Today I officially hate nursing

Nurses General Nursing

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So as you may know i left hospital for home health. While some aspects are better as far as chaos and pandemonium, I have to say Im pretty darn stressed out. Loose ends are haunting me and a few of the patients Ive seen drive me insane as well. I have a s/p stroke pt with aphasia who is non compliant with everything! The visits are like torture trying to communicate with her. I actually understand what she is saying, however she is tangential...hell bent on letting you know she knows what she's talking about. She doesn't have voice mail set up so there's always issues and confusion about appt times. All of the 3 times Ive been to her home she's been in the shower after I've specifically set up a time with her and her family. That's the other thing. There are about 8 people in and out of her home at any given moment....all chiming in or looking on....and when I would like to talk to one of them, they are reluctant to get involved. I only want to suggest a white board calendar so everyone knows when her visits and dr.s appts are so everyone is on the same page! UGH its so frustrating. Nothing gets accomplished. She has PT, OT, ST and HHA involved in her care and I haven't been able to collaborate as of yet.. ..I feel like Im spinning my wheels. Out on the road with my GPS...trying to get here and there. Meanwhile the loose ends are just swirling around in my brain. I also don't think I like wound care. I haven't done strokes or wound care since I was a newbie...I was LDRP and psych for most of my career and now I remember why. Maybe Im just a malcontent but direct patient care is for the birds if you ask me. I HOPE THIS GETS BETTER!!

Specializes in Complex pedi to LTC/SA & now a manager.

Have you considered post partum/maternity home care? Often hospital based. When I had non-union of my C/S wound I had home health for 6-8 weeks for wound care plus BP checks (post partum HTN/pre-eclampsia) they also did f/u with my son and helped with breastfeeding as the hospital lactation consultant was MIA. These ladies were awesome. All experienced LDRP nurses. Two were f/t two were per diem (f/t in hospital) they only did post-partum or gynecology. She had 10-12 post c/s patients when I was on service. Already had well established relationships with the local OB/GYN groups.

Thanks Just Beachy. Thats a great idea! But Im new to this job so the last thing I want to do is leave...I was in LDRP for 5+ years and psych for 2 years. I'd like to stay put somewhere at this point in my life..and it's not as if these jobs are abundant anyway. The job market in my area is slim pickens. Im really just venting I guess. At some point in my life I would like to get out of direct patient care altogether but I will need to get BSN Im afraid. A whole other can of worms at the age of 48 with 2 young teens, husband, several pets and working 40 hours. Gosh, I sound like a real complainer I know. Just had a rough day. I truly envy those who love their job! God bless ya!

Specializes in MICU, SICU, CICU.

In the shower when you arrived for all three visits is no coincidence.

The family member is putting the patient in the shower in order for you to bathe and dress this patient or do the heavy lifting.

Do not allow yourself to be manipulated. The next time this happens, tell the family to call the office to re-schedule.

You can diminish the stress by moving into extended care, your agency may also support this type of case. With extended care, you get the chance to get accustomed to one patient/family situation and can move around until you find a case(s) that is acceptable. Then, when you have a handle on all of it, you can move back into visit work or schedule yourself for a mix of visits and shifts to suit your needs.

In the shower when you arrived for all three visits is no coincidence.

The family member is putting the patient in the shower in order for you to bathe and dress this patient or do the heavy lifting.

Do not allow yourself to be manipulated. The next time this happens, tell the family to call the office to re-schedule.

When this happened the second time, I would have known that the circumstance was deliberate.

Specializes in Complex pedi to LTC/SA & now a manager.

Definitely deliberate. Unavailable and move on.

Vent away. See if your agency does psych or OB home health. Even as a per diem for "fun work"

Look at online programs for BSN. Many are affordable like

Im trying to decide if this is a control issue the pt has. She is definitely frustrated by her impaired communication related to the stroke. She wants to control her meds, as I filled her med box last week and she did not comply with taking her meds. I've asked her to have all her meds ready for the visit so that I could help her prepour...nope...not happening....like pulling teeth....."Cindy would you please have all of your prescriptions in one container and ready for our next visit?" Blank stare. Changed subject. "I don't need anyone helping me I've been independent" "Im a smart woman" "I used to have a big job as a pit boss in Atlantic City" etc etc. (Names and locations changed)...but when I asked her "Do you think you need a nurse to visit you?" She says yes. I'm having difficulty finding what the skilled need is here. I definitely think this is partly a control issue and partly impaired cognition/memory due to effects of stroke. She gets agitated if anyone in her family or myself tries to coordinate appointments or explain that we need her to be ready and compliant. Her family basically allows her to do what she wants because they don't want to deal with her wrath....she is sort of an intimidating person I suppose that's also part of my problem. I seem to be unable to take control of the visit....it's all over the place and I feel like Im accomplishing nothing with this pt. Im thinking of discharging her from Skilled Nursing and keeping PT, ST and HHA on service..although she said she didn't like the HHA. Described her as "lazy."

Don't quit! You have to get through this to become comfortable with your position. I make a list of things I need to follow up on in my calendar if there is a specific day or just a "to do" list like ordering supplies, contact such and such MD, etc. If I have a patient that has time management issues (like with showering) I call them before I see the patient before them. I tell them "I should be there in about an hour please make sure you are ready for our appointment". It has greatly cut down in that type of thing. Make sure you schedule your times appropriately so that you have enough time to drive, call the doc, etc. Do you have a messaging system (like email, but hipaa compliant) where you can send a message to all clinicians on this case? That can help everyone get on the same page.

Give yourself a little time. It takes awhile to get comfortable with everything you need to do as a home health nurse. It really is a great job! There will be difficult patient's. I have a couple right now that are quite a challenge, but such is life!

Specializes in MICU, SICU, CICU.

It sounds like you were chosen to manage this difficult case due to your extensive psych experience. She is running everyone even her family and that needs to stop. It is time for some tough love and firm kindness.

Although you are a guest in her home, It might be very effective to spell it out like this. "We're not playing these games anymore." I might say that I dont want to find you on the floor because you had another stroke. I would ask her point blank to you want to get better? I might even ask her do you want to stay in your home or end up in a nursing home (depending on her individual need for custodial care) . Or tell her you're too young for the nursing home something like thst.

Keep it short and simple and concrete. CVA patients have great difficulty receiving information. One voice is a challenge. Two voices is like static on the radio. Turn off the tv and radio during the visit and keep distractions to a minimum. Do some teaching on what part of her brain was affected and assess for recovery.

Does she have a working clock? Can she tell time? Put a calendar for July and August on the refrigerator. Make her read it out loud.

Fill the pillbox. Set some expectations in a non threatening manner. Depending on the severity of the situation let her know that you are here to monitor her health and well being and if she can not care for herself a referral will be made to the physician ( for med compliance and safety concerns). Do acknowledge her intelligence and ability to maintain her independence. If she doesn't want her family involved that's okay, prove you can do it yourself. Take her out for a walk. Get her laughing. Tell her Trump is running for president.

She sounds kind of lost, maybe depressed, and in need of people to get her back on track.

Maybe coordinate with the HHAs company. You can call them and say I am seeing Mrs Jones on wed and Fri at 10am. Could you have the aide know so that she can get Mrs Jonesready for my visit. You could explain how she is not ready or is in the shower at your appointed time.

Specializes in Hospice.

You really need to discuss this case with your Supervisor and the patient's PCP.

CMS takes a dim view of noncompliance. It's a reason for discharge from Home Care.

Quite frankly, there are too many patients out there who would really appreciate your presence to waste your time and energy on someone who has no desire to follow instructions.

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