Professionalism

Lorie P. · Mar 5, 2009

another thread i posted on got me to thinking more about professionalism. professional behavior is extra important with private duty. working shifts in a private home is truly a unique situation. i don't know if my experience is unusual (??), but i have encountered multiple issues with nurses lacking professional behavior and professional boundaries in the home. i'll briefly give several (and these are all lpn's or rn's by the way, not aides or sitters):
*a nurse, who besides doing the nursing duties, was doing things like household cleaning, laundry, errands, babysitting (other kids in family), tutoring (helping with homework), etc - and some of this on her own time. it created a nightmare...as the family grew to expect this...
not going to happen with me!
*a nurse who did not do these extra things, but became overly friendly with the family and essentially socially integrated into the family. the nurse lost all objectivity, and started making risky subjective nursing decisions.
will create problems
*a nurse who made herself too "at home" in the home. she was using their computer, eating snacks from their cupboard, looking in closets, etc - essentially acting like their home was her home! this particular family was wealthy, and the nurse indicated she had the right to do this because they had so much!!
i use my own laptop, yet i have a certain counter/cupard for putting my things, since my shifts are 12 hrs 5 days a week. have my own shelf in the extra fridge to place my lunch and drinks that i bring with me for the day.
*nurses who give the family their home phone number, instead of having communication go through the agency.
this i have done only once, ( for my current pt) so that mom could call for simple questions that i can answer because our agency office is over 2.5 hrs away and the recruiters are not nurses and would only call me anyways. besides i only live 20 minutes from work. i can also say mom has never abused agreement and has actually called me to say not to come in because pt was as er and being admitted. this happened 3x and she called as a courtsey to me at 11pm instead of waiting until the am. wich i greatly appreciated.
maybe my experiences are atypical? unprofessional behavior creates so many problems. it can be like a domino effect. with private duty, i feel that if one is going to err on one side or the other, one should err on the side of being overly professional. only when a nurse is professional, can she maintain objectivity and be sure the patient is getting proper care. and the patient getting proper care is the bottom line.
my experiences have made me feel that all agencies need to develop some type of module on professional behavior.

thanks so much for bringing this up. looking forward to how others feel about this issue.

ArwenEvenstar · Mar 5, 2009

Thanks for your reply! There are for sure "shades of grey" with PD. I actually had a case where I also gave the family my home phone number b/c of a "situation" going on, but generally, I think it is better for all communication to go through the agency. Giving a family your phone number should be the exception, not the rule. Ya know? Too easy for things to get out of hand otherwise...which I have seen...It can be hard to say no to a "needy" family who keeps calling, as opposed to the agency.

Using your own computer at their house, storing your own food in their fridge, etc. is totally appropriate. When working a long shift you do have to "use" some areas of their home. But the nurse situation I referenced was totally out of hand....she was using their stuff, eating their stuff, and going in personal/private areas of the home that she had no right (or reason) too. The family complained. I generally limit myself to the pt's room, the bathroom, and kitchen (and maybe living room depending on circumstances). No need or reason for me to be going in and nosing around in other bedrooms, bedroom closets, the office, etc.

Lorie P. · Mar 6, 2009

thanks for your reply! there are for sure "shades of grey" with pd. i actually had a case where i also gave the family my home phone number b/c of a "situation" going on, but generally, i think it is better for all communication to go through the agency. thank goodness they do not call me for just the sake of calling. mom will call only if she needs to.
giving a family your phone number should be the exception, not the rule. ya know? too easy for things to get out of hand otherwise...which i have seen...it can be hard to say no to a "needy" family who keeps calling, as opposed to the agency i have just the opposite! it's the office personnel that call me all the time for stupid stuff. did i get the paperwork i asked for, did i make sure to fax this that. of course this person is new and doesn't know me that well, yet!
using your own computer at their house, storing your own food in their fridge, etc. is totally appropriate. when working a long shift you do have to "use" some areas of their home. but the nurse situation i referenced was totally out of hand....she was using their stuff, eating their stuff, and going in personal/private areas of the home that she had no right (or reason) too. the family complained. i generally limit myself to the pt's room, the bathroom, and kitchen (and maybe living room depending on circumstances).i am in the kitchen, living room, nursey and bathroom. not parents bedroom or quest room. i respect their privacy!
no need or reason for me to be going in and nosing around in other bedrooms, bedroom closets, the office, etc.

me either, not a need to know reason for me, as to what is in those rooms.

i know what you mean, i filled in for a nurse that had a family emergency and the client she worked with, she was best friends with mom and the whole family. she did the laundary, cooked at the house. i made sure the family knew i was there to take care of pt only, meds, feeds, suction, adl's nothing else! we got along well after i set my boundries.

ArwenEvenstar · Mar 6, 2009

Quote: "I know what you mean, I filled in for a nurse that had a family emergency and the client she worked with, she was best friends with mom and the whole family. She did the laundary, cooked at the house. I made sure the FAMILY knew I was there to take care of PT only, meds, feeds, suction, ADL's NOTHING ELSE! We got along well after I set my boundries."

Well, we are having a great dialogue! : ) Maybe someone else will jump in!

What surprises me is that the nurses who cross all boundaries, and become "pals" with the family don't understand why it is a problem! They are not helping anyone, and only making the situation worse. As the lead nurse on a case I used to work, I was asked to speak with another nurse on the case who was having "boundary" issues. No matter how I explained it, I could not get the nurse to understand why her behavior was a problem. She accused me of being cold-hearted and lacking compassion. She was so enmeshed in the situation she had lost all objectivity... Long story short...This nurse was eventually asked to leave the case (fired!) due to a number of risky, subjective nursing care decisions. And she still did not get it! The rest of us were cruel and cold-hearted! No...we simply wanted the patient to get cared for properly which can only happen when proper boundaries and objectivity are maintained.

This quote was recently in another thread and I thought it applied here.

"The martyr sacrifices themselves entirely in vain. Or rather not in vain; for they make the selfish more selfish, the lazy more lazy, the narrow narrower." Florence Nightingale

Lorie P. · Mar 9, 2009

quote: "i know what you mean, i filled in for a nurse that had a family emergency and the client she worked with, she was best friends with mom and the whole family. she did the laundary, cooked at the house. i made sure the family knew i was there to take care of pt only, meds, feeds, suction, adl's nothing else! we got along well after i set my boundries."
well, we are having a great dialogue! : ) maybe someone else will jump in!
what surprises me is that the nurses who cross all boundaries, and become "pals" with the family don't understand why it is a problem! they are not helping anyone, and only making the situation worse. as the lead nurse on a case i used to work, i was asked to speak with another nurse on the case who was having "boundary" issues. no matter how i explained it, i could not get the nurse to understand why her behavior was a problem. she accused me of being cold-hearted and lacking compassion. she was so enmeshed in the situation she had lost all objectivity... long story short...this nurse was eventually asked to leave the case (fired!) due to a number of risky, subjective nursing care decisions. and she still did not get it! the rest of us were cruel and cold-hearted! no...we simply wanted the patient to get cared for properly which can only happen when proper boundaries and objectivity are maintained.
had this one nurse that actually cooked her meals at the clients home. she did the laundary for the whole family, ran errands, went and bought fast food for everyone. this is not in my job description and i do not do these things.
this same nurse really didn't follow the 485, but since she and the pt's mom were/are best friends things go on without the office of the agency knowing it.
this quote was recently in another thread and i thought it applied here.
"the martyr sacrifices themselves entirely in vain. or rather not in vain; for they make the selfish more selfish, the lazy more lazy, the narrow narrower." florence nightingale

i will keep the bounderies!