Long story short, I'm a relatively new nurse, and just got hired to a home health facility. However, I was assigned to an also new adolescent client. Parents appeared very friendly and welcoming at first.
However, as the days went on I started to notice that they can be extremely sharp or crass towards me when something is worded wrong before I can correct myself, or times when they believe I am making independent choices without any clinical judgment or without permission (by family, client and physician). I've always asked my client's permission before I do anything. This has always been the case since I started working as an RN. I am not being given a chance to reexplain regarding the situation before my head is bitten off by the family. At times, I'm being spoken to more like a child than a healthcare professional. Their expectations from the parents of me do not reflect company expectations nor is the careplan or physician orders followed very well when I work. I do document like it's my licensure insurance. Clinical manager is aware, but they've also stated that they've never had problems with other nurses (mostly NOCs). I work days.
I've only been working with them for several days, and this is the impression I'm already getting from the family.
I wrote a long email to my clinical manager entailing details for their next care conference.
Just one quick point, keep your e-mails short. I supervise twelve people in my day job and I do not have time to read more than a few sentences. At times when they get too long-winded, I summon people to my office to give me an oral summary of their e-mails. When that is done respectfully and kindly, it can often help people to work through their anger and sometimes they get new perspective on it. I've had people hug and make up in my office.
I'm not a nurse supervisor (I'm in nursing school) but in my experience as a middle-manager in another field, managers are busy busy busy and they get nonstop griping. Sometimes there are no easy answers, and sometimes things are not so black and white as we feel they are. The bosses have to balance both sides. There are stresses, disagreements, and misunderstandings in every field. Keep your chin up, be pleasant with your supervisors, and watch them go to bat for you!
She wanted the details of what had happened, but there were a lot of things I could not say over the phone because the family was looming over my shoulder.
Specializes in Oncology, Rehab, Public Health, Med Surg.
Many times--ok, many many times-- the family believes since they "pay" you, they direct your nursing care. It can be hard to accept that the nurse works from a medical plan of care, not the parent's directive.
Other times parents feel a need to establish territory. As in -you may be the nurse but I am the mother/father That gets easier with time as roles and boundaries are established doesn't sound like that's what's happening with your case Though
I wouldn't expect much support from agency. They have to keep the family satisfied This family holds the upper hand ($$$). The agency knows that all this family has to do is snap their fingers and there would be multiple agencies on their doorsteps competing for their business
Your obligation is to follow the plan of care. Even if the parents don't approve. If they can't accept that then it's time to move on. To preserve your peace of mind and your license.
Move on from that job. You don't need that type of treatment and you need to work in a safe environment if you are not free to be a nurse and use your nursing judgement and skills this is not safe practice. For some reason some families think that they need them because they are paying you when it is really the opposite.
I don't work in home health, I work LTC/SNF. When I come across family with control issues, sometimes I have to remind them (tactfully of course) that I take orders from my manager and the doctor and legally, those orders are what I have to follow. If they have a problem with the rules, they need to bring it up in a care conference, where their care team can try to accomodate their needs or reinforce their policies, depending on the issue.
Unfortunately, the care conference won't be held until another two weeks. I've tried emphasizing that It is my duty to follow the careplan, but get shut out before anything is further explained. If the client refuses, I always chart. But there is a huge communication issue between the client, mom and dad (Whom are both very pushy towards the client sometimes).
I am a Pediatric Home Health nurse (I also work in a Pediatric Facility). There are plenty of parents out there like that. I was schooled on what to expect. These parents are feeling out of control. Put yourself in their position. It is challenging just having to need someone to take care of your child. Most of these parents do not go and get the mental help that they need to deal with the issues of having a child with special needs or having an ill child. I had my "script" ready by the time I went on to my 3rd homecare case. I simply told the parents. " I understand what you want me to do and I understand that this is your child, but the nurse practice act does not allow me to stray from my careplan."
" I don't disagree with what you feel that needs to be done, but I have contraints as to what I am to do by law." If you feel the need to have this or that done, you are welcome to do that yourself as I am not allowed to do it." You almost have to become their Psychologist. They also probably see that you are a new nurse and that gets their radar up in a hurry. My first trach/ vent pediatric case went this way. The mother was MEAN . I mean MEAN! She tested me every step of the way. For example: there was a certain procedure of switching from the bedroom ventilator to the living room ventilator. She refused to do it the way it was written in the care plan. She wanted to start up the living room vent, take the child off the bedroom vent, then carry the child down to the living room vent and place her on. The careplan required me to use the ambu until we could place her back on the living room vent. She refused and said it took too long and besides it only took her a few seconds to get to the living room. Da Da... the supervisors and staff just told me that I had to write each day in my notes that "mom, refused the aid of the nurse to conduct this procedure." She also started to feed her by mouth before the pulmonologist would allow it. She did it all on her own. But, I will HAVE to say this for her, that child would not be in college and essentially normal had it not been for her "not listening" to these people. Her motto "as normal as possible" also went for disciplinary actions too. If the child pulled out her trach because she didn't get her way, she was placed on time out. As mean as she was in the beginning, I became this mom's best friend and someone she could trust. I spent 8 years on that case. Her mom even admitted to me that she was mean because she was tired of people that did not care and wanted to "weed out" those who she thought would not stay. lol I told her, "if the money wasn't as good as it was, you would not have seen my a** here past the first week." I still keep in touch with both her and the young lady. She pretty much calls me her second mom.
Many times--ok, many many times-- the family believes since they "pay" you, they direct your nursing care. It can be hard to accept that the nurse works from a medical plan of care, not the parent's directive.
Your obligation is to follow the plan of care. Even if the parents don't approve. If they can't accept that then it's time to move on. To preserve your peace of mind and your license.
Good luck
Correction here: The nurse derives and follows the nursing plan of care and implements some parts of the medical plan of care. We would be poor nurses indeed (and in violation of our practice acts) if the only care we delivered was in response to medical prescriptions.
That said, any plan of care can be modified to fit the needs of the patient (and in this case, the patient includes the parents).
If they object to things that are parts of the plan of care prescribed by the physician, the next step is to have the physician clarify or modify them, or get it in writing that they have been informed about the consequences of refusing them.
For a safe nursing plan of care, you get to be a professional and revise as you have to within the boundaries of patient safety vis-a-vis your nurse practice act, and it's on you to clarify those actions or get the parents to refuse them in writing so there are no misunderstandings later.
JoseQuinones
281 Posts
Just one quick point, keep your e-mails short. I supervise twelve people in my day job and I do not have time to read more than a few sentences. At times when they get too long-winded, I summon people to my office to give me an oral summary of their e-mails. When that is done respectfully and kindly, it can often help people to work through their anger and sometimes they get new perspective on it. I've had people hug and make up in my office.
I'm not a nurse supervisor (I'm in nursing school) but in my experience as a middle-manager in another field, managers are busy busy busy and they get nonstop griping. Sometimes there are no easy answers, and sometimes things are not so black and white as we feel they are. The bosses have to balance both sides. There are stresses, disagreements, and misunderstandings in every field. Keep your chin up, be pleasant with your supervisors, and watch them go to bat for you!