Not the right agency for me? Private duty nursing

[changeofpaceRN]

So I work for a staffing and HH care agency. They sent me out on an orientation (gave me a whopping 1 case to choose from) and I went on it. I come back and they asked how I liked it. I said exactly what I thought: the pt is very ill and that scares me because I haven't had someone that critical before and the mom (who stays at home) has OCD and is always behind you nagging if you did this or that the right way. There is a right way to brush his teeth, comb his hair, which shoes to put on (although there is no paralysis or abnormalities in either lower extremeity), expects you to change over the laundry AS SOON AS the buzzer rings- if not, she will get mad and rewash things to avoid wrinkles, if you make the bed wrong, she will mess it up and have you do it again, ect..

I voiced my concerns but in their eyes, I saw my refelction of what they were thinking.. all they saw as I stood there talking was ~~~$$$ for us, a nurse in front of us, that's all that matters~~~~ I'm kind of upset that my concerns over not being experienced enough for this case weren't addressed and they assigned me for 9 days right away at 12 hrs a day starting on Sat.

I understand that I only have 1 patient in my hands so I can give enough time to them. I get all that. I wonder if everyone on private duty nursing is as critical as this one- this is my first case ever with HH and I don't even know what papers I need to fill out!

[ArwenEvenstar]

Hi! There is a private duty forum now. You may want to search around there for info on various PD issues... I have done PD as a RN for 3.5 years now.

I had a few questions....

Are you a nurse (RN,LPN) or nurse assistant?? Just wanted to clarify. You mentioned doing laundry. I have never heard of a nurse doing laundry or other housekeeping duties. A nurse assistant or family should be doing stuff like that. The nurse needs to focus on the pts health and medical care!

(FYI: Sometimes you have to set FIRM boundaries with families. Some can take advantage and will ask you to do all kinds of other things like clean their house!)

You mentioned the pt is very ill and critical. Please, more details?? To receive private duty they should at least be stable!! Is the patient not stable at least?? I cared for a pt who was ventilator dependent, got nebulizer treatments q 2-4 hrs and prn, chest PT, straight cath QID, bladder irrigation BID, bolus PEG feeds QID, etc, etc. A lot of care, but the pt was stable and everything pretty routine.

Is there something specific (like a specific skill) that you don't feel experienced enough for?? Whatever it is, you should request specific training. Like are they on a ventilator? If you lack vent experience, you should demand specific vent training. A GOOD agency would NOT want you to care for a patient if you lacked specific skills necessary for the case!! A lawsuit waiting to happen....

You mention the OCD mother. My experience is that families in these PD cases can react in very different ways. Some pull back and let the nurse have free rein. Others hover around and want everything done a certain way. Families learn to cope in different ways when they have a long term disabled loved one. In fact, I would say that dealing with complex family dynamics can be the most stressful part of PD.

On my current case, the mom is VERY particular about how everything is done. You just have to learn to do things her way. And actually, in this case, some of the odd little ways this mom does things actually work pretty well!! She has cared for her loved one for years and has learned the most efficient way to do some things. With PD, you often have to "go with the flow"....

Hope my thoughts help. Final comment: It concerns me that your agency would send you to a case if you lack specific skills. And you mentioned not knowing the paperwork. You should have been oriented to that ahead of time. Is this agency a reputable one?? Remember that it is your nursing license on the line!! Sometimes you have to be assertive with these agencies....