie and I think you did a good job under very bad circumstances!

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Specializes in acute care, LTC, currently home health.

If there's one thing I've learned in the 18 months since I started working home health, it's to be prepared for anything. Regardless of what

the scheduler or office tells you about a client. The scheduler's priority is to get the case covered, so they really don't care about your

comfort level or length of time with the agency. You may want to decline any further cases like this until you get a few more months of

experience under your belt.

I'm sorry this happened to you, and by the way, I think you handled the situation very well.

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Well, look at it this way: Trial be Fire ! I've been through a lot of those kinds of shifts, not with Hospice, but with my agency. I've been with them some ungodly number of years, like literally half my age. (Oooh that's scary!) and sometimes it still shocks me when the BS starts getting high and deep.

But, I swear that there is a GREAT similarity between our agencies! They must be first cousins!

Edited to add: You sound like a smart cookie and I think you did a good job under very bad circumstances!

Why thank you! I got myself into that mess so I had to ride it out. I'm a tough Philly chick, I've seen worse, lol. I just don't like feeling as if I'm lost without a clue. I can handle being out of my comfort zone but I like to know and follow protocols. I'm learning fast that in Home Health you learn as you go. Hmm maybe they are related! :)

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