Refusing to Accept a Patient

[adreamdeferred, MSN, RN, APRN, NP]

I hope I am expressing my thoughts clearly. As a Per Diem or per visit home health nurse we have the ability to decline cases for various reasons. Cleanliness, safety, complexity of the case, pay, animals, smoke, niche, etc. My question is what do you do if you refuse to continue with a patient after you have been to the home and decide for whatever reason you do not want to move forward, for example bug infestation, questionable family members or surroundings, complex case that will have you barely clearing minimum wage, can you compartmentalize what you have seen or experienced and just move on to the next case? Do you just assume the next nurse will take care of everything or do you try to avoid "passing the buck" and initiate referrals, make calls if necessary. I realize you cannot pick up a home and place it in a different neighborhood so please don't think I am insisting on anyone doing something they don't agree with. We have to have a good work life balance. Most of us are in home health because we have a high need to love where we work and not dread going. With this "luxury" is there extra responsibility to clients we are not going to see again? This post is intended to create a dialogue and seek solutions so that patients don't fall between the cracks because their lifestyle or situation doesn't make for an ideal work environment. Please refrain from judging or bashing anyone at this time. I think it is more important that people are honest about their behavior so that we can find solutions and expose any pitfalls in home care. I believe everyone is familiar with our ethical responsibilities, however, I want people to talk about what they are experiencing and witnessing on a daily basis. What are some office policies and procedures for refusing to accept a patient? Please share scenarios and/or solutions. Once you refuse, are you on to the next or do you give it a second thought? What becomes of these patients? Thanks in advance.