Parental Neglect

[crochetmom1]

I have been reading some posts and can identify with many of them!!!! I thought my pediatric home situation was unique, but apparently not! I have been in the home almost 3 years. Mom expects more and more from the nurses (doing dishes, washing clothes, babysitting for other children, etc). If I could offer any advise to a new pediatric home care nurse I would say: Never start doing things in the home that you are not responsible for; it is eventually expected and often not appreciated. I am the "case manager" and have to listen to all the other nurse's complaints, but they are afraid to say anything to the mom. There have been many parental neglect issues over the time I have been there, to the point where the child's life has been endangered. Not only that, you are there to care for the child, not the rest of the family. One of the nurses called child protective services about mom not giving the child meds when nurses are not there, but they said there is nothing they can do because the child has 16 hour a day nursing care. There are many, many safety issues in the home. I called my manager today because I am afraid something will happen to the child and the nurses will be blamed ( this has been the history -- mom blames nurses for things that she is responsible for.) Mom pits the nurses against one another, lies at doctor appointments, gets upset if the nurse calls the doctor about anything (she wants to do all the doctor calls). Recently I was told by another nurse that mom did not want me aware of the things that were told to her at an appointment with a specialist. I realize there is a "control" issue here, and do all I can to give mom as much control as possible. I could go on and on but I think I have said enough. The agency told me to call and talk to the doctor. I am afraid this will make matters worse. Has anyone had any experience confronting a parent in a "staff meeting" type setting where all nurses are present. That way everyone knows what has been said and what is expected. I would very much appreciate any input or suggestions. This is how I feel --

[caliotter3]

The easy way to deal with this is for the agency to give notice and terminate services. Under the circumstances, it might be the appropriate thing to do. The agency has no responsibility to get overinvolved with how this family functions. You can't tell them how to live and they will fight every suggestion tooth and nail. Lack of cooperation and the neglect allegations are sufficient reason to end the relationship. It is quite apparent that no amount of intervention on the part of the agency is going to change behaviors and it is too risky for the nurses and the agency to continue the games that are being played with the nurses' livelihoods and the agency's liability funds.

[ArwenEvenstar]

Yea....I have been doing PD over 4 years now....and although it is way less stressful than the hospital, issues like the ones you describe are the #1 problem! I have actually found issues like this to be pretty common. Sigh. One must be vigilant to keep a professional boundary...if you give an inch, they take a mile.

I agree with the other response that it may be best for your agency just to terminate services. Sometimes certain situations can get so out of hand that they can not be fixed. Trying a intervention meeting may be worth a try, but from how you describe things, I don't think it will be effective. But I don't mean to sound pessimistic! If you do an intervention meeting, I'd love to hear an update of how things resolve. One thing for sure: ALL the nurses must be on the same page and be consistent with what they do and don't do for the family!! The family may not like this, and could choose to switch to a different agency on their own...that would eliminate the problem for you! :wink2:

Quote: "If I could offer any advise to a new pediatric home care nurse I would say: Never start doing things in the home that you are not responsible for; it is eventually expected and often not appreciated." AMEN!!!!!! YES!!!!!!! I have been so frustrated by nurses who do NOT "get" this!!! In fact, although the families understandably have coping and control issues, I lay more blame on the nurses for how things get out of hand in these cases. I have been flabbergasted at all the nurses I have come in contact with who have no professional boundary whatsoever! And not only that, they don't even understand why it is a problem.

I think all agencies need to develop some type of mandatory inservice for PD nurses on the importance of keeping a firm professional boundary, and how to properly deal with some of the complex coping and control issues that one can encounter with these families.... For me it is common sense, but evidently common sense is not so common! Sorry, don't want to get too negative....

I've rambled more than enough! Hang in there!

[texastaz]

I had a PD case like that were the "Gaurdian" of the patient played the "don't tell this one that" game also and tried to minipulate the whole health team , when everyone became aware of it the support was there and it was a stress relief. The Gaurdian I think was selfish and while it is a long story-she ultimantley was looking at covering for herself. When I think back to it - remembering the Gaurdian's sad concerned face it just tees me off. The patient was a saint-eventualy all ended well. Good luck!

[crochetmom1]

Thank you so much for your reply! I am going to talk to the agency about an inservice on maintaining professional boundaries and some of these other issues. Wish me luck! I do plan on trying the meeting with all the nurses involved in the case and let you know how it goes.