What are the home care policies?

ArwenEvenstar · Oct 6, 2010

What are the general policies of Home Care (caring for one patient in their home)? My agency didn't provide me with a pamphlet of any sort. They had me read their policies in their office and that was it.. I sometimes feel lost as to what I can and cannot say to family members and what exactly my role is regarding to keeping the home clean yet not becoming a housekeeper.. I'm an RN, btw.

It is really sad that agencies don't provide in-service training on " professional boundaries" in the home. It is really needed, because too many nurses seem to lack common sense and professionalism in this regard. I am not saying this towards you, but just speaking generally! I have seen too many nightmare situations in the home created (mostly) by nurses who lacked boundaries and professionalism... they essentially socially integrated into the family, became their friend, lost all objectivity (without realizing it) and besides nursing were house cleaning the entire house, doing errands, family laundry, babysitting other kids in the family, etc!

I guess my brief advice would be:

*The family is not your friend. Yes, you can be friendly! But the relationship should be primarily professional.

*Do NOT give the family your home phone number or cell. Communication should go through the agency.

*Generally, the nurse should only do direct care nursing related to the patient. Follow the care plan. If you do cleaning and laundry, it should ONLY be for the patient. Example: Keeping the pt's bedroom or immediate environment clean, especially the medical equipment. If the pt soils their clothes and bed linen, you could do a load of wash since it is all the pt's. Etc.

*If family wants you to do more than this, be polite but firm. You are there to care for the patient.

Hope some others chime in with advice! I hope I don't sound too severe or cold...but I have observed too many crazy out of hand situations. If you give an inch, many families will take a mile!

grateful2010, LPN, LVN · Oct 7, 2010

It is really sad that agencies don't provide in-service training on " professional boundaries" in the home. It is really needed, because too many nurses seem to lack common sense and professionalism in this regard. I am not saying this towards you, but just speaking generally! I have seen too many nightmare situations in the home created (mostly) by nurses who lacked boundaries and professionalism... they essentially socially integrated into the family, became their friend, lost all objectivity (without realizing it) and besides nursing were house cleaning the entire house, doing errands, family laundry, babysitting other kids in the family, etc!
I guess my brief advice would be:
*The family is not your friend. Yes, you can be friendly! But the relationship should be primarily professional.
*Do NOT give the family your home phone number or cell. Communication should go through the agency.
*Generally, the nurse should only do direct care nursing related to the patient. Follow the care plan. If you do cleaning and laundry, it should ONLY be for the patient. Example: Keeping the pt's bedroom or immediate environment clean, especially the medical equipment. If the pt soils their clothes and bed linen, you could do a load of wash since it is all the pt's. Etc.
*If family wants you to do more than this, be polite but firm. You are there to care for the patient.
Hope some others chime in with advice! I hope I don't sound too severe or cold...but I have observed too many crazy out of hand situations. If you give an inch, many families will take a mile!

Thank you for your response. Great advice. I have no experience working at a medical facility therefore I'm a bit ignorant to many issues, rules and regulations since it's in a home setting (more laid back). How do I deal with the Aides that work with my patient? Am I allowed to discuss medication?

caliotter3 · Oct 7, 2010

You agency should have provided you with guidelines during your orientation. If you have any specific questions, then ask your supervisor as you think of them. It is part of the supervisor's job to answer your questions.

allnurses Guide · Oct 7, 2010

I didn't get any formal guidelines either but I was so darn lucky to be assigned to a home with more than one person in it that was in need of nursing care, so I learned many things from some of the veteran private duty nurses who had been years in the field.

Every home, every family, and every client/patient is unique so it's almost as if each case is a "job" in itself with all sorts of possible variables in age, involvement with/concern for the person in need of the care, what they expect you to do, where to sit, etc etc. A good orientation is something I've always insisted on. Don't let them "oh it's easy - you'll be fine" Make sure you get a chance to review the Plan of Care. The agency should have a copy in the office and one in the home.

Everybody will tell you this but it bears repeating because it's so easy to get sucked into a dysfunctional family dynamic - always keep your professional boundaries. Repeat nothing you hear from one family member to another, for example. It sounds innocuous, x told me to tell you that y did this and. . .I just politely tell them I won't do that. I might let them dictate a note or I will set the phone up for them, but acting as a go-between will usually bite YOU in the backside! This sort of game can be played by other nurses on a case as well, unfortunately.

As for the housework situation. I don't, and I don't think the other nurses should clean up after the entire family. This is difficult, because it becomes a bargaining chip in a tight job market. Most agencies say the nurse is not there to babysit siblings, do all the family dishes and laundry etc., but some do that anyway to curry favor and make sure they are always the first nurse called for.

Just 3 days ago I heard one of the parents in a home I've been in happily for a long time, "why can't the nurse scrub the kitchen floor all she does is just sit there" to his daughter and oops! I guess he thought I didn't understand Spanish! I'm still honestly feeling hurt about that, and also really :madface: as all of his children's care is paid for by other people and I've proven my worth as a nurse time and time again. I guess they don't understand that. The point (other than a mini-vent) is he may have been genuinely confused by other nurses who clean-up after able-bodied relatives when the admission paperwork they signed clearly stated that was not part of our job.

What I do:

1. Wash dishes I use for the patient, wipe counters, put dishes away.

2. Disinfect, wipe down surfaces in the client/patients immediate area such as bedside tables, etc and whatever the DME (durable medical equipment) is ventilator, suction machine, g-tube supplies, etc. Refill supplies - catheters, suction catheters, trach care sets, etc.

3. Soak, wash rinse non-disposable items like vent and suction tubing, humidifier chambers, suction cannisters, etc.

4. Take out trash from waste areas in the immediate area of patient.

5. Soak or handwash stained/soiled clothing and linens, or washing machine if it's convenient to do so and you check with the family first.

That gives you an idea, but you'll find most of the time the family has already got their routine down pat and they will tell you what they need. You will find that sometimes they will have rituals that make you say "whaa---?" but they've been doing it their way forever, and you have to be flexible within reason. Hope this helps! Good luck!