sandera

The caregivers in this case are paid by pt, unlicensed and I have never seen them demonstrate competency. I'm new to HH, the case mgr of this pt, and I feel completely out of the loop with the Dr giving orders to caregivers and accepting their pain assessments over mine. I don't want my license on the line, and I'm not getting a lot of guidance at work. The caregiver didn't want me to bother taking pt pulse because "it's always 40-50." And, I don't have to look at his bottom, his "skin is fine." :icon_roll I have to push and push to get anything done. Then it isn't taken seriously. If the Dr prefers the CGs to carry out tasks and perform assessments, he shouldn't have ordered an RN case mgr. I'm worried that somehow I'll be held responsible for this mess.

I'm relieved that the foleys and IMs are okay. I didn't know anyone could do them. But I'm still uncomfortable with the caregiver's and Dr's pain assessment of 0/10 in a screaming, moaning pt. He was pleasant, oriented and chatting the week before. I'm going to meet with our social worker tomorrow. thanks everyone for the input.

Tell me if this is weird. I'm a new home health nurse and I have an end-stage heart failure, copd, renal insufficient 100 year old pt who refuses hospice, wants to avoid the hospital, and stays at home with two unlicensed caregivers. The first time I saw him 3 weeks ago, he was alert & oriented x3, sitting in a wc. Now he's in bed, screaming, moaning, can't get up, his skin is breaking down. The md thought it was a UTI. Since pt was already on macrobid, the doc decided to have the unlicensed caregivers start giving him daily ceftriaxone IM. And the the caregiver, a bookkeeper, inserted a foley over the weekend. No one is concerned about screaming/moaning. The doc said, "oh he moaned when I just touched him, so I don't think it's pain." Does this situation seem strange to anyone else? I don't even know why they have me doing visits. And the caregiver is so hostile to me. Can doctors give just anyone orders to give IMs and foleys? Any help would be appreciated.