Private duty conundrum

ArwenEvenstar · Apr 16, 2008

i work a pediatric case where i believe that one of the parents may be so over-vigilant that decisions are being made that are clinically not very wise. to compound the problem, i think that one of the other nurses on the case may be enmeshed in the family dynamic and may be going along with these questionable decisions. my agency is very supportive of me, but i am dreading having to say no and possibly having some sort of an altercation with the family if asked to do something that i find clinically wrong. any advice?

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well, it is great your agency is supportive. that is important. are you completely sure that your agency understands your position? have you let them know specifically that you will be saying "no" to certain family requests? make sure that your agency is clear about what you will be refusing to do and why. then i would just say "no" to the family as calmly, politely, but firmly as you can when it comes up. if the family starts to have a fit, simply tell them to call your supervisor at the agency. hand them the phone if necessary!

a similar situation happened to me, and i handled it just like above. i made sure my supervisor understood my position. she did, and totally supported me. when it came up with the family, i politely but firmly stood my ground. the mother literally had a fit and began shouting at me. (the poor child heard this, and later asked me why i was fighting with her mother. sad.) i told the mom to call my supervisor, which she did. my supervisor supported me, tried to explained the rationale to the mother, and was able to calm the mother down. however, things were very tense in the home for awhile after this. it was awkward and stressful. but eventually the situation smoothed over...

sometimes doing the right thing is tough. but i knew i had done the right thing. we have worked hard to get our nursing licenses, and we must do what is clinically right for the patient and for ourselves as well. and we will only be able to do what is clinically right, if we maintain a professional boundary. a nurse who gets "sucked in" may not even realize it, and start making subjective and risky decisions.

the other nurse on the case with me totally lacked a professional boundary. a couple times i tried to explain to her the need to keep a professional boundary, and encouraged her to avoid getting overly socially involved with the family. but she just did not "get it". she saw me as "cold hearted and cruel" because of the position i took...

i hope your situation works out. hang tough! and maybe the family will be more understanding than you think. you never know!

well, i could blab on and on... i love private duty, i really do!!! i've been doing it 3 years. really the only possible negative aspect of pd is...well...situations like you have just described! i've ranted and raved (haha) on other posts about the importance of keeping a professional boundary....

neonatal3 · Nov 8, 2008

Hello!

I appreciated reading your comments about private duty home health situations in which there are dilemas about professional boundaries versus family requests. As a fellow private duty home health nurse, I have made some calls to my employer about clearing up doctor orders which were not consistent with what the patient's family was asking me to do. It is good that bsrn23 writes that the agency is supportive of the nurse. So far, my agency has been supportive of my patient advocate efforts,too. I believe that it is the ethical duty of us private duty nurses to speak up for "clinically wise" care for our patients.

Good luck on your home health adventures!

caliotter3 · Nov 9, 2008

Should you find that your agency is not supportive of you, you can decide where you will draw the line on going along with family/patient wishes that contradict doctor's orders or good practice. When you reach this line, it will take a conscious decision on your part, to ask to be removed from the case, if the family can not be convinced to see things your way. There are some instances where you can bend to go with their wishes, and some instances where you have to be mindful of what is best/dangerous/ill-advised for the patient, your license, and your job. When your agency does not support you in general, then it is best to leave the case. You can't win when the agency won't back you and the family/patient are asking you to do what you know to be wrong. By leaving the case, you can preserve your job and keep from constant conflict with the patient/family. If you find that your agency is routinely placing your license and job in jeopardy then you might need to leave the agency.