HCSllc

I'm glad you feel supported! I do want to reiterate what Nurse56 said about possible violence. It is a bit difficult to tell from the original post how severe pushing your patient into the table was. I'm sure it was horrifyingly rude. If it was dangerous as well, you need to go to the end of the earth to protect your patient! j

Wow! What a nightmare for everyone involved. What happens on my planet is often not realistic in the home setting but see how close you can get to this. The jerk son is telling you something and likely it is not about paper towels or laundry. He is in a wheelchair and if he received good care after his car accident and is seen by good doctors, he is pretty independent. His care has been being told to, 'get it yourself' and 'you can do it'. And you know what? He just doesn't want to sometimes. And here you come, little Mary Sunshine. From what I can tell you are not a good aide. You fall into the extraordinary category. How wonderful it is for you and your patient that you actually like what you do for a living and enjoy your patients! I bet you make your patient feel special because in your heart you believe she is special. This is what home health is all about whether you are a nurse, a therapist or a CNA. You make a difference. But what about Bozo in the wheelchair with his less than sunny attitude? What can you do with him? Unfortunately, the most efficient answers are not legal. So, you can do two things. The first is to take the bull by the horns and meet the conflict head on. Frankly, I think you would lose. There is an element of cruelty in this man's pain that you will never match. The second is to give him a little time and attention. Try showing up ten minutes early with a newspaper clipping about something he likes - sports team or whatever floats his boat. Give him ten minutes of listening. I think the greatest gift we can give anybody is simply to be heard. If you have time or if your MSW is willing, you can look for wheelchair activities he might be interested in to get him out of the house periodically. When he impedes your progress, do not give in but do not engage in conflict, either. If he is upset about paper towels, explain that they are preferred for infection control and his mother may be at increased risk for infection due to age. Then ask him how he might go about procuring more paper towels. In other words, quietly and with a smile, lay the problem at his feet. Again with the laundry. It is perfectly alright for him to refuse to let you do the laundry. It is his house after all. But quietly and with a smile, explain that if you are not able to do the laundry for his mother, you need to be assured that it will get done as soon as possible. Is he going to do it that afternoon? When the alternative to not letting you use the washing machine is to do it himself, he might have different ideas. In my spiritual practice, being 'present' is emphasized. That means really hearing what the Bozo is saying and understanding that what he is saying reveals more about him than it ever will about you. You do not want to win this battle because in order to win the battle you must agree to fight. If you decide to listen to him with your entire presence for ten minutes, end your conversation on schedule. Explain that you will be back. If his mother needs anything before you get back, he can call the agency. Again, you are giving him an option to 'get in touch' but not by giving him your contact information. I think you are a remarkable aide based on what I see. Don't let this unhappy person get under your skin. It is really easy for me to sit here and tell you this but I know how very easy it is to let it bother you. I have been in your shoes many times myself and wished I had followed my own advice. Congrats on a job well done and let us know how it turns out. julianne

Yikes. I'm a consultant, too and I would lose all my clients if I asked them to write 7 page care plans. The problem with care plans that are too lengthy and too specific is that important stuff gets buried. Furthermore, think of an entire episode. If your visits are weekly you have eight visits max between comprehensive assessments. You are not that good. Sorry. Determine what you want for the patient and how it will be accomplished. I had an article published in Homecare Outcomes this week about writing care plans if you have access to that publication. Be real careful what you write because if you don't perform all those myriad orders you haven't followed the plan of care which became MD orders when he or she signed the 485. j

You should be in hot demand just about anywhere. There are requirements over and above that of a home health RN for seeing psychiatric patients. My best advice is to ask around about agencies first. You want to work for one with a reputation for high quality. You can look up some information at http://www.medicare.gov under the home health compare option. Also, if you are a psych RN, maybe you can check with some of the psychiatrists you know to see if there is an agency they prefer. You should have no trouble locating an agency that will hire you. julianne haydel