PDN and family boundaries

[gingah828]

Just wondering what are reasonable expectations that family should have of their nurses. For example, first day on the job had to jump the father's car to transport the patient to his appt for the day, unless that is a recurring problem, not unreasonable.

Second day, dad forgets patient has school and has to be out front for the bus on time, leaves the home. Normally, he will take the chair upstairs (we're in the basement) to use the ramp through the garage door. I called his cell and he told me to take the child's wheelchair out the back and push it up the hilly and unstable yard through the gate to the front of the home. This is unsafe for the kids and not exactly safe for me either.

Any experiential input is appreciated. I have enough experience in home care to understand there is a certain amount of psychosocial nursing involved.

Anyways, thanks in advance for your help.

[caliotter3]

The agency wants to keep the case for the income. They will go easy on the clients. If it were me I would pose the problem to my clinical supervisor to have the air cleared. Once established that the client is going to continue this behavior, I would arrange to change cases.

[caliotter3]

BTW, had you damaged your car in the first instance, do you really think your employer would pay for the repairs?

[gingah828]

Thank you for your insight, caliotter3. I have taken your suggestion. It was really helpful. I appreciate the time you took to respond. I have decided to forego this case.

[caliotter3]

This much drama on day one and day two foretells the future. Most likely, it would have only worsened, and the agency would have been looking to you to "make it so" for them. Good call on your part.

[gingah828]

Thank you! I trust that is the truth. Those were my thoughts exactly. Although, I am not sure how the agency feels. Time will tell. I'm not PDN is for me.

[caliotter3]

Extended care works out if you get a near perfect family/patient situation and agency personnel who practice "benign neglect" when allowing you to do your job (no silly micromanagement) and when they do their part. It also works out when you remember why you are working and do not allow anything to push you beyond your boundaries for 'reason'. It does not hurt to have a little give and take with the client, but always remember that they can turn on a dime and this is your livelihood. You should affiliate with two agencies so if things change at one agency (client goes to hospital for extended period, passes away, etc.) you are not entirely out of a paycheck. Working with only one patient at a time for near the same amount that one can make at a facility for a ton more responsibility and work, has its advantages in the long run. Don't be too fast to walk away from it. You can also get a regular facility type job and just work one or two extended care shifts a pay period to keep your foot in the door. Many nurses do this. Good luck on your next case.

[catsmeow1972, BSN, RN]

I did an extended care gig that was actually pretty nice for a while. Adult patient, TBI, wheelchair, etc. His/our routine in the AM was pretty lockstep...out of bed, shower shave, dress etc. (he had a custom done suite with roll in shower and such.Quite posh, actually.) Out to the kitchen for breakfast. I usually gave him 2 choices for breakfast (TBI made it so too many choices rattled him) He'd eat then settle in fron of the computer or TV. i'd clean his suite area (disinfect foley bags, etc) and wash dishes from breakfast. If there were a few dishes in the sink from the family, i washed those too. I just thought that polite and not a big deal. Unfortunately that did not last long. Gradually the family (his mother, mostly) complained when i did not wash the mountain of dishes from their dinner last night or sweep and mop the entire house!! There's a line between helping out a little and becoming a maid. I felt my responsibility ended at cleaning after my patient, not the whole family. i found that this family had run several nurses out of there over the same such behavior. I left, primarily due to that. My patient was really rather cool. Played a great game of Monopoly, but you have to draw the line somewhere....and like all other nursing jobs...document, document, document.

[gingah828]

I am planning to keep my foot in the door if all goes well. I have been working with a Lennox Gestalt patient for 9 months now, I will likely stay with him as I continue to move forward with other pursuits. I do appreciate your insight as it confirms what I have been thinking myself.

[Elektra6, ASN, BSN, RN]

it's a shame that so many patients lose good nurses because of their family members.