What are they telling us/not telling us

[holly2422]

I am a new LPN and was hired by hospice. I wait for an assignment and commit to 3 days of 15 overnight hours each night and document every 15 minutes as long as the patient survives.

when the case came to me, it was by text, I wanted to know where the assignment was and about the clients condition. My response was basically do you want it or not, I'm a little busy. I chose to take it, being afraid of rejecting the first case is not so good.

the case was in a very bad neighborhood, mice and roaches in the home, the patient unresponsive with a trach, gtube and running a constant fever that would not budge.

no gloves provided by the hospice the first night in this home (thank goodness I had my own for the suppositories and trach care).

During one night I suctioned the trach, as a new nurse and not informed by my nursing school it was shocking..... a large yellowish gobber came ejecting out and a piece flew several feet in the air. I had no mask on or supplied with one from the hospice. I was more concerned about getting the gloves on quick because the episodes of congestion would come on quick. Thank goodness the piece did not hit me in the face.

The one daughter and father in the house were terribly ill and I questioned the antibiotic and why it was prescribed for the client. No one at the agency could give me an answer. The family barely spoke English and did not seem to know either.

Well, I find out after the passing that the client had pneumonia. As my first round in home care, this is an early lesson and makes me wonder what an agency can tell you and not tell you about the client (airborne, droplet and bloodborne afflictions).

Could I be walking into a care setting with someone with EBOLA, TB ... etc and not be informed prior by my company ?

I am aware of infection control, I even asked the agency if they would supply me with an N95 mask if needed for a client with TB, they looked at me strange.

I understand the danger of nursing, I want to be a good nurse, to help my client through the end of life process and to make them comfortable and at the same time want to protect my own self.

I could sit in a home with full protection not knowing if the client has a major contagion, but that could be over doing it.

does anyone know what an agency is obligated to tell us about our clients ?

thank you in advance

[xoemmylouox, ASN, RN]

I would NEVER work at an agency that didn't provide gloves and a mask for a patient with a trach. You survived your first day and you'll be able to survive many more, but I would seriously keep looking for another job. There are good agencies and bad ones. It sounds like you are in the latter. If you are desperate for money please make sure you have Liability Insurance before your next shift. Document, Document, Document.

[Doodlebug21, RN]

I feel from reading her post she handled the situation very well. Especially for being a new nurse. That being said, new nurse or not it doesn't matter what type of nursing position she is in. Her post was directed at the fact the hospice center she works at is not well equipped or managed very well. A nurse with 20+ years of experience would even complain about this as well. You come off very rude BTW

[Midwest4me]

I Believe that you should always be properly oriented to a new position. You should be properly provided with the equipment that you will need. It is also the agency's responsibility to provide all of the information that you need to properly care for that client. In my opinion that means information regarding the care plan, diagnoses, medications, treatments, etc. Otherwise you are walking in blind. .

[holly2422]

Well... it gets worse as I go on. I have my resume out all over the place and a few new prospects. I hope I get into a better place.

So, I had a few more patients/clients. I go to the home, with barely any info except for an address. Medication may be on a table, maybe the family knows what to do with it. However, I do not have a report from my company. Some times a med is not there (to dry secretions and told the pharmacy is in another state and could not get there in time?!?!?!)

This has happened many times, or a client has a med routine that I learned, they go to respite and comes back home with new meds and no new instructions....this is frustrating as heck.

I finally contacted my HR rep. I explained this problem. I was courteous and to the point. I get no background, missing equipment, medication is at the house with no care plan available. She mostly blew me off, I heard her quickly typing something and said she just mailed out an email to the case managers to leave care plans at the homes.

There was one incident, the patient had 10 medications that were not part of the hospice meds. The case manager came to the home that one time. The family said they know how to give the regular meds, but she denied them and said we handle all meds and she proceeded to change their routine of administration.

PROBLEM - she had me write the new plan down. Not being paranoid, but she did not order these meds, if something was to go wrong, it is kind of her word against mine since the process was in my own writing with nothing documented from her. She also just picked the meds she felt needed to be administered (not all of them). I'm in a dangerous situation, I am aware of this. I questioned her and got yelled at in front of the clients. If I had another job, I most likely would have walked out of the home right there and left her to carry out the administration.

Honesty, I think this whole company is working by the seat of their pants. Since I'm new, it seems I don't know what I'm talking about (of course I have nothing to bring to the process) , so no one is going to listen to me. The calamity is that they don't even have many clients either, so, its not an overload issue.

Is this how hospice works ?