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Nurses aren't maids!

Specializes in Pediatrics, Cardiology, Geriatrics.

I'm sorry. I really, really need to vent. I work for a pediatric private duty nursing agency, and I'm an RN. This is what I wish I could say to my new patient's mom: Why the heck would you ask your child's new night nurse to do her laundry?! When the hell did they put laundry questions on the NCLEX? Oh, yeah, they DIDN'T because NURSES AREN'T MAIDS! I'm not your kid's nanny, I'm a healthcare PROFESSIONAL - just like a physician. You wouldn't ask your pediatrician to do your kid's laundry, so you better not ask the nurse to do it, either! It's not 1950, anymore, Sparky!

Of course, I didn't say that. To be nice, I folded the kid's clothes tonight, but then I sent off an email to the clinical director at the agency complaining profusely about this insulting request. I mean, seriously! Where do people get the brass testicles to ask a nurse to do a maid's job?

Why do people automatically assume when they get private duty nursing covered by the state or their insurance that whoever is paying for it also thinks it's cool to provide you with housekeeping services? Isn't that insurance fraud? THe state doesn't want to pay for someone to do your kid's laundry. You can't ask me to do that! Not only is it DEGRADING to ask a healthcare professional to do laundry, it must be abuse of services. I hope to God above that no one at my agency told this woman that nurses do chores, because I will go all the way to the top of national corporate management if someone did. This better be an unfortunate misunderstanding on my patient's mom's part as to what nurses do and DO NOT do.

Has anyone else had to deal with this? I had one other patient's mom ask me if that was something we do, and she totally apologized for asking when I politely told her no. This new patient's mom guided me to the laundry room to make sure I understood how the machines work because she is assuming it's totally in my job description to do laundry. She didn't even ask, she just started out with "when you do her laundry..." Excuse me?! I clean the kid and his or her medical equipment. Nothing else! I'm not a home health aide (whose job it would possibly be). It's just not *my* job to do household chores!

OK, vent over. I feel a little better. Thanks for letting me vent.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Perhaps you should have offered a very friendly clarification: "I have not been hired, recruited, or trained to provide laundering services. However, I am very competent and capable of handling any healthcare issues that may arise with your child."

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

Perhaps you should have offered a very friendly clarification: "I have not been hired, recruited, or trained to provide laundering services. However, I am very competent and capable of handling any healthcare issues that may arise with your child."

I know, in hind sight, I wish I had done that. I was just so shocked by the whole encounter that I froze and couldn't say anything. If my agency doesn't intervene tomorrow, I will talk to her myself when I've calmed down.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

If my agency doesn't intervene tomorrow, I will talk to her myself when I've calmed down.
I certainly hope that your agency intervenes swiftly. I hope that they are not into the new trend of 'customer service' so deeply that they would overlook something of this nature.

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

I certainly hope that your agency intervenes swiftly. I hope that they are not into the new trend of 'customer service' so deeply that they would overlook something of this nature.

I was assured by someone at the national corporate office when I first took the job that corporate doesn't tolerate local offices expecting nurses to do household chores, and to report it to them if I am asked to. If the agency tells me tomorrow that they told her I would be doing laundry, I will report the office to corporate.

I'm tired of hearing about customer service! Someone has to say enough is enough with the customer service garbage. They're PATIENTS, not customers! And how can they be all about customer service when the state/Medicaid is paying the bill? Having a kid who needs private duty nursing they can't afford without government assistance does not equal winning the lottery and getting free maid service. I'm actually really here so mom has the free time so she can work, sleep, and do her own housework. Sigh...

LoveMyBugs, BSN, CNA, RN

Specializes in Pediatrics.

I did pedatric home health for awhile too and it depends on the company and the parents.

I had 2 cases that I worked, one was great all that she asked other then care for her child was to help organize the medical supplies, as she hadn't had help in years and her house refeclted it, as I was there more, the house became cleaner and cleaner as mom now had the time.

The other one there was a huge language barrier and my company does advertise housekeeping services when you have a compainion, but I am a nurse and was there to provide medical care to her child, but she too wanted me to fold the laundry and finish the loads of laundry and the dished, how can I keep an eye/ear out for your child if you want me in the kitchen doing the dishes!?!? Didn't stay on that case for very long.

Mike A. Fungin RN

Specializes in Trauma ICU, Peds ICU.

Of course, I didn't say that. To be nice, I folded the kid's clothes tonight, but then I sent off an email to the clinical director at the agency complaining profusely about this insulting request.

If my agency doesn't intervene tomorrow, I will talk to her myself when I've calmed down.

I understand from your second post that when this happened maybe you didn't trust yourself to address the issue directly. That was probably a good idea if you were in danger of losing your temper, but there's a happy medium between losing it and your approach.

Being passive aggressive isn't likely to help you build a good rapport with these clients. How do you think the patient's mother is going to feel when she gets blindsided with this by your agency? Unless you left some details out for us then as far as she knows you folded the clothes, it's part of your job, and everything is fine.

Consider also that this might give your clinical director the impression that you're unwilling or unable to resolve minor conflicts on your own. If I were in his/her shoes as a manager then my first question would be whether or not you spoke with the client already and what was the outcome. I hope they give you that chance, because it's not too late.

lulu67, LPN, LVN

Specializes in school/home health/behavioral/prison.

Hello,

I'm an LVN not an RN ..but I thought of replying to your thread....I couldn't agree more!

Here in Idaho, however, we do their laundry or dishes because it is an item that belongs to the pt. and needs tending to(per my manager). I have complained but to no avail. They said it is my responsibility- especially if the client's clothing is saturated with body fluids. I too have worked with home health peds --and in my most recent case..the mom put me to the laundry task immediately. I was offended as well, but realized that my pt wasn't able to do it and the mom wouldn't...so ergo..it seems to have fallen to me? I was very appalled. ..but i did it anyway...the kid(16yo) had no support of any kind really.(so I felt it would help her self esteem to have clean clothes for school and smell like fresh laundry instead of urine) I only did HER laundry and no other family members laundry.

However, after that..the mom directed me to cleaning out her closet! I said "no, sorry, but I have charting and other things to do. I was able to redirect that instance but otherwise we do have to do their laundry and dishes here in Idaho anyway. I am curious how it turns out for you.

I do not agree with us being maids as well as health care professionals at all!

Edited by lulu67

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

I understand from your second post that when this happened maybe you didn't trust yourself to address the issue directly. That was probably a good idea if you were in danger of losing your temper, but there's a happy medium between losing it and your approach.

Being passive aggressive isn't likely to help you build a good rapport with these clients. How do you think the patient's mother is going to feel when she gets blindsided with this by your agency? Unless you left some details out for us then as far as she knows you folded the clothes, it's part of your job, and everything is fine.

Consider also that this might give your clinical director the impression that you're unwilling or unable to resolve minor conflicts on your own. If I were in his/her shoes as a manager then my first question would be whether or not you spoke with the client already and what was the outcome. I hope they give you that chance, because it's not too late.

I kind of understand what you're saying, but she did take a condescending tone about it, so I had to keep my mouth shut to avoid getting angry with her. She won't be blindsided if the agency tells her politely. I was blindsided by the announcement that I will be doing the laundry, and here's how the washer works. Why is that ok? Why doesn't the mom have to worry about building a good rapport with me? Management needs to do something to earn their pay. It can't be up to the nurses to fight every battle, especially if someone in management thinks they're being funny and is now offering housekeeping services. They can deal with the obnoxious and ridiculous fantasies of parents who think the state paying for private duty nursing includes free housekeeping services on the tax payers' dime. I'm not ok with customer service in healthcare. It's total bull hockey. So, yes, that may be passive aggressive, but that's how I roll after having been taken advantage of so many times before. I'm not going to be the one to address this if the office did indeed say we now do laundry, because they can't do that, so they will have to retract that statement. I'm not getting guilted into doing housework for my patients, and believe me, some people in the office have noticed I can be guilted into things, so I have to protect myself! They need to take responsibility for any misleading promises they made to my patient's parents. That's not a minor conflict that I need to prove I can deal with, it's a major problem they have to deal with if they aren't able to accurately convey to patients' parents what services are actually offered. I'm not going to be held responsible for explaining services. My lower-than-average nursing pay only covers my doing professional nursing. I don't get paid enough to do administration and public relations, too.

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

I did pedatric home health for awhile too and it depends on the company and the parents.

I had 2 cases that I worked, one was great all that she asked other then care for her child was to help organize the medical supplies, as she hadn't had help in years and her house refeclted it, as I was there more, the house became cleaner and cleaner as mom now had the time.

The other one there was a huge language barrier and my company does advertise housekeeping services when you have a compainion, but I am a nurse and was there to provide medical care to her child, but she too wanted me to fold the laundry and finish the loads of laundry and the dished, how can I keep an eye/ear out for your child if you want me in the kitchen doing the dishes!?!? Didn't stay on that case for very long.

Organizing medical supplies is a reasonable request, I think. I wouldn't complain about doing that. I've read my company's info on the web and what they gave the parents. Nowhere does it offer housekeeping. I really don't know where she got that idea from. If my office thinks I'm doing this, I'll be looking for a new job. You're right, you can't be a nurse and pay attention to the kid if you're doing housework, which is why we exist! So mom can do her housework! D'oh!

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty.

It's unfortunately a game parents will play - and I can assure you there are many posts here detailing families wanting the nurse to clean the bathrooms, do the family dishes, and/or babysit for the other siblings.

Many of them have the belief that since it's 1:1 care you have a "cushy" job and if there are HH aides in the house who do housework they will compare you to them and what hard workers they are while "nurses just sit around". They have no grasp at all what critical thinking or assessment skills are.

Even with a family I got along wonderfully with for years - muttered something under his breath about nurses, and I said to myself "no more". I'm a human being, too - and when I can't afford the insurance I pay taxes so you can get for free. No. Not happening anymore. I felt myself getting very close to the edge of losing it with them.

However, I don't feel this falls in line with the "customer service" trend exactly, but what happens is sometimes the agencies side with the families if the families threaten to change agencies. My agencies did not have that type of dysfunction going on, but it is not all that unusual from what I can tell.

I wash the dishes I use for the patient's meals, the DME and associated tubings and supplies, restock suction catheters or other medical supplies the patient uses, and sometimes put a stained sheet to soak but that was as a favor for the daytime caregiver and not something I felt obligated to do.

I certainly have felt the same frustration! Hope it works out for you. :)

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

Hello,

I'm an LVN not an RN ..but I thought of replying to your thread....I couldn't agree more!

Here in Idaho, however, we do their laundry or dishes because it is an item that belongs to the pt. and needs tending to(per my manager). I have complained but to no avail. They said it is my responsibility- especially if the client's clothing is saturated with body fluids. I too have worked with home health peds --and in my most recent case..the mom put me to the laundry task immediately. I was offended as well, but realized that my pt wasn't able to do it and the mom wouldn't...so ergo..it seems to have fallen to me? I was very appalled. ..but i did it anyway...the kid(16yo) had no support of any kind really.(so I felt it would help her self esteem to have clean clothes for school and smell like fresh laundry instead of urine) I only did HER laundry and no other family members laundry.

However, after that..the mom directed me to cleaning out her closet! I said "no, sorry, but I have charting and other things to do. I was able to redirect that instance but otherwise we do have to do their laundry and dishes here in Idaho anyway. I am curious how it turns out for you.

I do not agree with us being maids as well as health care professionals at all!

I don't agree with your manager. If they really need those services, they can pay for home health aides. It is never the nurse's (RN or LVN - a nurse is a nurse) job to clean the patient's dishes or clothes (or anything other than the patient or his or her actual medical equipment). Since mom doesn't have to do the nursing stuff, she has PLENTY of time to do the cleaning! If she won't, that's child neglect and she should be reported to the authorities. It was sweet of you to do it, though. Bull snot about the body fluids, by the way. Do nurses in hospitals do laundry because it's saturated in body fluids? No! It's just greed. They'll say and make us do anything to keep that account, won't they? I'm hoping my agency didn't tell the mom I would do laundry. Yes, they've taken advantage of me in the recent past, and they could be doing it again, but I want to believe it's just a weird fantasy mom has that my agency (who has lately promised to make up for past issues) will make go away. Other than the maid garbage, I like the family.

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

It's unfortunately a game parents will play - and I can assure you there are many posts here detailing families wanting the nurse to clean the bathrooms, do the family dishes, and/or babysit for the other siblings.

Many of them have the belief that since it's 1:1 care you have a "cushy" job and if there are HH aides in the house who do housework they will compare you to them and what hard workers they are while "nurses just sit around". They have no grasp at all what critical thinking or assessment skills are.

Even with a family I got along wonderfully with for years - muttered something under his breath about nurses, and I said to myself "no more". I'm a human being, too - and when I can't afford the insurance I pay taxes so you can get for free. No. Not happening anymore. I felt myself getting very close to the edge of losing it with them.

However, I don't feel this falls in line with the "customer service" trend exactly, but what happens is sometimes the agencies side with the families if the families threaten to change agencies. My agencies did not have that type of dysfunction going on, but it is not all that unusual from what I can tell.

I wash the dishes I use for the patient's meals, the DME and associated tubings and supplies, restock suction catheters or other medical supplies the patient uses, and sometimes put a stained sheet to soak but that was as a favor for the daytime caregiver and not something I felt obligated to do.

I certainly have felt the same frustration! Hope it works out for you. :)

I've been asked to babysit by 2 families (because the other nurses do it), but I didn't do it. See that's the problem. If we don't get the office to step in and say "this is not acceptable," the pushover nurses (and I'm almost one of them - but not there yet!) and the families will just have a free for all over what new tasks can be added. I've also had parents comment on how little we actually do on the night shift. You know what, I don't make nearly as much as I would in a hospital. I only have one patient (which is why I do this, so I can focus on one patient and give the absolute best care possible), and when I'm not doing what I need to for that patient, I'm gonna study or watch a movie on my computer (always ready to jump up and tend to the patient). That's my reward for not getting a break at all during my 12 to 14 hour shift and having such low pay and NO benefits. Last time *I* got sick, I racked up $20,000 in hospital bills I can't pay and couldn't get a nurse to help me with my wound that I had a hell of a time tending to myself. Yeah, you're so right. It's not fair that we work so hard, have no benefits, and get treated like crap. I stay because I love my patients like my own family. However, I don't do my family's laundry, either. :p

In a former "life" I was the clinical coordinator for a branch of a "nation wide pediatric agency" that shall remain nameless.

If the child is medicaid their service plan very likely includes doing the child's laundry, washing their dishes, preparing the meals, cleaning the child space and equipment, etc as part of the nurse's duties in the home as time permits. If it is included in the service plan it is the agency's contract with the state and you have to provide the service.

I've also seen private insurance contracts that also list those tasks, again, as time permits.

Medicaid (and many private insurance) know that very often the 'nursing care' being provided over night consists primarily of monitoring the child and intervening as needed.

Check the child's care plan and 485, what does it say about meeting the child's environmental needs?

Private duty Peds nursing isn't just about the patient, it's about providing support to the family too.

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

In a former "life" I was the clinical coordinator for a branch of a "nation wide pediatric agency" that shall remain nameless.

If the child is medicaid their service plan very likely includes doing the child's laundry, washing their dishes, preparing the meals, cleaning the child space and equipment, etc as part of the nurse's duties in the home as time permits. If it is included in the service plan it is the agency's contract with the state and you have to provide the service.

I've also seen private insurance contracts that also list those tasks, again, as time permits.

Medicaid (and many private insurance) know that very often the 'nursing care' being provided over night consists primarily of monitoring the child and intervening as needed.

Check the child's care plan and 485, what does it say about meeting the child's environmental needs?

Private duty Peds nursing isn't just about the patient, it's about providing support to the family too.

Nope - the care plan says nothing about housekeeping chores. My supporting the family means (to me) that mom and dad can sleep at night so they can work and do chores during the day. If the plan includes this, they should provide a home health aide to do this. I'm sure an agency home health PT, SW, or OT isn't expected to do housework. No where in my state's nurse practice act does it say that nurses do housework. Someone at the corporate level at my agency said our agency does not do this and I should report the office to corporate HQ if asked to do housework (so, if I hear in the morning that the agency told mom I would do laundry, I will be reporting it to corporate). I don't think in my state they would waste precious nursing money for maid services. If Medicaid pays for that for *anyone* under 18 (because honestly, anyone under 18 should have at least one parent who should not be so damned lazy), I will stop paying taxes! No one deserves free servants! Where's my government-supplied maid?!

Seriously, I will leave nursing forever if this is what it's coming to. I'm a college educated professional! I'm a little ticked off that people think that night nurses should do all the junk no one else wants to or "should" do. Day private duty nurses don't really do much more than we do. That's a weak excuse to use college educated professionals as indentured servants. No one would go into nursing at all if it really involved being a freaking maid (unless they're stupid - who pays tens of thousands of dollars for college to do someone's laundry on the tax payers' dime for so little pay?)!

Edited by AnaCatRN

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty.

Maybe it's a state by state thing then as far as it's delegated or contracted with the families, but (and I have only two agencies to speak of through experience) the client had to sign an agreement to be placed in the front section of the home chart stating in specifics what we can't do.

We are supposed to evaluate the environment for safety hazards (both tio the patient and the nurse) and make sure there was a safe exit for the patient in the event of an emergency (fire, earthquake, etc).

Here in California the state (Medi-Cal, our name for Medi-Caid) itself will train caregivers of the patient's choosing provided they pass a (not very strict) background check and have a valid social security card. They pay them a little bit more than minimum wage ($8-9) here. Here they have separated the monthly allotments to these patients all along into "skilled nursing" (RN/LVN) hours and HHA hours. The 485 will have a specific number for hours for both that can't be exceeded, or category switched.

As we've hit the wall here in our state budgets they are trying to save money by whittling down the patient's skilled nursing hours to the bare bones, hence even private duty nursing jobs are drying up when we used to have staffers literally driving a 60 mile round trip to take a nurse to a case.

Our 485s never addressed the subject of housework at all.

PS AnaCat - if I ever have occasion to need an extra support person to get my point across -- I will come to your house and get you!! :up:

Edited by nursel56

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

Maybe it's a state by state thing then as far as it's delegated or contracted with the families, but (and I have only two agencies to speak of through experience) the client had to sign an agreement to be placed in the front section of the home chart stating in specifics what we can't do.

We are supposed to evaluate the environment for safety hazards (both tio the patient and the nurse) and make sure there was a safe exit for the patient in the event of an emergency (fire, earthquake, etc).

Here in California the state (Medi-Cal, our name for Medi-Caid) itself will train caregivers of the patient's choosing provided they pass a (not very strict) background check and have a valid social security card. They pay them a little bit more than minimum wage ($8-9) here. Here they have separated the monthly allotments to these patients all along into "skilled nursing" (RN/LVN) hours and HHA hours. The 485 will have a specific number for hours for both that can't be exceeded, or category switched.

As we've hit the wall here in our state budgets they are trying to save money by whittling down the patient's skilled nursing hours to the bare bones, hence even private duty nursing jobs are drying up when we used to have staffers literally driving a 60 mile round trip to take a nurse to a case.

Our 485s never addressed the subject of housework at all.

PS AnaCat - if I ever have occasion to need an extra support person to get my point across -- I will come to your house and get you!! :up:

We have to evaluate the environment, too, but the agreement signed by the parents states that it is the parents' responsibility to clear any obstacles (so they have to clean the mess blocking the exit) or the nurse can leave and they can be reported to the state and lose their hours. We don't have anything called a 485 that I know of. Just an agreement with the parents and the agency that clearly states that a professional nurse's role must be respected. That to me means no maid service. Our state has a huge backlog of patients who need nursing and little to no funds, but they are still paying for currently open cases, so our agency needs nurses big time, but they won't keep any nurses if they ask us to do housework. That won't fly around here.

We should band together, nursel56!

I agree that nurses aren't maids. We have nursing - 16 hours per day (12 from private ins., 4 from Medicaid). The agency we use DOES state that nurses are responsible for all dishes, cooking utensils, laundry, towels and garbage that they use for my child or themselves.

I do not permit our nurses to wash bottles or syringes. I also do not allow them to wash any drinking glasses that they have used. Our kitchen is too far from my son's room. I wash everything when our day nurse gets to work. I also make all the formula for the day.

I do my son's laundry. One of our awesome night nurses will peek in the washer or dryer. If his clothes are in the dryer, she will grab it and fold it and put it away. If they are in the washer, she will transfer them to the dryer and then take care of them. I never asked her to do this but she knows how much I appreciate it! I do ask ALL the nurses that if my son's clothing or bedding becomes soiled that they put it in the washer and soak it. She is also the wonderful nurse that every few weeks stays over her shift a couple of hours on a Saturday or Sunday morning so we can sleep in!

The nurses wash the suction canister when I wake up (night nurse) or just before they leave (day nurse). I try to empty it when the night nurse arrives so she doesn't have to deal with it.

Nurses take out the garbage from my son's room when they leave for the day.

You asked how parents get away with demanding nurses to provide housekeeping - it's sad but here is why: insurance pays a lot of money to your agency. Your agency pays you a little of that and sends you to the house. If you don't do what the parents want, they tell the agency not to send you back because you were "uncooperative" or "lazy" or "disrespectful" or whatever. They tell the agency that they need the nurse to do ABC, WYZ and only send nurses that will. The agency will do what the parents want because they make good money! I don't agree with it but I have been doing this for long enough to have met some really lousy parents and I really sympathize with some of their nurses.

As far as what to expect, our agency has a very detailed information sheet with stuff about our house so that all nurses are prepared BEFORE they consider working with us (for ex. we have cats, we keep our house temperature at 67, we have religious considerations so nurses can't bring in certain food items, food allergies so they don't bring nuts, that they must use a baby monitor if they leave my son's room for any reason, etc.).

Our day nurses do a LOT more hands on care as they do PT/OT exercises, transfer him in and out of his wheelchair/bed, get him ready for appointments and go with us to the appointments, do multiple nebulizer treatments and chest physiotherapy multiple times. They help me bathe him (daily) and they help me change his trach tube (weekly) and vent circuits (weekly). One of them will usually help me check in supplies when our 180 pounds of supplies arrive each month! Our night nurses do all the "maintenance" things - change and wash filters on the vents every other day, change suction canisters and tubing twice per week, wipe down equipment, change nebulizer sets weekly, change the feeding pump bag daily. All of the nurses are obviously responsible for diaper changes, never-ending suctioning, an incredibly complex medication schedule plus PRN meds/neb treatments, position changes, etc.

As a parent, I can tell you that even with 16 hours of nursing, I am EXHAUSTED all the time. Once our night nurse gets here, it takes me a bit to give her report and get myself ready for bed. Then I need to be up a bit before she leaves so I can take care of other kids, cats, myself so I never really get much more than 6 or 6.5 hours per night. Sometimes a lot less when I hear pulse ox or vent alarms going off a lot. Sometimes none when the nurse doesn't call out until five minutes before her shift and the agency can't find anyone to cover. Our son is adopted and I wouldn't change a thing and I don't regret for a second our decision to take him. The life he has had with us is infinitely more rewarding than the first year of life he spent in a hospital with no visitors but a SW.

To the OP, I hope you find a great family to work with! To ALL the nurses, thank you for everything you do to make the lives of your patients and families better.

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty.

Bless you, ventmommy. :redpinkhe I really only have a partial understanding of the relentless stress that comes with your situation. I'm sure it must be difficult to explain - as most stresses, no matter how horrific they may be, have an endpoint, the thought of (even if it's death) will keep you motivated to hang in there, or that your pain will end.

I always tried to remember that for us, we go home at the end of our shift, and for the families, there is no "go home".

It sounds like your family is exactly the family most of us wished we worked with every day.

But I aint washing your husband's skivvies!! :) ( I bit of jest, of course.)

AnaCatRN

Specializes in Pediatrics, Cardiology, Geriatrics.

I agree that nurses aren't maids. We have nursing - 16 hours per day (12 from private ins., 4 from Medicaid). The agency we use DOES state that nurses are responsible for all dishes, cooking utensils, laundry, towels and garbage that they use for my child or themselves.

I do not permit our nurses to wash bottles or syringes. I also do not allow them to wash any drinking glasses that they have used. Our kitchen is too far from my son's room. I wash everything when our day nurse gets to work. I also make all the formula for the day.

I do my son's laundry. One of our awesome night nurses will peek in the washer or dryer. If his clothes are in the dryer, she will grab it and fold it and put it away. If they are in the washer, she will transfer them to the dryer and then take care of them. I never asked her to do this but she knows how much I appreciate it! I do ask ALL the nurses that if my son's clothing or bedding becomes soiled that they put it in the washer and soak it. She is also the wonderful nurse that every few weeks stays over her shift a couple of hours on a Saturday or Sunday morning so we can sleep in!

The nurses wash the suction canister when I wake up (night nurse) or just before they leave (day nurse). I try to empty it when the night nurse arrives so she doesn't have to deal with it.

Nurses take out the garbage from my son's room when they leave for the day.

You asked how parents get away with demanding nurses to provide housekeeping - it's sad but here is why: insurance pays a lot of money to your agency. Your agency pays you a little of that and sends you to the house. If you don't do what the parents want, they tell the agency not to send you back because you were "uncooperative" or "lazy" or "disrespectful" or whatever. They tell the agency that they need the nurse to do ABC, WYZ and only send nurses that will. The agency will do what the parents want because they make good money! I don't agree with it but I have been doing this for long enough to have met some really lousy parents and I really sympathize with some of their nurses.

As far as what to expect, our agency has a very detailed information sheet with stuff about our house so that all nurses are prepared BEFORE they consider working with us (for ex. we have cats, we keep our house temperature at 67, we have religious considerations so nurses can't bring in certain food items, food allergies so they don't bring nuts, that they must use a baby monitor if they leave my son's room for any reason, etc.).

Our day nurses do a LOT more hands on care as they do PT/OT exercises, transfer him in and out of his wheelchair/bed, get him ready for appointments and go with us to the appointments, do multiple nebulizer treatments and chest physiotherapy multiple times. They help me bathe him (daily) and they help me change his trach tube (weekly) and vent circuits (weekly). One of them will usually help me check in supplies when our 180 pounds of supplies arrive each month! Our night nurses do all the "maintenance" things - change and wash filters on the vents every other day, change suction canisters and tubing twice per week, wipe down equipment, change nebulizer sets weekly, change the feeding pump bag daily. All of the nurses are obviously responsible for diaper changes, never-ending suctioning, an incredibly complex medication schedule plus PRN meds/neb treatments, position changes, etc.

As a parent, I can tell you that even with 16 hours of nursing, I am EXHAUSTED all the time. Once our night nurse gets here, it takes me a bit to give her report and get myself ready for bed. Then I need to be up a bit before she leaves so I can take care of other kids, cats, myself so I never really get much more than 6 or 6.5 hours per night. Sometimes a lot less when I hear pulse ox or vent alarms going off a lot. Sometimes none when the nurse doesn't call out until five minutes before her shift and the agency can't find anyone to cover. Our son is adopted and I wouldn't change a thing and I don't regret for a second our decision to take him. The life he has had with us is infinitely more rewarding than the first year of life he spent in a hospital with no visitors but a SW.

To the OP, I hope you find a great family to work with! To ALL the nurses, thank you for everything you do to make the lives of your patients and families better.

***I became a nurse to help heal people, and that is all I care about - healing people. I do NOT give a rat's behind if anyone thinks I give good customer service. I do NOT strive for 5! I DO strive to keep your butt alive. Nothing else matters to me. Dr. Gregory House is my hero (even if he is a rude jerk to nurses).***

I want to believe you weren't flaming me, and that you meant what you said about not agreeing with the nurses as maids idea, but you didn't really convince me after you listed all of your demands (yeah, this ignorant woman thinks she has the right to demand that I become a freaking vegetarian four times a week, that I wear special indoor shoes in her house, and that I wear a specific outfit). You do see nurses as servants who deserve no respect and are lucky to have jobs. That's so wrong. Patients and their parents may be "clients" or "customers" to the agencies, but they are PATIENTS to the nurses. You don't tell us what to do. No one tells us what to do. If you could tell me what to do, I wouldn't need malpractice insurance. I make my own decisions.

First of all, I have had wonderful families that I would go to the ends of the Earth to help, and I have done special things for them, because they appreciated me and didn't expect it. This was the first night with this family and she talked to me like you would a new maid on her first shift. My agency DOES NOT have a policy allowing (let alone forcing) nurses to do housework, yet this mother started the conversation by saying "This is the laundry room. When you do her laundry..." NO, MA'AM! She has not yet impressed me with how much she cares about her child and appreciates the help she ignorantly complained the state took too long in giving her (especially since she and her husband are well-paid healthcare professionals themselves who obviously think very little of nurses). I do nothing special for anyone who expects/demands it, and certainly never before they EARN it! Being rude and condescending to me on my first shift will not make me care how tired this woman is after partying with her friends all night while her husband oriented me to the case and I took care of her kid (yep, she came in after 11pm so she could talk down to me). Furthermore, this child does not really need a nurse at all in my opinion (there seems to be a lot of that going around at my agency), and I'm angry that Medicaid is paying for this case just so the parents can get out of parenting (because like I said, the parents are AFFLUENT). The parents are affluent, and the kid doesn't need a nurse all night. I'm not cleaning jack crap! Everyone is making money but me, and I'm not gonna bend over and take it like that!

You might actually deserve the special care your nurses give (and if you do, then I would probably bend over backwards to help you around the house, too), but unfortunately, you also use an agency that should be destroyed for abusing and exploiting nurses to satisfy their greed. Who knows? Maybe you live in a backwards state that still thinks women are their husbands' property, too. Something is wrong where you live! NO ONE, no matter how sick their kid is, deserves to expect or demand free housekeeping services paid for by tax payers. Maybe we abused nurses should expose this crap to the media and see how long that garbage keeps going on. Why is it that people on welfare (sorry, that includes Medicaid and disability because very few people actually deserve it, most are scam artists) get to live better than people who work their butts off with no benefits and sub-par pay, AND apparently get to tell others what to do? When the tax payers are footing the bill, you don't get to demand ANYTHING! How dare someone getting assistance paid for with MY TAXES judge me and what I will or will not be expected to do (especially when that is DEGRADING to anyone with my education and experience)?

Are you seriously implying that I'm lazy because I won't do a high school drop-out's job? Because if you are, HOW DARE YOU?! I graduated from college! I have a BSN. Does anyone even know what nurses really do since the 1950s ended?! It has NOTHING to do with cleaning or being subservient to ANYONE! I don't do chores. I will clean the heck out of any medical equipment - no problem! I have NO problem washing bottles, syringes, suction canisters, trachs, any equipment the kid has, because that's something you need training for to avoid contamination. I will happily empty the trash in the child's room at the end of the shift and as needed. I'm a night nurse (who is really sick of people thinking day nurses work harder than we do - you freaking stay up all night and have no backup or any breaks at all - see how long you survive that with a smile and a chipper can-do attitude), and I don't use anything in the patients' homes. I bring my own sandwich and soda, and I take my garbage home with me (if I find time to eat; many mornings that sandwich goes right back home with me, because something ALWAYS happens to screw me right out of any kind of a break). Do you work 12 to 14 hour shifts with no break, sometimes even to go to the bathroom, always having to triple check everything you do to avoid killing the patient or losing your hard-earned license? Of course not, because as a nurse, I'm just a servant and you're better than me. I never use the parents' plates, cups, or utensils. I don't make a mess, but if I did, I would clean up my mess.

The day nurses you have are nicer than the ones I've worked with. The ones I work with like to make sure that ALL maintenance things, stocking, cleaning, changing, etc. is left for the night nurses. Who has time to keep the kid from dying, do all the busy work no one else wants to do, and do laundry/clean the house? Keep the kid from dying, you say? Why yes, that is why we're there. Nothing else matters but keeping the kid from dying! NOTHING!

No one would ever ask a physician to do their kid's laundry! Why, oh WHY do people think that nurses are some low life servants who will do demeaning and degrading things? We are physicians' PEERS! I was educated to heal and save people, use nursing judgement - not clean! That parents are rude enough to expect that is ridiculous!

My mother is sick and bed ridden, but I manage to work and take care of her, and no one supplies me with a nurse to help nor a maid to clean up after her for me (and I would kill for that). She has been to the point where she wanders around filthy and naked, and doesn't know who I am. I'm single, and I can't afford to hire a nurse or put her in a home. I get paid crap to be degraded - I've been sexually assaulted and treated like I'm less than human. No benefits. You expect me to feel sorry for the agency for having to suck up to obnoxious parents who are bilking tax payers, just so they can make their money while screwing the nurses over? Not gonna happen! Do people really still think that nurses are servants and prostitutes? Come on! Who the hell do these parents think they are, and how DARE they think people should feel sorry for them or agree that they deserve to demand that someone else take care of THEIR parental responsibilities?! What idiot decided that family centered care means the parents can shirk all of their responsibilities and treat highly educated healthcare professionals like servants? NURSING IS A PROFESSION, NOT A TRADE! When you drop your laundry off at your doctor's office, or your accountant's office, and they don't throw you out on your butt for thinking they should personally do your laundry for you, come back and tell me how lazy and disrespectful I am. I am NOT subservient to my patient's parents. I don't OWE them respect or have to do ANYTHING they say!

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