My choice or required

smartnurse1982 · May 4, 2015

I think many of the nurses(myself included) do not know how to interact with patients that are unable to well,interact and understand you.

One supervisor did not want us to talk as the kid did understand you.

For instance,I was turning the tv channels when a supervisor was visiting.

I came across Barney.

I asked in a playful voice to the 4 yr old boy

" Do you like Barney?"

I did not expect him to answer,but she said "Why ask him that if he can't answer you?

caliotter3 · May 5, 2015

I don't see the point in many patients going to school. Have discussed this with parents. We all seem to agree that if nothing else, it serves the purpose of getting the patient out of his/her bedroom and out into the fresh air and among the living for a minimum amount of time. In that respect it is beneficial.

The supervisor who made the comment about talking to a non-responsive person missed something in nursing school. She needs a session of sensory deprivation training so she can see how she would like lying in a bed all day long with absolutely no stimulation. This is another topic that I've discussed with parents and we've concluded that a soft voice, and soft touch go a long way to acknowledge the patient as a human deserving of human interaction. Stimulation also alleviates possible fear. I can't imagine being tied up within myself and not knowing if the other presence was my friend or a total stranger. Just because we think nothing is going on in their brains, doesn't mean that is the case. The supervisor should know better.

nekozuki, LPN · May 13, 2015

I would get through the shift by putting on a big show when the parents walked by, and then never, ever taking that case again.

cat1235 · May 15, 2015

I kind of have a patient like that. He's not actually a vegetable, but Def is not all there. Doesn't understand you or communicate or react on a personal level ... just kind of reacts to stimuli... doesn't speak ... might look your way in reaction to a light or stimuli but no real actual eye contact. Parents also used to have him in school. Now a young adult. Really?? Just seems exhausting for the child and makes the parents feel better. Spasms in response to pain ... no verbalization. Mom thinks he's "vocal" when he has respiratory noises exacerbated by certain meds or interventions. Just lays there. (Has some degree of brain damage). I think one (though not the only) reason I don't like home health is because this is not quality of life .... I guess I feel bad and like it's just ridiculous for the poor kid to be here living like this.... and for me to be interacting with someone who doesn't really know I'm interacting with him ... it's sad and not quality of life ... :/ however I always,wonder if maybe even people like this can't understand at least a little. Or at least a close family member's voice. So some stimulation or communication is good, they are human. I just think some forms of stimulation are over done and actually exhausting for the patient and just serve to make the family feel better.

CloudySue · May 15, 2015

Retts Syndrome, I believe, is particularly misleading. These girls seem catatonic but I feel in my heart that they are alert and oriented, just locked in. I briefly took a 12-year-old girl w Retts to school and they sat her in regular classes, and I do think she enjoyed those classes much more than her life skills class, which was most of the day. When we got back to her house, I always made sure we sat and watched iCarly together. She seemed riveted to it, like any middle-school girl would be.

Sostuckrn · May 16, 2015

This is my frustration with home care. :bored:

We are not those things and the agencies need to clarify that with families and then back us up!

SDALPN · May 16, 2015

This is my frustration with home care.
We are not those things and the agencies need to clarify that with families and then back us up!

It will never happen. They want the money from these cases. As long as another warm body with a license walks through their doors, they will send nurses to those type of homes and make what they can.

danarooo, BSN, RN · May 16, 2015

This is what I'm dealing with right now. I took a case, a pre-school child who has full cognition but can only move fingers. She does need stimulation for sure and I'm ok with playing with her and trying to find ways to keep her occupied etc...but not to the exclusion of doing my job. I am an RN, I am not a teacher or nanny and I HAVE to be able to document the care I provide and do my job but I'm expected to play with her and keep her from fussing the entire time. I was also told I need to do her laundry. The 485 actually says "SN to provide stimulation and active play" or some such thing. Because that crap is in the 485 I literally end up going 4 and 5 hours before having a chance to document anything. Every time I go to document one of the parents is like "would you like the nurse to read you a book?". The HH agency told me that while I'm in the home I have to provide holistic care which includes ADL's and went on to say I can prepare light meals, do laundry and fold/put away laundry, clean the patients bathroom and kitchen and of course wipe down and sanitize DME and other areas of patient care and if the parents give me permission I can answer the front door. Since when is answering the front door or laundry an ADL for a pre-schooler?

I don't feel like an RN, I feel like an over educated nanny/house keeper. On top of this the parents micromanage so much that they will come and take the suction out of my hands and push me aside and do the task I was doing 4 out of 5 times per shift. I was given a word for word typed out script of what to say if I ever had to call EMS by the parents. There is a two page typed "if sats drop to this, do this" typed set of instructions the parents put in the home chart. I actually got a "you did a good job" when one parent asked if I or his wife put on the patients bipap mask, like this is the ONLY bipap mask in existence and no one in the world has ever been able to correctly put it on this child before.

I understand the parents feel a loss of control over the situation their child is in, and it must be incredibly difficult BUT at the same time there has to be a limit set. I feel that they totally disregard my education/training/knowledge/experience with the over-bearing micromanagement and need to control EVERYTHING I do. I can't even do my job because they continually step in, and it's teaching this little person that no one is competent to care for them but their parents so I get to deal with this child fussing and not wanting me to suction, or fussing after 5 minutes of an activity that child chose and me having to spend 10 minutes going "do you want to do this, do you want to do that" until I get a "uh-huh" for the child to then repeat this 10 more times. Yesterday alone a video had to be changed 3 times in the span of 20 minutes because all the sudden the child got bored and began fussing. I don't have the time, energy or desire to play that game with a pre-schooler all day then when I'm trying to get my documentation done be told to go do the patients laundry.

This is the first case I've ever left after accepting it. I don't even think I want to do any patient care in PD/HH anymore because to me this BS is setting nursing back about 60 years. If this is what nursing is in this area of nursing then no thanks.

caliotter3 · May 16, 2015

Danarooo, you got me when I got to the script for calling EMS. That is the tipping point for me. I would be out of there.

danarooo, BSN, RN · May 17, 2015

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.

An agency will follow the money EVERY time. To them this is a business and no one is in business to not make money. These agencies will keep the difficult family until an incident happens which forces the agency discharge them (if an incident even happens). It is exactly right that the nurse is expendable.

What I don't understand is why oh why do nurse across our country put up with this crap? I don't know any other professional in healthcare who would put up with what we do. Try telling a Doctor he's going to be paid $7 an hour to "orient" like nurses are with these agencies...that would never happen. Try telling a PT that after they do a home visit w/a patient to go start that patients laundry...that won't ever happen. But here we are, nurses, putting up with this crap. Nursing will NEVER advance as a profession when we allow ourselves to be worked into the ground and paid nothing, insulted and treated like "the help" in ANY healthcare setting. When will we learn and do something about it?

That is my opinion on it anyways.

Sostuckrn · May 17, 2015

I agree with certain aspects of your post. I refuse to do laundry or housekeeping unless I caused the mess caring for the patient. It is not my job. Luckily my agency does state this in their policy and will back us up. I hate when nurses do these tasks to be helpful because it is expected of us then.

I have been trying to get out of pdn for years. I feel pretty depressed about it at times. I have watched some not so great nurses get the jobs that I truly wanted.

I do love taking great care of one patient and knowing I did everything right. I think we are important and our job can be extremely difficult. We are nurses and are not idiots. (Well, some of us) I have taken care of some extremely acute kids. I have resuscitated children on my own and watched kids die. I have taken kids by ambulance and had emts who were too intimidated to touch my patient. I have sat in ER and taken care of my patient when the staff was intimidated. My patients go immediately to the ICU when admitted.

jojoe · May 17, 2015

Seems the family/patient can say anything they want because there is no one else around to say or prove otherwise on behalf of the care provider alone with them. The agency IS a business and nurses are definitely expendable! I actually enjoyed some of the occasional "extras" performed by me in PDN, such as making jam and canning pickles. It would have been nice though, to be forewarned before accepting the case when we not only supplied patient care, but also took care of three dogs, two cats, shoveled the driveway for the next nurse on duty, plus much more. Live and learn.