Please Help Me! I’m Over It!!

[londonflo]

When I was going to grad school  I took a case of caring for 2 non communitive  patients.  I should have wondered why this was readily available. The identified care giver was more interested in her horse race betting.   It scared me when the betting agent came to collect on the bets.

One this day the  care giver left for a "couple of hours",  The patient needed suctioning.  The power went out and I thought I should go to the basement to reset the breaker. When I approached the doors, I was met with furious barking from dogs. I tried to manually suction but no power. There were cockroaches on all the equipment, even a lit light bulb.

I finished out what I had agree to fulfill but I was out of there.  I felt really bad for the two women patients who had strokes previously and decubiti. 

 

[Kitiger, RN]

On 3/31/2022 at 11:03 AM, londonflo said:

When I was going to grad school  I took a case of caring for 2 non communitive  patients.  I should have wondered why this was readily available. The identified care giver was more interested in her horse race betting.   It scared me when the betting agent came to collect on the bets.

One this day the  care giver left for a "couple of hours",  The patient needed suctioning.  The power went out and I thought I should go to the basement to reset the breaker. When I approached the doors, I was met with furious barking from dogs. I tried to manually suction but no power. There were cockroaches on all the equipment, even a lit light bulb.

I finished out what I had agree to fulfill but I was out of there.  I felt really bad for the two women patients who had strokes previously and decubiti. 

I would have taken myself off that case, too. It probably wouldn't have occurred to me to be sure ahead of time that it was safe to go down into the basement. Wow! 😮

This is another thing about home nursing that new nurses don't always realize. You're on your own; there is no back-up. In the hospital, power outages are automatically resolved by going to a generator for power. The nurse doesn't have to do a thing. You have tornado drills and fire drills, and everyone knows what to do.

In the home, you need to have emergency equipment and a Go-Bag ready at all times. Emergency equipment means external batteries for the vent and the internal battery is charged, O2 tanks (if they normally use an O2 concentrator), a battery-powered suction machine (and it's fully charged!), a battery-powered pulse oximeter (charged), an Ambu Bag (BVM, or Bag-Mask-Valve), and the Go-Bag. The Go-Bag contains all the supplies you might need for the trach. If they are vent-dependent, you also have a spare vent circuit in the bag.

I want to be ready to safely exit the house with my patient and any equipment that might be needed.

When I arrive, I check the O2 concentrator to be sure it's delivering the right amount, I check the tubing by the trach to be sure O2 is actually flowing to the patient (no leaks or disconnects), I look at the O2 tank, the AMBU, the spare trachs, and check to be sure all batteries are charged. Then I start my nursing assessment . . . 🙂

[amoLucia]

Kitiger - ah.... A true home care nurse. Funny that now I'm personally housebound, I've noticed that I'm houseproofing my environs like for a HC case.

Folks also need to know that NHs are also subject to major safety lapses, altho usually not intentional (like you don't know until something happens!). 

Not to hijack this thread, but I think we could start a new safety thread for all that we've experienced during our LTC careers.

Caring for people in their homes is not for the weak...

[Crystal-Wings, LVN]

I’m so glad I’m no longer doing private duty. I was tired of crap just like this. Long term care is hard, but at least where I work I don’t have to put up with families anymore and I’m not treated like a household servant. 

[caliotter3]

I just had to join the conversation.  In total agreement with all previous responses from Kitiger, amoLucia, Crystal Wings and the others.  I highly suggest that you go way, way back in the private duty and home health subforums and research numerous threads on the same situations that occur over and over and over again.  Same tune, different day, to paraphrase.  This is home care, in particular, extended care home health.  Your 45 - 60 minute intermittent visit type of home care is not going to expose you to so much negative interactions with patients or families.  But there can also be possible friction there too (the patient who won't answer the door).

Similar examples of toxicity in extended care home health:  Reporting for duty to care for a blind, paralyzed, severely intellectually compromised patient who can not speak or clear his own thick secretions, twice within a three week period of time TO FIND THE APARTMENT EMPTY (except for the patient), mother GONE. On same case:  dealing with night visit from police knocking on patient's bedroom window, dealing with minor sibling doing drugs, dealing with coworker nurse or nurses, diverting the controlled substances (more than one) prescribed for the patient.  Getting a slap down from the mother to the agency when forced to transport her teenage child to the ER.  Where was she?  Why would she not answer her cell?  And that is just one case.  All reported to the agency.  End result:  Life goes on (the money goes around and around) and the reporting nurse becomes jobless.

There is also dealing with the multitude of cases where other nurses and the client families commit insurance fraud and the parents or other nurses or both try to draw one in, using blackmail, to be an accomplice.  Trust me, insurance fraud is rampant in extended care home health.  One should become familiar with how to keep oneself safe from criminal charges.  Etc.  Etc.  Etc.

My advice?  1.  Do not quit extended care home health just yet.  Give it one last try with a new case/agency. 2.  As advised previously, remove yourself from the case.  3.  Quietly look for a new agency (with perhaps a survivable case).  4.  Start thinking about a different area in nursing?  Are you young and healthy?  Are you an RN with greater employment opportunities or an LPN/LVN with limited opportunities?  Can you withstand a med-surg position in acute care or a position in long term care?  Can you break away from the "perk" of being paid to care for only one patient?  Follow through on your career path as your circumstances dictate. Best wishes on your survival.

[K. Everly, BSN, RN]

On 3/30/2022 at 2:04 PM, 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. 

It sounds like you could use a pick-me-up in your skills of assertion. 

The mother may be VERY defensive, but you are the nurse, you have a professional duty to discuss certain matters with her. Her defensive demeanor and your discomfort around that do not afford either of you the right to avoid having conversations that clearly need to take place. 

She has been taking advantage of you, and yet people can only take advantage of us in so far as we allow in situations like these. 

So what if the agency DOES tell the mother you reported her? It's already an unacceptable environment and I dare say that even if the family were to change, it's already become a muddy environment where boundaries have been crossed and it's no longer a good fit for you to be there. 

[Wlaurie, RN]

You need to look for a new case now. There is good and bad families out there. This is not a good one. Cleaning up after a dog and babysitting another child is taking advantage of you. Sensing from your writing it seems like you are hesitant to stick up for yourself. Talk to your employer, request a new assignment and tell this family you just can't work there anymore and move on. 

[amoLucia]

^^^ yes yes yes ^^^

[HiddenAngels]

Wait, people can leave their other kids with you? And Dog poop, you’ve got to be kidding me.

This sounds like they are completely taking advantage of you. I would leave

[Nurse5678]

Hey guys! 
sorry I’ve been so busy I haven’t had time to respond to everyone. I’ve decided enough is enough and I’m over it. Im looking for something else currently but thinking about stepping away from private duty. I just think being in someone’s house may cause issues cause at the end of the day it’s is THEIR house. The issue is that I’ve already been here with them for almost two years. So It wasn’t until almost a year in they started doing things like this but regardless I still stayed which was a mistake. The issue is that I should have said something from the beginning and never did so now I feel like it’s too late to say something now. I’ve tried to talk to my DON about the mom dashing it’s okay not to do care and the dogs and the misbehaving without redirection from family. Well she said she would get back to me and never did. That was almost a year ago.. so ultimately I do feel like it’s my fault for letting this go on so long 

[Kitiger, RN]

I'm not so sure that you should leave private duty entirely. You say the problems didn't start until you had been there a year. 

You have three things going for you. First, you now know that some parents will try to take advantage of you. Your eyes have been opened, and forewarned is forearmed. Second, it is MUCH easier to deal with problems when they first pop up. Letting things go in the beginning and hoping the problem will resolve itself is not a good plan. You know that now. 

Third, you are an experienced private duty nurse. OK, maybe not experienced in every aspect of home care, but you are not a newby. 

Of course, I love private duty.