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My choice or required

Private Duty   (4,695 Views | 28 Replies)
by Rdforever Rdforever (New) New

349 Profile Views; 1 Post

With a patient with a low mental age and immobile am I required to play with toys, read, dance around and entertain him all day. My case manager is flat out ignoring me about it and fixing to go to the next person above her to get my questions answered. A couple hours of choice play seems more effective than 12hours of forced constant interaction. If they want him read to 3 hours a day should they pick up a book? Seems like Medicare isn't expecting me to do that, or are they?

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,334 Profile Views

Uuuggghhh. I dread those cases. Delusional parents that think all of that forced interaction will help their child. I hate to tell ya, but the parents will win every time on this one.

I had a pt that just layed there. No indication of sleep/awake, no response to pain, etc. Kid died not long after. The mom....no exaggeration, gave me a monopoly board game. Really? The kid had very low tone. She expected me to get the kid to sit up and play.

There is only so much we can do. I have no problem reinforcing therapy. I have no problem playing games on the appropriate developmental level. But the forced interaction is awkward. Sometimes I think it wears the kids out and its too much on certain ones.

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3 Followers; 37,074 Posts; 98,532 Profile Views

The agency almost always gives in to the family's unreasonable requests. The only thing you can do is to request another case. The agency will send another nurse to please the family, they don't care. If this happens too often, you will find yourself without offers of work from this agency.

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,334 Profile Views

The agency almost always gives in to the family's unreasonable requests. The only thing you can do is to request another case. The agency will send another nurse to please the family, they don't care. If this happens too often, you will find yourself without offers of work from this agency.

Not necessarily. The agency may know how the family is and they may just be trying to make the money while they can. I've seen that happen and then the agency discharges the family when nobody will work for the family.

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3 Followers; 37,074 Posts; 98,532 Profile Views

I have yet to see an agency discharge a family for being obtuse. One was threatened with the fact that there were no more nurses available, but that was the extent of that. I suppose that could happen when business is plentiful. It has been my experience that nurses are the expendable commodity in this equation.

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CloudySue has 6 years experience and specializes in Pediatric Private Duty; Camp Nursing.

710 Posts; 15,016 Profile Views

I worked w a 20-yr-old woman once who was really unable to do much of anything, and was partially blind. The mom expected me to play with baby toys with her all afternoon, just hold the toy, guide her hands to push buttons, drop in the blocks, etc. and react to the music and toy action cheerfully, over and over. To make matters worse, the mom did all the meds, feedings, etc. and only used me to provide constant stimulation and to help her carry the girl into the tub so she could bathe her. I lasted about three shifts there!

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SLHLPN has 27 years experience and specializes in Tele, Cardiac Stepdown, (New) Peds PD.

17 Posts; 3,739 Profile Views

With a patient with a low mental age and immobile am I required to play with toys, read, dance around and entertain him all day. My case manager is flat out ignoring me about it and fixing to go to the next person above her to get my questions answered. A couple hours of choice play seems more effective than 12hours of forced constant interaction. If they want him read to 3 hours a day should they pick up a book? Seems like Medicare isn't expecting me to do that, or are they?

I can see parents wanting us to do SOME activities. As far as being required to provide constant 12 hr entertainment, hire a clown! We are healthcare providers. Entertainment falls under "parenting". While requesting some age/mental status appropriate activities is reasonable, 12 hrs of forced play is not appropriate. It would be exhausting for the nurse and the patient. I wonder if the parents provide non stop entertainment when they are caring for their child.

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3 Followers; 37,074 Posts; 98,532 Profile Views

Parents have complained to me that nurses sit on their arse amusing themselves watching TV or on their phone, while ignoring the minimal requirements that are even spelled out on the 485. The condition of the patient usually gives it away. Justified complaint. But there is a big difference between this type of situation and demanding that the nurse engage the patient for 12 out of 12 shift hours. I would probably comply the first time due to the difficulty in leaving after having accepted the assignment, but they would not see me back there a second time. I believe this would only be the tip of the iceberg in dealing with the expectations of such a family and beyond my pay range for the case.

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,334 Profile Views

You can always remind the parent they need to pick up a med or something....so you can take a break!

Seriously, these parents need to learn what nurses do. We aren't maids, we aren't babysitters, we aren't slaves, we aren't chefs, etc. If they want those services, they need to hire those people just like the rest of the world does.

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3 Followers; 37,074 Posts; 98,532 Profile Views

The parents would probably have an easier time understanding the role of their nurses if the agency supervisors would take the responsibility for explaining this clearly at start of care and reinforcing as necessary. However, once the money starts flowing, that seems to be the end of agency management involvement when it comes to supporting the field nurses in many situations.

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dirtyhippiegirl has 8 years experience as a BSN, RN and specializes in PDN; Burn; Phone triage.

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I worked w a 20-yr-old woman once who was really unable to do much of anything, and was partially blind. The mom expected me to play with baby toys with her all afternoon, just hold the toy, guide her hands to push buttons, drop in the blocks, etc. and react to the music and toy action cheerfully, over and over. To make matters worse, the mom did all the meds, feedings, etc. and only used me to provide constant stimulation and to help her carry the girl into the tub so she could bathe her. I lasted about three shifts there!

I was on a couple of those and the worst part was the family usually only had, like, four or five toys.

The one mom who insisted on having a teacher come every day for a few hours for her profoundly impaired, blind, probably deaf kiddo who spent the majority of the day having seizures. She had a new teacher come by with the beginning of the year and the poor lady was just totally baffled.

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smartnurse1982 has 7 years experience.

1,775 Posts; 24,385 Profile Views

All of my cases are similar to the case in the OP.

Most just basically lay there,and they do not make eye contact,cannot interact,cant talk/walk/eat,etc.

All of them have trach,vents,and gtubes.

I do not understand why some of them go to school to be honest.

The most annoying part is not the parents,but the nurses who say false things to the parents.

For instance,there was a nurse on one of those cases who told the family she had a dream the boy was walking.

I say that is false hope.

ANother nurse told the family that the therapists and doctors were lying when they told them that Johnny does not communicate,is deaf,and is blind.

She claims he does communicate with his eyes,even though he has had hundreds of tests.

He does not move anything for us other nurses,but she claims he does it for her.

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