Is my situation normal?

[NurseAlexandra]

Hey everyone this is a long tale but I feel like I need some help deciphering what is going on.

I’ve been an RN for five years with the majority of my experience being on an ICU stepdown floor which I loved but I was PRN and after 3.5 years I was getting put on call so often I wasn’t making any money. So I happened to find a job posting for a private duty position to a fourteen year old male nonverbal and bedbound patient with CP and severe epilepsy. His mother stays home with him around the clock and the father does not live in the home and is not involved with his care. The mom took a class through Medicaid to qualify as her own EOR and be able to hire, train and fire all her own nurses versus going through an agency after numerous “nursing horror stories” according to her. She said the longest they’d kept a nurse was four months. (First warning sign?) Anyway while she controls the hiring etc I am still paid via Medicaid not out of her pocket.

The job has sucked my soul out. I am expected to do all work related to my patient. ALL. While I don’t mind washing his g tube supplies and med cups etc and even washing and putting away his sheets and towels THAT I USE WHILE IM THERE she expects me to do all laundry while I’m there (except her stuff although when I leave towels etc not related to my patient she points out where they go so I can put them away next time...like that was the reason I didn’t). She chewed me out one time for his shirt drawer being disorganized except I had no idea I was supposed to maintain that and if it was messy it was from her not me as I never use it. She has made it crystal clear that I am expected to take out his dirty briefs to the dumpster (they live in an equal housing opportunity apartment building) and used to leave their household trash sitting by the door for me to take too without actually asking me to take it. When I just ignored it and wouldn’t take it she started putting my patients briefs in the household trash so suddenly I had to take it. She says because my patients supplies get put in there and because I throw my apple core etc in there I shouldn’t be mad about taking it out. Her grown son who uses prescription drugs lives there and so her excuse of her arthritis hurting her wrists too much doesn’t fly with me. At one point she even took the trash cans away “since everyone is arguing about who will take out the trash we just won’t have any.” I had to put all my own trash in my bag and collect my patients in a plastic grocery bag to take out at the end of the day.

when I first started there was a designated bathroom for me to use that she kept clean and no one else really used. But she made it clear she expected me to wipe down the vanity and sink and once even passively left the toilet bowl open with a brush and cleaner in it like a hint for me to clean it since I’m the only one who uses it. Now the whole family uses it and it is often disgusting. I never throw anything in the trash can in there and barely touch anything and yet I’m still expected to periodically clean it??

and then the baby monitors. My patient has severe and frequent seizures so I understand having them but she didn’t my first six months. Now the whole house pretty much is monitored with the bathrooms and one or two little corners being the only area she can’t see. And she watches it constantly even when she’s home. She will be sitting on the porch while im sitting there with the son and be watching him on the Monitor. She checks him constantly when she goes out too. She goes back through the footage to see what happened and to prove me wrong about things frequently. When I gently finally asked her if she was monitoring me because she didn’t trust me blew up at me about her right as a parent to know what’s going on with her son at all times. She may be right but isn’t this excessive?

within a week of me starting there she texted me the WiFi password. One of the main draws to me taking this job was she assured me in my down time I could be working on my BSN and other classes. But then suddenly she’s telling me I’m on my phone too much even though I only do it when my patient is sleeping or having such a bad seizure day that we are just sitting around and I’m at his bedside. We have to keep it dark on those days so I can’t read so am I expected to just sit in the dark all day? Then suddenly she changed the WiFi password and when I asked her about it she said “oh I never give out my password” and I said well you did and she acted like she had no memory of our conversation about school work etc. so she hasn’t given me the new one and now I sacrifice my own data to chart and put in my time sheet.

she hardly ever leaves and hovers around me all the time doing half his care often. She asks my opinion on medical things and then quickly rebuts me as she always knows better than I do because she is “a researcher and has studied up on these things”.

there is so much more but that’s the gist. Is this situation bonkers? Some days I’m like oh it’s fine I can deal and other days I’m like this is so demoralizing and ridiculous. I love my patient but this can’t be normal right?

[caliotter3]

I got through less than half of your post before I decided that you should make up your mind to leave the case. If you try to tough it out, sometime in the future you will regret your decision. It will not hurt you to go to an agency for the same type of work. Yes, you will probably get LPN wages for LPN level work, and that may not be what you are making now, but the chances of getting a tolerable case are there with an agency and a tolerable, or even pleasant, family can make up for a lot. Good luck.

[NurseAlexandra]

I figured as much. Yes the pay is good. But not THAT good. I wanted low stress to focus on some continuing ed but honestly I’m thinking of just grabbing a med surg job for two quick 12s a week at this point while I finish my courses.

Its sucking me dry

[caliotter3]

That's the main problem with extended care home health. The families tend to suck a good nurse dry and the agencies encourage this behavior because the nurses are expendable.

[kaliRN]

It does not sound worth it to your mental or emotional health, if this was reported to me by a nurse I would work to re-staff them with anything I had available and then explain to the family exactly why I was forced to remove them.

I would definitely say the quick turnover on this case and the parent’s choice to employ outside an agency are huge red flags and clearly have to do with the mother’s unacceptable behavior and attitude. All the best to finding something better

[kaliRN]

11 hours ago, caliotter3 said:

That's the main problem with extended care home health. The families tend to suck a good nurse dry and the agencies encourage this behavior because the nurses are expendable.

I find this statement so sad “the agencies encourage this behavior because the nurses are expendable” - my nurses are the reason our agency stays in business. They are the very backbone of what we do and while there’s so many challenges in shift care as it relates to nurse-family dynamics ... never would I consider a nurse expendable. Yes, I have limited ability to mandate how a family behaves (unless it’s outright abusive or unsafe), but I always try to mediate and create a better work environment whenever I diplomatically can. If I can’t - I will certainly restaff a good nurse should they be truly unhappy or unable to “get along” with a patient or their family

[Crystal-Wings, LVN]

Run for the hills!

[nursenmom3]

On 6/30/2019 at 2:08 AM, kaliRN said:

I find this statement so sad “the agencies encourage this behavior because the nurses are expendable” - my nurses are the reason our agency stays in business. They are the very backbone of what we do and while there’s so many challenges in shift care as it relates to nurse-family dynamics ... never would I consider a nurse expendable. Yes, I have limited ability to mandate how a family behaves (unless it’s outright abusive or unsafe), but I always try to mediate and create a better work environment whenever I diplomatically can. If I can’t - I will certainly restaff a good nurse should they be truly unhappy or unable to “get along” with a patient or their family

I agree that it's sad. Coming from an area where finding and keeping PDN nurses is really hard, it also really confuses me. The agency doesn't make any money unless they have both patients AND nurses. Around here, the nurses are the ones who seem to be in short supply. So, why wouldn't the agency treat them like gold?

For example, the agency tells me that there are no nurses to even come do a meet and greet with us. So, when a nurse comes to them with a story like this, why don't they send them to us? I think we're sane. Maybe not 100% sane, but we definitely beat this parent! Plus we offer all these job perks that I didn't even know were perks until I read this board. We have toilet paper and light bulbs, and a fridge to put your lunch in and a microwave to heat it up, and your choice of several nice seating options that includes chairs and couches! Plus the only living things in our house are humans and one beta fish! Not a single roach or rat to be seen! So, given the choice between having a nurse quit, or moving them to one of the many unfilled jobs that agencies seem to have, why wouldn't they move them so they can still bill Medicaid?

I don't think this is an issue that's unique to my area. I am a few Facebook groups related to kids with disabilities, and particularly kids who use vents, and I hear the same thing from all over the country. "No nurse tonight, my wife and I are splitting the night". or "We haven't had nursing coverage in a week."

[Kitiger, RN]

Too many nurses are afraid of vents. If the nursing agencies would offer more vent training, they might solve the problem.

I have to say, though, that I was initially taught home vents by one of the moms. That was back in the 80's, using the LP4, 5, and 6 vents. Do any of you old-timers remember those?

[nursenmom3]

18 minutes ago, Kitiger said:

Too many nurses are afraid of vents. If the nursing agencies would offer more vent training, they might solve the problem.

I have to say, though, that I was initially taught home vents by one of the moms. That was back in the 80's, using the LP4, 5, and 6 vents. Do any of you old-timers remember those?

OK, that's definitely a factor. But I swear I've read posts on here where people had patients with ventilators AND crazy parents, and the agency wouldn't back them up. So, it's not like nurses who can work with vents are treated well either.

[quiltynurse56, LPN, LVN]

If you haven't already left, I suggest you leave. Too many red flags and you are a nurse, not a housekeeper. If you want to continue to do this, find an agency to go through. There are good families out there and will let you do the job. Most agencies will tell both the parents and the nurses that you are not a housekeeper and you are not the babysitter for other children.

If you find a family is not a good fit, let the agency know. I have had to do that. Right now I am kind of the on call nurse. I have decided that working PRN is the ticket for me.

[oldnurse28]

Oh hell no.

I am pro camera/video and think it protects ME as much as my patient. But I am in a home similar to the one you described. Mom even makes comments about it...like when she leaves and I say call me if you want an update..."oh no I will just watch the camera" seriously?!

This is not a good case. You need to leave before there is a REAL problem that endangers your reputation or your license.

I am super picky about my cases. I don't get attached. I have been burned by parents and agency schedulers alike so I now everyone knows yes I care about your child. Yes they are safe in my care. But I bail at the first sign of problems, I just don't want to invest my time or heart in a patient when the family will cut you out at the blink of an eye.