Please Help Me! I’m Over It!!

[Nurse5678]

I need advice big time. I’m new to home health about 2 years now and need advice. I’m seriously over it and considering a new specialty or being completely done with home health all together. I am constantly being taken advantage of.

For example, the dogs poop and pee everywhere. Siblings will see it and do nothing so I feel I have no choice but to clean it cause that’s gross! I didn’t mind. But now, my patient (pediatric) will see poop or pee and demand I clean it.

Next.. they leave their son with me. He’s in elementary. I didn’t know any better and figured if he stayed in his room I didn’t care cause it only happened a few times but now it’s way more often. He also doesn’t stay in his room.. the parents are well aware that he isn’t supposed to be home with me. IDK how to report them without the company throwing me under the bus saying I told them. I feel like it would be awkward.

Then my patient is very “her way or no way” she’s active, mobile.. no issues besides her health conditions but she is constantly refusing care or throwing a fit to the point where mom will tell me to just give her space or tell her it’s okay and that she doesn’t have to do medical care. I try to handle it on my own with verbal redirection but the minute she calls mom.. mom completely contradicts what I say and basically shows that she doesn’t have to listen to me. My point is if she continues to refuse medical care then why am I here.

Do you all think I should leave home health or family? She is also starting school soon. 

[amoLucia]

First, you MUST report these behaviors/expectations to your Admin. Esp deviation from the medical plan of care can change the course of continued care with reimbursement for your agency. Of course, your agency might be really hesitant to rock the boat, but a conference with the family is in order. There IS liability involved re the 'supervision' of the sibling for which noone is being compensated.

Start looking for other employment QUIETLY. I don't think think home health itself is the problem here, but rather the family/pt are the issue. Give your agency a chance to remedy the case, or ask for reassignment.

Be professional, unemotional, non-threatening with your agency, and likewise try to flex your muscles with the family as to what your care plan covers.

Be prepared to move on if nec. 

And I always try to recommend that ALL nurses carry their own Liability Insurance, esp in HH, where boundaries can become muddied.

Good luck to you.

[Nurse5678]

10 minutes ago, amoLucia said:

First, you MUST report these behaviors/expectations to your Admin. Esp deviation from the medical plan of care can change the course of continued care with reimbursement for your agency. Of course, your agency might be really hesitant to rock the boat, but a conference with the family is in order. There IS liability involved re the 'supervision' of the sibling for which noone is being compensated.

Start looking for other employment QUIETLY. I don't think think home health itself is the problem here, but rather the family/pt are the issue. Give your agency a chance to remedy the case, or ask for reassignment.

Be professional, unemotional, non-threatening with your agency, and likewise try to flex your muscles with the family as to what your care plan covers.

Be prepared to move on if nec. 

And I always try to recommend that ALL nurses carry their own Liability Insurance, esp in HH, where boundaries can become muddied.

Good luck to you.

I do find that it’s difficult cause they’ve been doing this for so long I believe that’s why I’m officially fed up. I’m afraid they may be like why are you barely saying anything but to be fair when I started I was never told sibling were not to be left with me. Common sense yes but I was never actually told.

[amoLucia]

You're being taken advantage of. Also happens when families try to leave an elderly family member for you 'to watch just a couple minutes'. Or to clear driveway snow or peel, dice & cook enough potatoes for the week!

You're resp for the instructions written in the care plan.  I doubt cleaning dog poop or cat pee are included. And sure as 'Heavens to Betsy' there's no instructions to babysit siblings!

Maybe it's time for Case Management to review the case for authorization.

[londonflo]

 you always have to protect your paid time that is to be given to the patient you are there for and being paid to be there for. 

Sometimes, in the oncology unit in the hospital, a care giver would leave the children with the hospitalized patient alone without an adult. The kids knew how to get to the cafeteria etc.  but did not have a responsible adult with them besides the patient who was medicated. If something would happen to the patient (transfusion, chemo, medication reactions, even death) and there was not an adult there to care for them we would have to call social services. 

Leaving a dependent (from newborn to teen)  alone with a hospitalized patient has happened more times than I care to admit. 

You're a very kind soul and nurse but stand your ground. 

[Googlenurse, ASN, BSN, RN]

I can’t stand when parents leave siblings for me to watch. I had to tell the family that the verbal, walking 13 child in the vent at night(no trach) cannot be respond for her five year old brother.

The family tried to say the pt was responsible for watching her brother. But I was there the whole time. If she can watch her brother than what the hell does she need a nurse for? Mom was so lazy she wouldn’t even get up out of her room to sign the timesheet. She had her 14 year old daughter do it.

[londonflo]

3 hours ago, Googlenurse said:

the timesheet

 

21 hours ago, Nurse5678 said:

no issues besides her health conditions but she is constantly refusing care or throwing a fit to the point where mom will tell me to just give her space or tell her it’s okay and that she doesn’t have to do medical care.. I try to handle it on my own with verbal redirection but the minute she calls mom.. mom completely contradicts what I say and basically shows that she doesn’t have to listen to me.. my point is if she’s gonan continue to refuse medical care then why am I here.

exactly.  you are signing that services are required. The onus is on you. You may eventually be on the line for Medicaid fraud. Are you there 7 days a week? 

[Nurse5678]

1 hour ago, londonflo said:

 

exactly.  you are signing that services are required. The onus is on you. You may eventually be on the line for Medicaid fraud. Are you there 7 days a week? 

What if I’m also documenting that care is being refused? No 5

[Kitiger, RN]

I think you can stay in home health, but probably not with this family.

Talk to the mother. Tell her that you cannot stay on a case where she does not allow you to give the nursing care that you are required to give. Tell her that you will not take responsibility for anyone other than your client. Tell her that cleaning up after the dog is not your job, and if the family won't do it, then you will not work there anymore.

Talk to your supervisor, tell her that you cannot stay on a case where the mother does not allow you to give the nursing care that you are required to give. Tell your supervisor that you will not take responsibility for anyone other than your client.

If your supervisor allows you to take responsibility for someone other than your client, then you must find a different agency.

Quietly look at other agencies.

[Nurse5678]

16 minutes ago, Kitiger said:

I think you can stay in home health, but probably not with this family.

Talk to the mother. Tell her that you cannot stay on a case where she does not allow you to give the nursing care that you are required to give. Tell her that you will not take responsibility for anyone other than your client. Tell her that cleaning up after the dog is not your job, and if the family won't do it, then you will not work there anymore.

Talk to your supervisor, tell her that you cannot stay on a case where the mother does not allow you to give the nursing care that you are required to give. Tell your supervisor that you will not take responsibility for anyone other than your client.

If your supervisor allows you to take responsibility for someone other than your client, then you must find a different agency.

Quietly look at other agencies.

The mom is very defensive when it comes to her kids. She’s not really someone I can talk to. I’ve been here for a while not and I feel that she may be like why is it an issue now?? But it’s always been an issue I just never said anything and allowed them to take advantage of me. I want to tell the agency but I’ll scared they will tell mom I called to report them.. then what? Awkward. 

[Kitiger, RN]

9 minutes ago, Nurse5678 said:

The mom is very defensive when it comes to her kids. She’s not really someone I can talk to. I’ve been here for a while not and I feel that she may be like why is it an issue now?? But it’s always been an issue I just never said anything and allowed them to take advantage of me. I want to tell the agency but I’ll scared they will tell mom I called to report them.. then what? Awkward. 

I would always first try to go to the person with whom I had the conflict, in this case that would be the mother. I would at least tell the mom that you need to talk to her. If she refuses, then go to your supervisor.  

Which would you rather, a mother who is mad because you "reported her", or a continuation of the present situation? This mess has to be stopped at some point. 

I am especially concerned that she is not allowing you to give nursing care. Your supervisor could give you some ideas on how to enlist her cooperation, but if that doesn't work, then your supervisor needs to talk to the mother. If that doesn't work, then you should be reassigned. The physician who signed the Plan of Care thinks this client is receiving the care that she needs. If the supervisor can't handle it, then the physician should be notified.

Sometimes, hearing from the physician that the patient will no longer be allowed nursing care (I.e., insurance won't pay for it if the physician doesn't order it) is what is needed.

You mentioned that you did chart that the care was refused. That works for an occasional refusal, but if she is always refusing then the physician needs to be notified. 

Very likely, your supervisor does not want to lose this case. The agency makes a lot of money off the work that you do. If your supervisor refuses to straighten things out, then you need to take yourself off the case. You can do this. If the agency then refuses to place you, go to a different agency. 

[amoLucia]

2 hours ago, Nurse5678 said:

What if I’m also documenting that care is being refused? No 5

Then she prob doesn't NEED or want services.

Kitinger -- you fleshed out my comments so well, except that I would give her agency Admin an ALERT immed, then talk to MOM. 

OP - you're more important than any singular home case, esp if insurance fraud could be a poss. And your agency should be too, altho often not. Don't let them schmooze you with pleas & platitudes, agency OR Mom.

You have 3 options - 1) continue being suckered (and jeopardize your career); 2) request a new assignment; or 3) get a new job in a new agency. Remember, you now do have real HC/PDN resume skills. You have VALUE.

So if your agency or Mom and/or pt balk and drag their feet, time to move on. And BTW, it's always a good idea to keep your resume updated.

Again, good luck to you and please, keep us updated.