lpns in home health

pagandeva2000, LPN · Aug 3, 2007

I graduated and received my license last year; started working home care last November part time on Saturdays. I had a 4 year old trach patient who was very active and was a behavioral problem at times. I learned nebulizer treatments and suctioning, an also had to review a bit on developmental milestones of pediatric patients. I was very honest with the mother as well as my agency in telling them I didn't have a great deal of experience. I enjoyed the case at first because the mother was a very organized and savvy parent who was very involved in her daughter's care. The child was not that bad, really, but would try you on occasion.

What made me decide to leave the case very recently is that when the summer months arrived, I began to feel more like a nanny than a nurse. During the winter, when the weather was nice, I did take the child to the park for recreation, but it was only about two blocks from the home. Should an emergency arise, I didn't have a far distance to travel to get her to the emergency equipment. But, in the spring, the mother wanted to take this child for outings such as the movie theater with other children, shopping or to birthday parties that were far from the home. I was constantly worried that this active child would get into altercations with other children and I would have to intercede. Or, if there was a case where she may destat, I found that the mother did not have portable oxygen. The other consideration was once, I went with them to a birthday party. Another child fell of of the swing and it appeared that his ankle was injured. The parents surrounded the child and were about to remove his shoes. I remembered "RICE" and suggested that they don't do it, but to take the child to the ER. I asked if they had bag of ice that can be placed on the ankle intermittedly until he can get there, and they ignored me. How I took this, is that I was not at this party as an invited guest, I was there as a licensed professional. Should something happen to ANYONE at these gatherings, they would have looked to me for assistance. How could I not help? That would be wrong. But, at the same time, this would be distracting me from being conscious of the child I was hired to be responsible for (who is already a management problem). I felt that I am not a babysitter or a paid escort or companion, I am a nurse. This was an excellent family, but, I really believed that as savvy and involved as the mother is, she was misguided as to the role of the nurse, and I felt it was best to leave.

I am about to do med-surg per diem at my hospital to obtain more skills and confidence. I still want to do home care, but would prefer an adult who is more settled and can listen to reasoning. I did like the laid back atmosphere of home care. It was more flexible, not as rigid and more personal. I was able to give total care and attention to my client. But, we have to be careful of family dynamics. Also, we have to keep in mind that in case something happens to that patient, we are on our own to sustain them until more help arrives.

orrwhat24 · Aug 3, 2007

I have worked in home health for over 2 years. I love the one on one. I have 1 client for an entire shift. You get to know them so well that you can take one look and tell if they are not feeling well that day. The down side for me is you do not use alot of your skills. I am also very close to the entire family, you laugh with them and cry with them. I do not see how you can keep distant, nor do I see why you would want to. There is alot of down time, sometimes good, sometimes a little boring. I wouldn't trade it for a hospital position where 10 patients are needing your attention. I think it is about finding your niche.

pagandeva2000, LPN · Aug 3, 2007

I have worked in home health for over 2 years. I love the one on one. I have 1 client for an entire shift. You get to know them so well that you can take one look and tell if they are not feeling well that day. The down side for me is you do not use alot of your skills. I am also very close to the entire family, you laugh with them and cry with them. I do not see how you can keep distant, nor do I see why you would want to. There is alot of down time, sometimes good, sometimes a little boring. I wouldn't trade it for a hospital position where 10 patients are needing your attention. I think it is about finding your niche.

It is hard to maintain distance when you are in someone's home. That is their space, their intimate setting and you are a part of it. But, there are times where I think it is necessary. Some family dynamics can be very overwhelming and because this is such an intimate setting, some families may manipulate the nurse into obiligation. The case that I had seemed to have those dynamics towards the nurse that is working with the child full time Mondays through Fridays.

This child has had her trach since birth, because she was a premie who had a damaged trachea because of too many intubations. The mother has insurance and did not have to pay for babysitting from day one. This nurse worked with them since birth. Now, the child is about to enter kindergarden and the Board of Education stated that they do not wish for the nurses from our agency to escort the child to school; that they have their own nurses that will greet the child and stay with her all day. Now, the mother decided that she would have her regular nurse (an older woman) change her hours from 7 am to 6 pm to 2pm to 10pm. This child is prone to respiratory infections requiring her to stay home often from nursery school. I asked the mother what she would do if she woke up in the morning and discovered that her child was too sick to attend school. Mom states that she will call her regular nurse (who would have gotten off at 10pm the evening before) at 6:00am and tell her to come in. Now, I felt that is not far to that nurse to have her schedule constantly readjusted like this. It may work for a moment, but not knowing her private life, this may be a problem if this woman is tired, has a second job that no one knows about or has plans for the morning. But, because of the long standing ties, the mother thinks this is okay. I don't know this nurse, maybe it is fine with her. However, things change.

Also, this same nurse escorted the child to nursery school and another child fondled this child. It was not mentioned for a few days and then, during a bath two days later, the child mentions this to the night nurse. The mother quickly visited the school to resolve the situation. Also, when I came in that Saturday, the mother mentioned it to me. There were no nursing notes speaking of this, nor was the agency notified. I didn't think this was correct. I suspect that the nurses decided not to make a big deal because of the mother's request, but for me, it was important for me to mention it to the agency for two reasons; one being that we are mandated reporters and secondly, the child was reminded of the incident by being bathed by a nurse. Children are not always reliable resources, unfortunately, and what if the message came out that one of the nurses fondled her? I was not going to take the risk and had to put that personal feeling to the side and turn into the professional by reporting it. This was another reason why I was basically uncomfortable with this case. Not what happened to the child, but, by the actions of the other nurses who chose not to say anything to keep from rocking their boat with the sweet arrangements of the mother. There are some families that will let the nurse leave early, but make the nurse feel obiligated to come in or stay late on a day where she absolutely can't. I didn't mean to ramble, but, I saw so much in this case, and it was a nice one, that I am a bit careful about how emotional I get involved, because after it is all said and done, business is business.

lc177985 · Aug 3, 2007

I am in an adult situation but definitely need to keep some type of distance. I am in a home for the whole shift and have been warned that this home is full of skewed family dynamics. The worst one being put between the spouses,one of whom is the patient. I feel like you pagan, I do sometimes feel like a babysitter. I am not here to entertain but to monitor health and make sure all equipment is operating properly. I am friendly and caring, I just try not to do anything that is not strictly nursing. I notice that they, the clients, take advantage of one of the cnas by having them to household things and run errands that are not part of the job. I mentioned it to him and he says he knows he's in a bad position but doesn't know how to get out of it because he's started doing these things and now they expect it. He's a great guy and really good cna and I feel bad that they take advantage. I also worry about not keeping up with the skills I learned in school. However, for our family this job is perfect as far as pay and schedule. The hospitals in our area work you to death, give you too many patients and then you get way too burned out. I do have to say that my supervisor is awesome and completely understands all of the ins and outs of home health and is always right there with help and encouragement. She is also a great part of this job.

pagandeva2000, LPN · Aug 3, 2007

I can see what you mean...once it starts, it is hard to stop. I started with escorting this client to some of the outings because I did believe that this girl deserves a high quality of life. She only needed suctioning and nebulizer treatments every 6 hours, she was in karate school and attended nursing school. She is smart as a whip with a funny sense of humor. But, I began to look at the other side of it and listening to the other dynamics; while not totally dysfunctional, could impede on my practice at a later date. I am glad I left the case, as easy and sweet as it was. Next time, I'll be stronger with such issues and draw a deeper line. I wasn't totally manipulated because I made a clinical decision to keep an active child occupied and safe, but, I saw the potential of legal problems and was not going to be compromised. At the home, the word can be between a whole family and the nurse. If you are not careful, the nurse may be the one to lose.

Years ago, as a home health aide, I had a client who stated to me that she would not need me all day, but that she would expect me to make up the difference in time. Naively, I thought she would give me notice. The same day that I had heavy plans, she would tell me I had to stay until like 10pm at night. This was over 20 years ago, and at the time, I felt that she 'had me' because she could tell the agency that I didn't work the hours I was supposed to. But, I snapped out of it and quit the next week. Nothing happened. Now, as a nurse, I had to see it differently. If something happened while I was not present, there is my license in jeopardy. Suddenly, families think differently and after speaking to friends and others, they suddenly remember that you should have been there and they want to pull you through the carpet.