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?
Libby1987
3,726 Posts
Are you talking about PDN?
At least in California, HHA's have to have the proper certs and inservices to provide intermittent visits.