LPN/LVN asked to be a preschool teacher to patient

[PBNJ1118]

I’m an LPN working in in home care with a pediatric patient. I’ve been working with this client for almost 3 years, and since then client has significantly improved, no longer vent, gtube dependent, and fully ambulatory. Able to speak clearly, and have needs known. Recently my nurse case manager came to me and told me I no longer had to focus on the patients medical needs or clinical area of the care but instead would work with client for cognitive development, learning, letter and numbers, playing with patient, and working on physical activities per patients mother. I was offended that the nurse care manager would not address that to clients mother that I am a nurse and not a preschool teacher. But end of story I asked to be changed to a different case. And that is on the process right now. But has anyone else working as a nurse In in home care be asked to do something completely non nurse related? Or is this normal? I feel bad that I don’t want to do that work because I’ve been with the family so long, but I feel that as a nurse that is no longer my place to work at and the family needs to hire a private preschool teacher if that is what their seeking and not expect a nurse to do that.

[NRSKarenRN, BSN, RN]

Quote

work with client for cognitive development, learning, letter and numbers, playing with patient, and working on physical activities per patients mother. ...I feel bad that I don’t want to do that work because I’ve been with the family so long, but I feel that as a nurse that is no longer my place to work at

Wow... sounds like you provided much skilled nursing care for this pediatric client so his medical condition improved -off vent, oral feedings, full ambulatory -- great work. So now the goals have changed to focus on clients cognitive and physical development-- quite appropriate for nursing care in client with developmental delays IN ADDITION to them receiving PT/OT via early intervention program if not yet able to attend school. You still would be assessing for respiratory+ feeding issues, medical complications but main focus has shifted.

I cared for 19yo client vent dependent@night/sleeping, had severe vision issues, wheelchair bound but our main focus was to developmentally improve their skills. I worked days/evening shift while mom worked. Built into daily schedule time with computerized vision screen to improve reading, participate/encourage them in making crafts so they could transition to attending adult workshop, instructing/observing them to make own lunch to improve hand dexterity + proper nutrition, transferring them to wheelchair for me pushing them for stroll around block to get sunlight/vitamin D as lived in basement room while encouraging them to interact with neighbors. All this was in addition to RN skilled assessment, trach + vent care, incontinence mgmt and medication administration. It was one of the most fullfulling home care assignments to see this client become slightly more independent over 2 years I was involved with them, transitioning to adult services at age 21.

Maybe you can rethink this type request going forward as pediatric clients medical issues resolve and focus changes to cognitive/developmental growth.

[PBNJ1118]

Thanks for your Input I Totally agree. In my case it is a bit different, client is a toddler, way above average cognitively, running around all day playing. There’s no developmental delay and her medical condition has greatly improved. That is why I feel the need to move on to another patient where I can do more skilled nursing and get more experience since I’ve only worked with this Client since graduating nursing school. But thank you for your I input. I apréciate it.

[middleagednurse]

I am in a very similar situation. I am caring for a toddler who is immune suppressed so she can't go to a sitter or daycare, so she qualifies for a nurse. I basically spend my days sitting on the floor, being a preschool teacher. I am also a PT, an OT, and a SLP. Sometimes I feel like I want a medically complex patient, but on the other hand, there are worse things than working in a clean house with nice people. I view it as rest and recreation to make up for all the years I was working like a dog. So, if you really hate it, move on. But, seeing a child grow and develop can be rewarding also.

[ruby_jane, BSN, RN]

On 2/13/2019 at 2:04 PM, PBNJ1118 said:

Recently my nurse case manager came to me and told me I no longer had to focus on the patients medical needs or clinical area of the care but instead would work with client for cognitive development, learning, letter and numbers, playing with patient, and working on physical activities per patients mother. I was offended that the nurse care manager would not address that to clients mother that I am a nurse and not a preschool teacher.

Wow.... and how exactly are they billing for that? It's not nursing services. It's barely ADLs. It would be interesting to read that contract, but I am pretty sure you're hired for nursing services. Anything else you want to throw in is a bonus. Good luck!