What are your limitations as a homehealth nurse?

caliotter3 · Feb 24, 2009

The job description normally addresses cooking, but limits the cooking to "light meals". You're not expected to produce nine course extravaganzas. I always let it be known that when it comes to cooking, I consider myself to be lacking. If warming in the microwave or something simple like scrambled eggs, ok. Otherwise I tell the patient and their family on day one that I don't do elaborate cooking. Actually, the agency should have addressed this issue when they decided who to send on the case.

In your situation, it seems as if the agency is on top of the patient's mental status, so you are pretty much covered as far as what they will hold you responsible for. As long as the family is aware of what is going on and they have no complaints, you should have no problem other than being uncomfortable. A problem would be more likely to exist if the patient was alert and oriented and picky and demanding; along with a family just as demanding and complaining. I would not stay under those circumstances. The agency is likely to go along with the family and patient when it comes to complaints (customer is always right syndrome), when all involved are alert. Not to say that you shouldn't try to make the patient and family happy. There is attempting to make happy, and going beyond boundaries to the extremes.

Laundry is part and parcel only if it belongs to the patient, as is light housekeeping. The patient's immediate area or bedroom. You are not to do the family's laundry or be cleaning any other room unless you are picking up after yourself. There are a lot of families that think you are the maid and/or the babysitter and/or family chauffeur. I've encountered this and have met others who have encountered this. If your agency does not set firm guidelines and back you up, then you can ask to be removed from the case. We had a case one time where the laundry room was across the house from the vent dependent patient. Our agency said: 1) licensed nurses don't do laundry; 2) required to be within sight or sound of patient and vent alarms. That particular agency backed up the nurses to an extent. The family started bringing baskets of laundry (only that of the patient) in for the nurse to fold when she was not busy. You pretty much have to have a line for yourself, using the job description as a starting point. If it is in your job description, you are expected to do it. You don't want to be without work nor do you want to be everyone's doormat.

Ms. Nurse Assistant, LPN · Feb 24, 2009

You don't want to be without work nor do you want to be everyone's doormat.

This is what I am having issues with! lol

The guy is fairly young, he is 43, and was in a car accident that left him paralzyed. He can get around on his own, with a cane, his right side is weak and still somewhat paralyzed. I think to an extent he is "faking" how little he can do.

When I arrive, there is a list of things I have to do which is:

sweep and mop the bathroom/kitchen

clean the tub/toilet

wash the dishes

vaccum the carpet

fix husband's meal (I heat it up)

The little hours that I have with this guy I try to make the best of it, but I feel as though the wife and husband is taking advantage of the HHA services and using it as some kind of personal maid/servant service. And the patient, is testing me, and seems to get gratification out of having me do things he can do himself.

For instance, he had me flicking thorugh the channels with the remote to find the station he wants to watch, even though he can do this himself, claiming that his arm is bad even though I have caught him changing the channels himself.

Then he had me making phone calls for him, when he can do this too, the first day I met him he was talking on the phone and making phone calls.

Also, he was very upset that I could not take him with me to run errands for him (I did this for two days I was unaware that the patient was not supposed to leave the house when I spoke to the manager yesterday), he called me a "snitch" and that he did not like caregivers who run their mouth too much (he was leaving this on the manager's voicemail). He doesn't seem crazy, just unreasonable, and and a bit slow. He complains alot and is never happy

He wants me to take him to buy dishes for his house, take him to the gym so he can workout, take him to Target or Kroger's to buy grocery's. The first day I even took him to a department store so he could buy a jacket.

Now that I told him that I cannot do all of this, I had to listen to him b!tch and moan about how it's so unfair & that he doesn't want to send a caregiver to the market so we can bring him back the wrong things.

caliotter3 · Feb 24, 2009

If it were me I would leave this case. All of these instances that you describe are cumulative; they add up to an ulcer and constant headache for you over time. He called you a "snitch" for doing your job? I would have quit the case then and there. It is not worth it. Find a case where everyone is more reasonable.

nursalicious · Feb 25, 2009

After reading this post, I am having MAJOR second thoughts about leaving ICU to go into home health. I'm finding more and more gray with HH...and I am so very black and white!

I can't offer any advice based on experience, but I'm pretty certain I would have to remove myself from this case for my own sanity/health. Good luck with whatever you decide.

caliotter3 · Feb 25, 2009

I can validate that you will have some degree of discomfort, nursalicious, if you are very black and white. Lots of times the supervisors will tell you "do what the family wants you to do, the way they want you to do it". OK for some things, borderline for others, license risking in other cases. And they never want to discuss paying you overtime for all the extra time you will have to spend doing the extra documentation required, when you "do it their way" and "their way" is contraindicated by prudent practice or the doctor's written orders. Then, they want to look at you in a derogatory way when you stand your ground and ask to be removed from the case because you value your license, or your personal safety, or some other commodity. A downside in the near perfect world of hh.

Ms. Nurse Assistant, LPN · Feb 25, 2009

After reading this post, I am having MAJOR second thoughts about leaving ICU to go into home health. I'm finding more and more gray with HH...and I am so very black and white!
I can't offer any advice based on experience, but I'm pretty certain I would have to remove myself from this case for my own sanity/health. Good luck with whatever you decide.

I've been doing home health work here and there, and it's really the luck of the draw. Sometimes you luck upon a REALLY good family, and a patient who is not demanding and on a powertrip. Usually, when you find a family like that you try to hold on to them for deal life

caliotter3 · Feb 25, 2009

I've been doing home health work here and there, and it's really the luck of the draw. Sometimes you luck upon a REALLY good family, and a patient who is not demanding and on a powertrip. Usually, when you find a family like that you try to hold on to them for deal life

And usually the people who have been with the agency the longest get these gems of patients/families and they do hang onto them for dear life! Like 27 years! You have to be lucky and find a good case when it is first opening with the agency and you can have a good work environment for as long as the patient is on service.

ArwenEvenstar · Feb 27, 2009

Interesting reading through this thread! Yea, I think the one "down" of private duty (whether it is a nurse or home care aide case) is families or patients who expect too much. It is so important to have an agency that will back you up when you refuse to cave in to unrealistic demands. It is also important to keep a professional boundary, and follow the parameters for care. The care plan should have a list of what the nurse or aide is expected to do. In the casual setting of a home, it can be easy for the nurse to start to do extra...but my experience is that if you give an inch, they take a mile!! And things can very rapidly get out of hand. Once out of hand, it can be hard or even impossible to rectify the situation.

In my 4 years of doing private duty now, I found that the "blame" lies partly with patients/families who simply expect too much, and partly with nurses who lack a professional boundary. These are general comments....and NOT specific to the OP. But I have been appalled at the nurses I have come in contact with who completely lack a professional boundary...they essentially socially integrate into the family, lose all objectivity, and become the family's nurse, maid, cook, errand runner, tutor, babysitter, and friend! Lest you think I am exaggerating, I walked into a case where the retiring nurse had been doing all those things!! She created a nightmare...

I have worked at two agencies now, and neither had any type of orientation class or module on professional behavior in the home - in regards to the importance of maintaining a boundary. I think this is really needed.... I think agencies should have some type of mandatory inservice on this. Are there any that do?? I like to write, and have actually thought of writing some type of article on the importance of keeping a professional boundary in the home. But my life is consumed with other things now...

Ms. Nurse Assistant, LPN · Feb 28, 2009

Update:

The client was very bothered by the fact that I did not know how to cook greens, hamhocks, turkey, fried chicken, fish, lamb, pork chops etc so he found a new agency. I came to his place, to see a new caregiver answering the door; and some other lady sitting on the couch signing papers, probably the manager of the agency

No hard feelings, I just said that I enjoyed working with him and had him sign my work sheets so I could get paid. I was not upset that I wont be working with him anymore. I never revealed this, but he was hitting on me, and asked me out--the man is married. The first few times that I worked with him I felt very uncomfortable, the conversation and the way he came at me was unprofessional. I let the agency know and he started to straighten up and take me a bit more seriously. It was very uncomfortable to run into his wife--I just don't know why such a nice lady would be married to such a sleaze bag but oh well her problem not mine!

lamazeteacher · Feb 28, 2009

I have worked at two agencies now, and neither had any type of orientation class or module on professional behavior in the home - in regards to the importance of maintaining a boundary. I think this is really needed.... I think

Quote from ArwenEveningstar

"agencies should have some type of mandatory inservice on this. Are there any that do?? I like to write, and have actually thought of writing some type of article on the importance of keeping a professional boundary in the home. But my life is consumed with other things now... "

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Your boundary should be clearly outlined in the Plan of Care (POC) in the chart. If it is not in the home, the POC and med list is usually taped to the refrigerator door. It says everything that you're expected to do, and you can point to it whenever a patient wants more than that.

As a Case Manager, I explain what's on the POC to the patient and family as I write it, and ask them to call the office if they want anything else, or if medicines are discontinued or new ones started.

The patient described by Ms. Nurse Assistant is clearly out of line. The Case Manager has to do a supervisory home visit while you're there, once a month, which is a good time to discuss what's working and what's not. If the agencies you work for don't have that in place, believe me you don't want to work for them. There are many good agencies in every community, and NAs are needed at all of them, so don't hang on to a job at a bad one.

DriBak · Mar 1, 2009

Let's see:

I have walked the dog, been shocked while installing a ceiling fan light kit, installed a lock in a cabinet, installed hand held shower heads, repaired broken furniture and just this past Thursday I installed a starter motor in a lawn tractor. I have cooked and cleaned in the past, taken a client's grand-daughter (who was on house arrest) to work and I'm sure much more in my 13 years in home care.