Nurse safety in the home

RubyRN,CHPN · Oct 12, 2008

Hi Jess,

This is usually outlined the admission packet often in "Pts. Rights and Responsibilities" during the admission assessment. It is not acceptable to be intimidated or abused by a family member, caregiver, or a pt. When people sign consent for services for home health often there is a statement that they have received this information. I have been a home health nurse for 12 years and can count the times on one hand I have been truely fearful during a visit and left. Never once been accused of abandoning. If this were to happen, you would let the pt and caregiver know you are leaving and why, document it as an incident report, notify your supervisor immediately and the physician. This person may not be appropriate for home health and aranagements could be made for care to be conducted in a different venue (clinic, LTC, MD office) if home environment is not safe. If I were interviewing with an agency, and this is a deal breaker, I would ask up front what provisions were in place employee safety to prevent such an incident.

Best of luck.

Jess_Missouri_RN · Oct 12, 2008

Thank you, Ruby. I'm glad to know it's a rare occurrence :)

RubyRN,CHPN · Oct 12, 2008

You are welcome. Many agencies understand that an unsafe home would not support home health services and at time of admission visit that could be determined by the RN admitting the case and then he/she might determine that home health might not be a good fit for this pt. There are instances when someone like this comes on to services and then a home health agency might write a contract for care (ie-put away the gun while the nurse is visiting.,etc.)

BTW, my first year as a HH nurse, I had a pt show me his "protection" (weapon) tucked in his recliner beside him during my admission. I have worked in some very bad parts of town. That was 12 years ago and I still work in home health as a visiting nurse.

Good Luck.

Ruby

caliotter3 · Oct 16, 2008

Leaving the patient has become necessary for me more than once. I always called my agency and let them know what was going on, to include what provisions I had made for the care of the patient by another family member. I try to call while still in the house. I've had to leave the house and then call. One time I drove about a mile away before I pulled over and called the agency. Unfortunately, one time I was assaulted. My agency's response to the incident was to effectively end my employment, accompanied by other adverse actions. Ironically, yes, this agency has a written statement in the contract that states a safe environment will be provided. Most hh cases are safe; clients for the most part know that they have to watch their behavior or they risk losing their nursing care. They don't want a bad reputation in the home health community. It is unfortunate that some employers pay lip service to the obvious, but that happens in all kinds of employment. Learn how to be safe on the job and what steps you need to take when there are problems and you will be able to enjoy your hh job. If your employer treats you shabbily, there are other employers.

DDRN4me · Oct 16, 2008

There are safeguards in the agency contracts that do allow you to leave if you feel that you are in danger.

when i was a manager in HH we would discharge pts (with notice to their MD and primary caregiver) if we thought it was an unsafe situation.

Personally I did have some bad experiences but it came with the territory. If we were nervous about a situation we would bring along another nurse so that we werent alone in the house. A couple of times we did need to involve the police and/or DSS.

It is much better now that we have cell phones. I would always keep one in my pocket just in case.