not sure how to work with this family

[mazy]

I'm relatively new to private nursing, and I've been working with this family since October. I'm having trouble figuring out how to deal with the family dynamic, I feel very awkward and out of step. i have a lot of respect for them, patient was never expected to survive but after two years of hard work on their part he's starting to walk, talk, is fully aware of everything, it's very amazing and inspirational.

I also really enjoy working with this patient.

However, wife can be very rude and disrespectful, lots of eye rolling and sarcasm toward nurses -- well, toward me as far as I know, don't know that much about how she relates all the other nurses, there is another one that she always complains about. I do know that the family dynamic is very man-centric, much sports watching and discussion of how relatives are bad parents because kids aren't in team sports, much drinking of the beer and sports parties, etc.

None of that is a problem except for the fact that all the other nurses are men, and of a similar disposition and very much adored as they have similar interests and spend time during the shift participating on a more social level with them. One of them actually does socialize with them outside of work.

I'm very "bookish" and cannot distinguish a soccor ball from a basketball. So spend most of my time in patient room and away from family, which seems to be satisfactory to them, except for the fact that I feel a lot of pressure to be more in line with their values. Could be that I'm overly sensitive, but I don't think i am. The times when i do have to interact with wife in terms of patient care she can be very sarcastic with me. Patient seems to really like me.

Also, wife talks A LOT about money and how much money she has and all the stuff they have, all the houses, cars, are still supporting kids even after college, and i don't understand why she is talking to me about this stuff, I'm the help. She is constatly talkig about how other parents are bad parents because they don't do the same and says things all the time in front of me about how she's spending her money and what she's buying her kids (a house, a car, etc.) I'm not sure why she keeps telling me this stuff, it almost feels like an act of aggression. Talks a lot about how spouses (wives) of family members are losers (much eye-rolling) because they don't fall into line with her values, and apparently do not spend a lot of time at family gatherings.

Patient is starting to rehabilitate his communication skills and was doing a writing exercise a few days ago, and wrote up a list of all the reasons he doesn't like her behavior towards him. Which I thought was pretty unfair given that she has devoted her entire life to his care, but must have been embarrassing for her.

This is the only patient the agency has abailable so I can't switch assignments and I have applied to other agencies but they don't seem to have a lot of work either. is there a way I can work with this family without feeling so awkward and icky?

[caliotter3]

Focus on your patient and his needs and wants. Come up with ways to address his needs for communication and companionship and leave the family in the background. Tell yourself that this is a job and a paycheck, right now, better ones are not available. After all, you say you are aware that no other cases are available and you say that you enjoy working with the patient. The patient should be all that matters, as hard as that may be to make a reality. Keep reminding the agency that you would like the chance to "broaden" your job horizons with a different case.

[mazy]

Thanks for your input. I have been feeling really bad about myself because of this, feel like a bad nurse, feel like a bad person. The patient doesn't really need much care, other than a PEG tube that's being flushed with water, he's a minimal assist with PO meds. family spends a lot of time out and about socializing and tell nurses to sign in and out for 12 hour shifts whether they work that or not. I sign off strictly on the hours I work, but am the only one.

I spend a lot of time doing laundry and paperwork, just to keep busy.

I'm starting an IV cert course (indpendent study) so can put that downtime to use studying. Also signed up for another nursing continuing ed course. I just feel so out of step with everything, I just want to be a nurse and get along with the family, but feel a lot of pressure to ...ugh, I just feel like a total misfit. Sends me back to my high school days.

Well, it's a job right? And I can use the time to get my certification and move on. Just need to look at it that way I guess and not stress. Easier said than done!

[caliotter3]

Thanks for your input. I have been feeling really bad about myself because of this, feel like a bad nurse, feel like a bad person. The patient doesn't really need much care, other than a PEG tube that's being flushed with water, he's a minimal assist with PO meds. family spends a lot of time out and about socializing and tell nurses to sign in and out for 12 hour shifts whether they work that or not. I sign off strictly on the hours I work, but am the only one.

I spend a lot of time doing laundry and paperwork, just to keep busy.

I'm starting an IV cert course (indpendent study) so can put that downtime to use studying. Also signed up for another nursing continuing ed course. I just feel so out of step with everything, I just want to be a nurse and get along with the family, but feel a lot of pressure to ...ugh, I just feel like a total misfit. Sends me back to my high school days.

Well, it's a job right? And I can use the time to get my certification and move on. Just need to look at it that way I guess and not stress. Easier said than done!

You state that the family has instructed you to falsify your hours and that you are aware that the other nurses do so. Would have to advise you that you are required to report this to your employer, i.e. "fraud, waste, and abuse". If you do not report, then you are also guilty of fraud. A written statement to the employer is sufficient, or if the employer has a "compliance" hotline, the major home health companies do, you can do it via a call to that number. Keep a record of your report, in case you are part of an investigation in the future.

[mazy]

Much needed reality check there. I'm not sure how I got myself so turned around as to think I was being a bad nurse.

Don't know how to handle this right now other than to get the flippity-flop out of this job. I reported a massive fraud situation at a previous job a while ago and am still reeling from the fallout. Have often thought I would like to run off to a desert island where no one knows me and I don't have to live under a cloud of dread and anxiety. Not being able to do that I decided to go into private duty nursing.

Well, I've now got my head screwed back on straight, i'll think this through. Thanks for your help. I guess it's better to talk about this stuff than just sit and stew.

[caliotter3]

Just because you make the report doesn't mean you have to leave your job. That is up to management whether or not they are going to target you instead of the wrongdoers. However, I would advise you to look for another case. Until something frees up for you, just go on about your business and don't breathe a word to the family. They can't force you to do anything. But they will get rid of you if they suspect you have turned in their "little family" of crooked workers. If the subject were to come up, look, who is to say that one of the managers didn't decide to sit in a parked car at a good spot at a certain time for a few days? If insurance investigators can do it, so can employers! Good luck.

[nursel56]

I agree with Cali, mazy. You have a good relationship with the patient. Jock nurses who like to yuk it up with the family, you can safely ignore. Same with the busy-body wife. Ignore. Be polite at all times when she starts talking, and talking then just pretend she never said anything and proceed to take care of your patient! :)

I have found it very intriguing how these family/nurse co-dependent monstrosities flourish, but once it happens, it is very hard to undo. However, the nurses who sign in and out for 12 hour shifts without actually doing anything are stealing. In my mind, they are thieves. In fact, I may go so far as to say that the family and the nurse are criminals, because the nurses are being paid for work they didn't do and the families are using other people's money to give them a power trip and currency to draw them into an unhealthy relationship.

Just as an aside, what the heck are these nurses charting? Do they just make stuff up to fill out their notes? They sound about as unethical and dangerous as you can get. People like that in nursing should be shown the door like yesterday. Sorry about your situation, though. Times are tough. We are just far less likely to kick a job to the curb. Anyway, your guy sounds like a doll. He still needs you. :)

[Elektra6, ASN, BSN, RN]

Don't feel bad, I mean everyone you meet you don't become friends with right? I'm sensitive too and I understand what you are saying.

Caliotter's advice about focusing on the patient is right. The client is what matters in the end and if you give good care and the family gets rid of you for whatever reason you can still feel good about your nursing care!