It's a scary world out there

[lovingnurse1967]

I recently quit my hospital job and decided to try home health nursing. I thought i would like the one on one patient care. My hospital job had become so hectic and emphasis on patient care was becoming less and less. My assignment was to take care of a lady for 12 hours in her home. She is very confused and gets up, pulls her g tube out occas. and sometimes is combative. The nurses are documenting very little on paper only daily vital signs and a quick note. The medications are set up by a weekly nurse and wound tx. done by another special wound nurse. I would be giving meds. three times daily through the G tube and changing the drsg. on the G tube site and foot without documenting or documenting very little on paper. I questioned the nurse giving orientation and she stated "It's a private case. You are working for the family. You don't have to write much." I feel if something goes wrong or if there's a question regarding my care if the documentation is poor then it puts my patient and myself in danger. Have I been a hospital nurse too long????

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Who sent you into the home? If the agency is paying you and set up your orientation, then you should follow the policies and procedures of that agency. Private case means that the patient is paying out-of-pocket instead of the agency billing Medicare or Medicaid or any other insurance company.

But you still should document what you do, what actually happens, etc., because you are still on the job and not a part of the family no matter how welcome they may make you feel. Respect and maintain those boundaries because if something goes wrong, remember sweet families (especially those who can afford to pay out-of-pocket) won't think twice about suing you. Your documentation will be your lifeline. If the agency has a problem with that, I'd choose a different one if I were you.

[purplegal]

There is almost never any problem for overdocumenting, but you could face serious issues if your charting is lacking.

You chart what makes YOU feel comfortable, and if that means being more thorough than another nurse, then so be it.

It's your license you have to worry about, not theirs and vice versa.

[NurseGirl525, ASN, RN]

Who is paying for this? Is there any third party payer like Medicare? I'm sure there is insurance involved somewhere. Yes, your charting needs to be up to par. Chart everything you did.

This makes me think your agency is just charging the insurance carrier for things that may or may not have been done. That's Medicare fraud and your agency could end up being shut down in the future. Always CYA. Chart what you actually did.

[lovingnurse1967]

The husband signs off on how many hours we work and the agency pays us. The contract I signed stated my wage, hours worked and shift can be changed at any time. I was hired prn. This client wants all laundry done, dishes washed and floor vacuumed before I leave. I do have a CNA to help.

[db2xs]

I don't work in home health, but the client's expectations of having the RN and CNA do all the laundry and housework doesn't sound right to me. You are not the housekeeper.

[CrunchRN, ADN, RN]

If you are there just do whatever helps them.