What would you do in this situation?

I had a similar experience when I was a new grad. I was called to replace the regularly-scheduled nurse in a home of two teenagers with juvenile Huntington's disease. The girl was older and had more severe disease at the time, with rigidity and dementia; her brother was still able to attend school and a second staff person attended with him. I was left alone in the home with the girl who was non-verbal and unable to communicate. The night nurse gave me a tour of the apartment, showed me where the meds and feeds were kept and showed me the care plan. (Imagine my shock to learn that part of her care plan included me cleaning the bathroom and washing the floors in the bathroom and kitchen!) I'd never used a Hoyer lift before and had no idea what to do with it. I was okay with themeds, tube feeds, suctioning and diapering, but there was so much I wasn't okay with. The shift passed so slowly! And to add insult to injury, when I was paid for the shift I found out that the agency normally placed LPNs in that home, so I was paid as an LPN. I never went back.

One home I worked in for several weeks was not a nice placement at all and things finally came to a head there when the mother (and the agency supervisor) instructed me to allow her to endanger the child. (The child's room was on the second floor, no lift or elevator; the older brother carried the child upstairs each night when it was time for bed. He had been in an accident and had lost a significant amount of blood, was wobbly and light-headed, but still expected to carry the child upstairs.) I never went back after that.

I was also placed in the untenable position of being the only RN on the premises at a nursing home for a night. No warning, no asking me if it was okay, I just arrived and was told, "Here you go. Don't forget to check for sick calls at 0530."

If you find that your agency continues to send you on assignments without sufficient preparation, you'll need to be assertive. Tell them that you cannot provide safe care without adequate orientation to the patient and the circumstances. Tell them that you're not willing to be their float, that you want a stable case load and proper support in each home. If they won't agree then start looking for a new job. It's not just your license on the line, but your patient's life and well-being. No one deserves to be treated badly, by intention or by default.

I have always told my employers that I am not open to working fill-in on a case unless it is a case that I have worked in the past. Lately, I have been doing it, but only because I have felt comfortable. Your agency should honor your wishes if they want to retain your services. You might want to explore your available employment options in case you can not obtain cooperation in this matter. You are not out of line in your preference here.