I've started with an agency recently to do private duty. I was mislead from the beginning. I was lead to believe that I would have peds cases and was put on an adult case. I'm very uncomfortable with this. To add to that its a complex case. I had/have my hesitations but desperately need work (haven't worked in months). I've been trying hard to make it work and to learn what I can.
I've done private duty for years and I have seen roaches before and other unsanitary conditions. This is no shocker to me at all. So I arrive at this patients home to find that it is in the ghetto of the ghetto. The majority of the homes around this place are condemned. I still decided to give it a chance and not judge the book by its cover. What I discovered was a home infested with roaches. The family keeps the windows open year round and doesn't run the heat. Even the window in the patients room is open. The high temp has been in the 30's. My assumption is that they can't afford the heat. I addressed the roach problem with the agency and they claim they have discussed it with the family. I have to watch for roaches constantly to avoid having one crawl on me. The family is very sweet. They don't have much of an education and I see an opportunity to do lots of teaching. But I don't think I can work in this environment. The thought if it being that cold in the home and having to give the patient a bath is disturbing...so are the roaches I have to keep from crawling on the patient.
I desperately need the paycheck as being out of work has left me almost completely broke. I don't feel comfortable with the complexity of the case, but I can learn. I'm comfortable with very complex peds cases. I just lack the experience with adults. So I do feel capable of learning what I need to know. I'm not comfortable with the roaches or the freezing cold home. I can't work in that kind of environment. The agency doesn't have any other cases available. I'm not impressed with the agency at this point. They have mislead me and the training has been poor. The orientation for the company pushed safe driving and made us watch a video about it. I won't be driving any patients. I have had 1 ticket in 17 years of driving and don't need to be told how to drive! But they never taught how to do paperwork in orientation. I would think the paperwork would be more important to learn than safe driving since I won't be using my car for work purposes. Its obvious the DON wants a warm body with a license...but this warm (when not on the case) body has a brain in it!! There isn't much work around here and it took me months to find this job. Any options? I'm already back to looking for other jobs in case anything else comes up. But until then?
Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
As others have said, you have an obligation to call adult protective services and make a report. If anything were to happen down the line, say the patient got hypothermia for example from living with no heat.. it is your license on the line.
Uckkkk!!!! That is not worth any amount of money --- what if you get those roach eggs on your shoe and bring them home??? Gah.......keep looking for jobs, there are jobs better than that out there, there really are. Who owns that building and why don't they call an exterminator?!
I wasn't aware that there was an adult protection services. I knew there had to be some sort of organization that does what child protection services does.
They do have heat and lights. But they choose not to run the heat and to keep the windows open.
I'm very worried about taking home some critters too. Its not my biggest concern. I'm more worried about the patients situation. I don't like the idea of a roach hitchhiking to my home. But worst case I can get an exterminator (have one in the family).
Call Adult Protective Services. They may remove the pt from the home. However, they may just tell the family "the heat needs to be on"-- if the home does have heat available--and if the family complies than that will be it. What about a space heater and keeping the pt window closed? At least that would be something.
As far as the roach infestation- I've seen many a pt in a roach or bed bug home- from what I've (personally) encountered, that is not necessarily considered an abuse or neglect situation. But definitely call APS and they should at the very least get a caseworker involved in there that can assist with overall environmental management.
Specializes in maternal child, public/community health.
Absolutely report to adult protective services. Also, document every time you talk to someone at the agency in detail. (Once you find another job, report them too) Every time you go, you are putting yourself in danger - you are in a house that is in the ghetto of the ghetto with all the windows open? What keeps anyone from coming into the house while you are there? Is it really worth it? I know jobs are hard to find but I would not go back, ever, at all. Not all agencies are like this. As someone said, do travel nursing for a while if you have to but get out now - for your personal safety, your patient, and your license.
Please continue to care for this patient. She needs the help. As for the situation, roaches and coldness of the place, maybe the family is poor (very poor) or they have cultural issues. Provide the needed care and education to the patient and the family. Document the conditions as accurately as possible ( no drama...just the facts). Your agency must have a case manager or OASIS coordinator and a social worker who can make afollow up environmental assessment and then make the appropriate referal to the local social service agency. The family may qualify for heat subsidies and other entitlements. The social worker knows this area and can be a tremendous resource.
From reading your post, you do not like or want to do adult health nursing-I could be wrong but this is the impression I get when I read your post. While your agency signed you up for pediatric cases, they should have told you to expect occassional adult assignments.
If you feel unsafe, ask your supervisor about having a security guard/escort go with you on your visits.
Please do not let this one sad case turn you off to home health nursing.
Its not home health, its private duty nursing. So its not just a visit. Its being there for hours at a time. Been doing it for years so I understand its not the norm. I just haven't done much with adult patients. I have worked with some adult patients. I'm just not as experienced with adults in the home. Yes, I do prefer peds. This has to be reported though.
Since posting the issue. I have already applied at another agency. Work is hard to find around here though. Applying doesn't mean hearing back from anyone. I will be talking to the DON about reporting them and if that doesn't work I'll report it myself and then report the agency. This is scary stuff!
I have a hard time understanding how so many people could allow this to go on. There have been many people there before me. From what I've heard they have had a hard time keeping staff there. I'm having a hard time sleeping over this. Its hard to believe these supervisors can go home to their warm, bug free homes and forget about someone living in these conditions. It seems like so few people actually care in this field anymore.
Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
Its not home health, its private duty nursing. So its not just a visit. Its being there for hours at a time. Been doing it for years so I understand its not the norm. I just haven't done much with adult patients. I have worked with some adult patients. I'm just not as experienced with adults in the home. Yes, I do prefer peds. This has to be reported though.
Since posting the issue. I have already applied at another agency. Work is hard to find around here though. Applying doesn't mean hearing back from anyone. I will be talking to the DON about reporting them and if that doesn't work I'll report it myself and then report the agency. This is scary stuff!
I have a hard time understanding how so many people could allow this to go on. There have been many people there before me. From what I've heard they have had a hard time keeping staff there. I'm having a hard time sleeping over this. Its hard to believe these supervisors can go home to their warm, bug free homes and forget about someone living in these conditions. It seems like so few people actually care in this field anymore.
While you do need to talk to your agency about reporting it, you should still report it regardless of what they do. Since you are the one working there, it is your duty to report it. They will need information from the person who has observed it. It's completely within your scope of calling it in. I've been through this before with a patient while doing home health. It's not just the agencyies responsibility to report it, it is yours.
AnaCatRN
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