Need help with Ethical/Boundries Issue

Movin'onUP · Sep 16, 2012

Well apparently ur agency doesn't do surprise check ins or they would have fired the girl by now or at least taken her off the case... Im having a similar issue now wit one of my pt. Well the nurse hasnt gone as far as moving in but she is waaaay tooo attached/involved wit the family personally. The only reason I haven't said anything is bc I plan on leaving anyway for scheduling purposes.. however in ur situation I would DEFINITELY inform ur office.. bc now they're just paying that nurse to live there, n the family is profiting off of it.. N then the girl has the nerve to tell u not to use the washer on ur shift???!!!??? O_o get the f*** outta here!!! Uve got to be kidding me!!!... Tell ur agency ASAP!!! IT'S A MAJOR CONFLICT!! bc if anything were to erupt between the 2 of u, the family is getting rid U! Not her!!... If u think u won't feel comfortable in the house afterwards then ask ur agency to find u another case before they approach her

xoemmylouox, ASN, RN · Sep 16, 2012

Wow.. That is so crazy. The messes people get involved in.. I would find a new case. Once you report this the family may be upset with you.. That is not a situation I would want to be in the middle of.

allnurses Guide · Sep 17, 2012

I think I would look for a new case, too. Many times those who insist on holding to ethical standards and those who don't care working in such close quarters are like oil and water with the result being a mess that can splash on you. So far I've been lucky in that I've only been on the sidelines of such situations, but I know they are not uncommon. Protect yourself. I know it's hard to see the light sometimes when we need the job, though. All the best to you. ♥

jadelpn, LPN, EMT-B · Sep 17, 2012

I would think that agency policy is such that conflict of interest is a real issue. Seemingly, this worker could be a 24 hour care person at a cheaper rate than the agency by being a live in. This potentially could cost someone their job.

Perhaps it is time to take on an alternate case. 6 years is a long time to be with a patient, and I know that it would be hard to let go, however, it may be time.....

LisalaRN99, BSN, RN · Sep 17, 2012

Definitely a conflict of interest there! Your agency should be informed for liability purposes.

JustBeachyNurse, LPN · Sep 17, 2012

Plus, if you are in the know/aware and fail to report you can be just as liable. This can also become an issue with insurance reimbursement to your agency aside from an ethics violation the BoN might ultimately become aware of....especially if things turn sour between the nurse and family. Family makes a report, someone investigates (state licensing agency, BoN, your employer) odds are the statement "Well maryen's known about it and never said anything"...

This is wrong. You know it's wrong. You need to move on, it's tough but sounds like you can't even care for the patient properly because of this situation.

rickandkatsmom · Sep 17, 2012

I have posted on this situation in the past and was hoping it would resolve itself but it is becoming more and more apparent that it is not and I am too emotional involved with the patient(been with her for 6 years now) that I know I am not thinking clearly on it. Would love input/advice. I work 3 shifts per week with pt. through agency. Pt. is vent/trach dependant and has 24 hour care. Pt. is very high needs and demanding and working environment is at poverty level so needless to say very high staff turnover. One of the night nurses was commuting from far away and was going to leave due to commute. Pt family said she could rent a room from them. She did it. Pays $500 per month. I turned a blind eye to it. Now it has been coming more of an issue. The nurse often comes into the pt. room during my shift to use computer, printer and has been leaving notes like" Do not use washing machine during the day, I am sleeping". In addition she attends family gatherings, goes out to eat with the pt. parents and dog sits for the parents when they go out of town. It is becoming very messy and unprofessional. I know I should tell the agency but I feel so conflicted for many reasons- I know that it will take months to find and train a new night nurse. I also feel like I would be a "snitch" I know that I am not thinking clear on this issue and would love any input/guidance.

I have never posted on a site before I hope this works..Here in FL. explotation of the elderly happens way more then we would like to think..It is very hard to take personal care of someone and not get personally involved with them especially after years of being with them they are treated as family and some of them treat the nurses as if they were family..You can't get to involved and not look like the tattle tale..This is a matter that should be disscussed with employee assistance.My agency has a person I can go to and discuss issues either personal or professional ( ie, an ethics dept.) they offer us a phone number that we can call in case we want to be anonomus..This is very helpful in many cases when you want to say something but you don't want a confrontation . Maybe your agency offers a similar dept. Someone should be made aware of the situation if nothing else just due to the issue with the washer does the nightshift girl expect you to wash the patients clothes at night and what happens when things start to disapear or the patient wants to allow the nurse use of her credit cards for shopping ..To many things can go wrong and you could easily get caught up in the whole mess..

FMF Corpsman, MSN, RN · Sep 17, 2012

I would think that agency policy is such that conflict of interest is a real issue. Seemingly, this worker could be a 24 hour care person at a cheaper rate than the agency by being a live in. This potentially could cost someone their job.
Perhaps it is time to take on an alternate case. 6 years is a long time to be with a patient, and I know that it would be hard to let go, however, it may be time.....

I think Jade pretty much says it all in her post. With Nancy Nurse living on the premises, she is effectually a 24 hour live in, whether the Agency knows it or not. Now, someone just needs to tell them. They will either negotiate with the family or fire the nurse, either way, it looks like you might be out of a job because they may not be happy with you for discussing their little arrangement. On the other hand, if you've been with them for 6 years, they may not say anything at all. Has anyone else been there as long as you have? Or, maybe this is your chance to grow a little. Aren't you just a little tired of working the same case after 6 years? Isn't it time for a change? After a while working the same environment and especially with exactly the same patient we can become stagnant and complacent, we sometimes lose our edge. I know we take CEU's, but they are about as worthless as ice cubes in Alaska. They get us through license renewal but do they really teach us anything we didn't know ? It is the same with you continuing to work in the same position, you will get a paycheck, but you are just going through the motions of being a Nurse.

txredheadnurse, BSN, RN · Sep 17, 2012

I'm going to echo what the other posters have said: time to get a new case or an entirely new job and move on. Report this to your agency. To not do so could possibly leave you responsible to some degree for possible insurance fraud since it sounds as if the family is receiving a type of service (ie virtual live in nurse) that is not what they have been approved to receive.

Personally I would also report this to the licensing agency who oversees the nursing agency because, unfortunately many private duty agencies are lax to investigate or rock the boat. This kind of situation illustrates that the agency is not performing their duty to provide periodic supervisory visits to each client. However I wouldn't report it until you have another job lined up.

These kinds of messes and blurring of boundaries and ethics is why I dislike private duty nursing so much. Not that there aren't similiar issues in other settings but not the extent that seems to exist in this unique speciality.

maryen · Sep 17, 2012

Thank you for such thoughtful and kind replies. I was hesitant to post as I feel so stupid for getting myself into the situation and letting it go on for so long. So much of everything said is true... I have become stagnant and complacent. And to the mix an Agency that is just as txreheadnurse described- I did report it to the visiting RN when it first happened. She said she would keep it confidential and look into it. She left the agency 2 weeks after I told her.Nothing happened so I do not think she ever took any action on it or plain just did not care. Then I just let it slide. It is very easy just to do my job and collect my paycheck. I will be relooking at it all this week and decide what to do. I know it needs to be reported- just not sure best way. I have a few reasons to stick with it for now and it is why I have stayed so long. The client home is just 5 minutes from my house, my kids are still in school so I have flexibility, and I do enjoy my shifts. I may call the agencies 800 number to report it annon- I am not ready to leave this position yet.

Thank you for the support/ advice - means so much! hmm..It just came to me that maybe she has told the agency that she is living there and they do not have an issue with it. With this agency it sure would not surprise me. It does seem that I am the only one at the work place that has issues with it.

FMF Corpsman, MSN, RN · Sep 17, 2012

If nothing else, maybe you could send them a computer generated anon letter with the details or even have a friend that you know you can trust, someone that cannot be traced back to you, call them with the details. All just suggestions to keep you out of it. BTW, how many other people are working the case with you or have worked the case in the past?