kaliRN

Agree with all above and enjoy the dialogue on here and multiple responses especially Ktiger spot on information- ceiling lifts are often the ideal solution for space, ease of use, limited disruption of the environment and events (besides applying the sling which becomes second nature - it’s not so disparate from carrying your own child when that’s no longer a safe and feasible option) I know you’re reluctant on the sit to stand but based on your child’s baseline mobility - if he uses or could benefit from the use of a gait trainer - I have seen great benefit in the Rifton TRAM https://www.rifton.com/products/lift-and-transfer-devices/rifton-tram You would need to trial it when he is weight bearing and decide if it makes sense for your home environment (yes you still need pathways but I find it significantly more maneuverable than most hydraulic lifts), the real advantage if it suits his abilities is it allows the child to participate in the transfer process and as I’ve been told is much less “scary” than being suspended in a traditional lift Thank you for the reminder of needing compassionate and thoughtful dialogue, this is something I consider a critical component of managing long term care needs for our patients and one of the examples of how delicate and “real” the emotional and practical aspects of this necessary intrusion are

Can any of those who posted about using electronic charting share what systems they are on? We are looking at potentially converting but have thus far only found charting modeled for intermittent visits.

Agree that there’s certainly challenges with using a school nurse - just giving the OP another perspective as I would if she was one of my patient’s parents to consider. This might be a transportation policy where you are - the parent would have to find out if this is the case where she is. I have many cases where the night nurse stays and gets the child ready for school or the and sees them to the bus and the afternoon nurse accepts the patient from the school nurse or the parent is available at one of those times. Of course as in all situations, it could be very stressful for a parent to be reliant on the availability of back-up care, that’s the primary reason I’m suggesting the school nurse. The 1:1 aide and LVN doesnt apply to this child per the OP’s statement. The OP’s child doesn’t fit what I had in mind, I was considering a child who needed very scheduled specific tasks - such as GT feedings or administration of routine and low-risk medications vis GT or scheduled catheterization times but only safety monitoring during class times.

I would ask your agency the question on hours, for us, there are certainly ebbs and flows to nurse availability, with the most difficult to staff almost always being weekend and NOC hours (which it sounds like you’ve already struggled with). If you are flexible, I would give your agency the opportunity to find any available shifts based on nurses hiring on. Just let the agency know you are trying to find reliable care but have some flexibility in how you use the shifts, so the next time a nurse comes in looking for full time work regardless of the hours they’re available - you’d like to meet them? Can you work opposite your husband for a time until you feel comfortable with a nurse being reliable and available?

The entire response was Hppy was very insightful, I did want to add the review of your personnel record is also subject to state mandates. In our state, the employee may request to review AND receive a copy of their personnel record in its entirety as it relates to their performance or any grievances filed against the employee. The employer may only charge the actual cost of duplication and postage if requested to mail the copy, all the employee need do is submit a written request As far as next job opportunities, someone mentioned maybe reaching out to a charge nurse or someone else in a supervisory position that may be willing to help with a reference that could be contacted directly. I would agree with Hppy though - if HR will only provide employment verifications and not references for liability reasons they will be highly unlikely to disclose anything at all about the reasons or even nature of your separation (whether it was voluntary resignation or termination) - many will give only title and dates of employment and not even answer “is this employee eligible for rehire?”

As all have stated, you need to look out for yourself and be able to guarantee your patient’s safety so you don’t end up making a costly error where your license or your patient’s life is at risk. Whatever your State mandate is on consecutive hours is a good starting point, but even if they don’t have one, you can simply state your own limitations should this situation arise: “I am sorry you have to find another staff member, but I need to leave after xxx number of hours otherwise I don’t feel I can safely manage my patient. I want to help as much as I can, but I know our patient’s safety is the top priority and that’s all I can offer” ... thing is if you continue on this case and they have not found a replacement you would need to call 911 to report off or be at risk for patient abandonment ... it would be messy but not as much so as you falling asleep and your patient being injured or dying

This is spot on - child or adult - willing and available caregiver should be a requirement for any agency in my opinion (here it’s state mandated but I would absolutely make it a requirement to be on service even if it weren’t)

I find this statement so sad “the agencies encourage this behavior because the nurses are expendable” - my nurses are the reason our agency stays in business. They are the very backbone of what we do and while there’s so many challenges in shift care as it relates to nurse-family dynamics ... never would I consider a nurse expendable. Yes, I have limited ability to mandate how a family behaves (unless it’s outright abusive or unsafe), but I always try to mediate and create a better work environment whenever I diplomatically can. If I can’t - I will certainly restaff a good nurse should they be truly unhappy or unable to “get along” with a patient or their family

It does not sound worth it to your mental or emotional health, if this was reported to me by a nurse I would work to re-staff them with anything I had available and then explain to the family exactly why I was forced to remove them. I would definitely say the quick turnover on this case and the parent’s choice to employ outside an agency are huge red flags and clearly have to do with the mother’s unacceptable behavior and attitude. All the best to finding something better

Is it your choice to have a PDN nurse attend school with your child because the school is using trained medical 1:1 aides and you are uncomfortable with this? Have you explored requesting/ requiring the school to employ an LVN to accommodate your son’s medical needs while on campus as part of his IEP? Since it can be difficult to find a nurse, guarantee their ongoing devotion to an assignment, and replace a nurse should it becomes necessary... often parents leaving the school district to be responsible for providing a free and accessible education by meeting the child’s medical and academic needs (with a 1:1 aide, 1:1 nurse, 1:1 aide and specific times the LVN attends to the child in an appropriate and dignified manner) is the best solution to guarantee the child’s unencumbered attendance. Not that it should matter but from a particular standpoint- State funding is student census based here, so home/hospital is usually a much more costly solution for the district and accordingly they may be motivated to properly staff a child at school so they can attend. If you have good input from the child’s physicians and a detailed overview of accommodations during the formation of the IEP - it’s certainly worth exploring if you can have the school accommodate with their own staff and then should a PDN nurse become available through your agency maintain the right to send the PDN nurse with your child instead.

Just wanted to provide a last bit of encouragement, do not feel like you have to disclose your injury to refuse this case. Simply state the truth, that there is no lift in the home and the child is non-weight bearing and significantly over a safe transfer weight and the parents will be either unavailable or unwilling to assist with safe lifting and transfers ... since this creates a patient safety issue you don’t feel comfortable working in that home environment. Good luck! I hope they find you a wonderful and safe next assignment

Well I hate to read that, having a trained nurse employed to provide skilled nursing services for a child who qualifies for them is the exact reason these programs are in place, a parent is certainly the best equipped individual to do this especially once they’ve obtained licensure. It is so wonderful to create a home environment where a parent who makes the choice to stay home and meet their child’s medical needs can support themselves financially doing so. I hope this will change in your State (and if I knew your State well enough would share how to advocate as such) On to your more immediate statements, I can say if you were without nursing in my agency, it would be because I just couldn’t get someone in the door whose hours matched your desired shifts (or anyone in the door at all). I know my “challenging” families (but abusive or unsafe work environments would not continue if they were reported to me either) - when I have a “desirable” home, family, and patient ... I just have to get someone in the door - so if you are successful in meeting a nurse from an advertisement - I would keep contact and if you felt they were removed to meet agency’s needs you might know where you stand. Nurses and families do communicate and many of the stories of agencies doing unethical things (moving nurses to another case against their wishes to a higher priority case for example) were reported by the nurse to the parent directly in confidence. I hope you find your “match” soon

Not sure where you are located, but here in California, recruitment is the most difficult part of the job. LVNs are required to have a year of experience before working for an agency and reimbursement rates were just increased for the first time in 19 years so wages were dismal in comparison to other job opportunities. Great advice from caliotter to advertise on an employment website such as Craigslist or some families choose Care.com (though this is much harder to find LVNs on). Agree from what you describe here that you have a lot of the “preferable” work assignment qualities. The challenge may simply be finding a nurse who is willing to travel to your location and/or work the hours you are working for Certainly not every agency is reputable and some do “business” by robbing from Paul to pay Peter (moving a nurse to a higher priority case), ours does not, but I’ve heard otherwise from patients and nurses I am curious- are you employed by your agency and working any unstaffed hours?

Parents may be resistant to putting a Hoyer lift in their home and counting on agencies to place “stronger” nurses or “only male” nurses (males and females all only have one back) Our agency follows OSHA guidelines and sets a 50lb weight limit, anything above that requires a two-person lift or a Hoyer. Period. I will assist a family to obtain a Hoyer, I will explain the importance of nurse and patient safety, I will respect a parent’s wishes if they prefer to do all transfers themselves with the assistance of my nurses or alone and delay a Hoyer (and continue to educate and encourage that they to could be injured), but I will remove my nurses from a home if this policy isn’t followed A back injury at work could cost a nurse their career, a patient injury at work has untold costs ... your agency needs to back you up on this and I would definitely decline this patient assignment.

@Ruby Vee Thank you for being courageous enough to share your story so transparently, I felt the mental and emotional turmoil so powerfully. Brought me to tears - so grateful your resilience is serving you on this new path. I remember being in the hospital, twice I had allowed the father of the child to attend with me at the appointments, we had separated after a second incident of violence this one during my second pregnancy in front of my child. Someone on an online community made me realize with their own raw story and honest recounting just how deep I was in the abuse cycle and what I would be facing if I left without the protection of a TRO to address custody. I was still so “in love” and wanting to keep our family unified in some way that I would never have thought to do this and yet I have no doubt that was a precious gift that changed the course of my life. Thank you for sharing your story, that person will never know but she may have saved my life, and she certainly protected me and my children from devolving into his power to manipulate and control us. You may have done the same with your story of resilience, strength, and courage. Your story struck me to respond because in the hospital twice during admission I was asked if there was any history of abuse or violence ... I allowed him to be present for these appointments so how could I answer honestly? I was safe, I was separated, I was legally protected and stable in my home environment, but if I needed any support, I could not have sought it then and I will always wonder if any one could be helped by more open ended questions in private. In my new life, I was asked these same types of question in front of my husband, thankfully I am truly safe now but still disheartening that not much has changed - across 13 years and 3 hospitals and a multitude of doctor’s appointments no one has ever truly “asked” me if I was or felt safe at home in a manner I could answer if I chose.