Why of why.....can nobody actually show up on time?

JustBeachyNurse, LPN · Dec 27, 2014

Call your agency or branch director with your very reasonable concerns. Perhaps consider another agency? There are often multiple agencies in more populated areas. Some have better reputations than others

SDALPN · Dec 27, 2014

I'm sorry you have to deal with this. Its an opinion and only that, but I'd bet that the nurses on this board are more likely to be the type to care about what they do. My guess is the lazy ones (there are lazy people in every job) don't care enough to be here to learn and share advice.

First, everyone who has ever worked has probably been late or had to call out at some point in their career. Life happens. But if its excessive and from the same nurse, its probably the nurse. Have a talk with the nurse. If that doesn't work, let them go. Always talk to the nurse first. I worked with one nurse that was late all the time replacing my shift. Turned out she had a medically fragile child and nursing at home and her nurse was making her late. You don't know unless you ask. Some things can be worked out. I had another situation where I kept getting colds because of another pt and the way my schedule worked I'd have symptoms when I was supposed to work my other case. I was calling out on my other case when it was because of the case that kept getting me sick. Not fair to the other family. I quit the case that kept making me sick and before I could get things straight, the other family requested another nurse. I'm very reliable...my last eval I had 99.6% reliability for the year. If the family had given me a chance, they would still have care. I hate it affected the family, but some things should/could be worked out.

Next, I believe in the saying that you allow people to treat you the way they do. I'm not saying be a jerk, but you need boundaries and don't let anyone cross them. If the nurse thinks they can show up late and get away with it, they will. Not all nurses, but some will take advantage.

If you have a list of tasks for the nurses, speak with the nursing supervisor about having them placed on the 485 (care plan). Then if the nurses don't follow that, you can notify the supervisor. If its just rules posted, it can turn in to he said/she said. But in writing and signed by a physician puts more authority behind it.

I hope that helps!

SDALPN · Dec 27, 2014

Oh yeah, and I've seen many times where agencies tell the family that a nurse is experienced when they aren't. You can always ask for a meet and greet with the nurse first and ask them directly about experience. If you are happy with the meet and greet, you could go on to orient the nurse or schedule orientation at a time where you can evaluate the nurses skills. I'm assuming you are also a nurse with RN in your name. So you would know what to look for. If you aren't a nurse, keep in mind that there are many ways to do the same task. Each nurse may have their own way, and each way may be the right way.

You can also ask the agency to send nurses with x years of experience or ask for specific nursing backgrounds.

I just picked up a case where the parent wanted nurses with no less than 5 years of experience in home care and nurses must have hospital experience. Its a complex case and the parent expects only the best. The parent expects the nurses to walk in knowing what to do.

I always tell parents that I can do nursing and that while I don't know everything, I'm always learning. The only thing I don't know walking in is where everything is and the house rules. So if they can tell me rules, routine, etc.and the location of needed supplies, I'm good.

If your rules are reasonable, you keep a clean home, you allow nurses to be able to heat up food, you make sure we have toilet paper, you allow the nurses to read/use internet/study/etc on downtime, then you should be able to keep good nurses and weed out the bad/unreliable ones easily. Good nurses will appreciate a nice working environment and that is a good incentive to show up on time/not call out. Good nurses won't want to ruin a good thing.

Gooselady, BSN, RN · Dec 28, 2014

I'm in the process of orienting to my first PDN job, which will involve peds as well as adults.

I'm very sorry you are going through this. You'd think that having a nurse to help with your fragile son would take a load OFF of your mind, not create more stress

"Forget" to show up for a shift? That is wayyyy not OK. Nor is it OK to be given false confidence in a nurse, only to be disappointed. This is supposed to make yours and your son's life BETTER, not add more crap.

I like what SDALPN says. I read here to get myself prepared for what they never teach you in a job orientation :) I've been a nurse for a long time, including recent hospital work, but I'll be walking into people's homes and they will be relying upon me when I am a 'novice' in this particular area. I'm already giving them credit for putting up with me and they haven't had to yet.

I hope you call the agency and give them a list of these occurrences. I don't have to be an old hat at PDN to see the nurse's behavior is unacceptable (the timeliness especially). As for your anxiety level with a nurse who lack a particular skill set, please do share this with the nurse manager AND the nurse in question.

If it were me I would feel bad but appreciate your concern and work to alleviate it. Seems like that's part of the job, and it's 'not about me', it's about your boy and his needs. I plan to inundate myself with all the knowledge/experience I can get my hands on, but I'm also confident in myself as a nurse, plain and simple. I may fumble with a ventilator setting but believe me, it would be the last time I did. I may miss a step in a process but I'd only miss it once if it is important. I'd want and need your guidance and experience as his MOTHER to show me how to do my job.

So feel empowered! The nurse is just another human being, nothing more, with a set of skills. She does her job, you do yours. There will be times you need to give her feedback about her job and vice versa. There should be respect going both ways.

yogastudentRN · Dec 28, 2014

Thanks for the feedback....it's hard being pregnant and sleep deprived and doing this! Anyway, I'm just kinda sick of people telling me they can do x-y-z and they get here, and hey it turns out they need me to go over a bunch of stuff with them because they weren't really that experienced and needed a lot of showing/explaining & training. Not talking about different ways.....but stuff like knowing that a male catheter needs to in more than 2-3inches, lol. That was THE best....she actually tried to bs me and said that was how she did it with an adult male. I just can't be staying up late or canceling plans last minute because the person needed 2 hrs of training instead of a 30 min orientation.

There re are good nurses out there but honestly they are very difficult to find since pay is awful in Ohio for private duty. I could not even afford to pay for normal after school care for my other son and work for those wages myself! It's a painful process to find a good match...that's all.

SDALPN · Dec 28, 2014

I keep reading on the FB trach boards that the nurses claim they have experience and then the parents have to train the nurse. At first I thought the parents were just trying to make themselves feel better, but I see it too much for it to be made up. Its just hard to believe they are that untrained. It makes me wonder about their school or state. I can see a new nurse needing a little help. But I've read nurses with many years of experience doing the same thing. Is it a state thing? An agency issue? Education issue?

I know we can't learn everything in school. I did 2-3 Caths in school...enough to know the basics. Did they miss the anatomy class on the length and differences between men and women?

I check with my clinical manager on new cases to see what skills are needed. On the rare occasion that I don't know a skill, I ask and prepare prior to going to the case. My office even has a lab for us to practice if we want. I've actually never used the lab except to check off skills. But its nice to know its there. Is this not an option for nurses in other states?

Just trying to understand :-)

Gooselady, BSN, RN · Dec 29, 2014

Not talking about different ways.....but stuff like knowing that a male catheter needs to in more than 2-3inches, lol. That was THE best....she actually tried to bs me and said that was how she did it with an adult male.

NEXT!!!

You aren't coming across as 'nothing will please me no matter what, I just want to complain!' It's hard for me to IMAGINE a nurse defending herself in the situation I quoted. I have been fortunate, maybe, to miss out on working with such a sub par nurse. I've heard about them. I've worked with startlingly unskilled nurses, but mostly not.

That's not an education issue. I hope you gave this as feedback to the nurse manager for this agency.

I suspect, but am not sure, that private duty nursing may allow in nurses who can't seem to make it in hospital or clinic environments. A few bad apples don't ruin the barrel when it comes to nurses :) That's the good news.

How long have you been coping with this agency and situation? Have you had any nurses with whom you were pleased and relieved to have there? As a customer, you have some rights to dictate who you'll have in your home caring for your son. You can 'fire' nurses and 'request' ones you feel best with.

I'm trying to get an idea of how long you've dealt with this to give an opinion about switching to another agency or just insisting only certain nurses treat your son.

SDALPN · Dec 29, 2014

NEXT!!!
You aren't coming across as 'nothing will please me no matter what, I just want to complain!' It's hard for me to IMAGINE a nurse defending herself in the situation I quoted. I have been fortunate, maybe, to miss out on working with such a sub par nurse. I've heard about them. I've worked with startlingly unskilled nurses, but mostly not.
That's not an education issue. I hope you gave this as feedback to the nurse manager for this agency.
I suspect, but am not sure, that private duty nursing may allow in nurses who can't seem to make it in hospital or clinic environments. A few bad apples don't ruin the barrel when it comes to nurses :) That's the good news.
How long have you been coping with this agency and situation? Have you had any nurses with whom you were pleased and relieved to have there? As a customer, you have some rights to dictate who you'll have in your home caring for your son. You can 'fire' nurses and 'request' ones you feel best with.
I'm trying to get an idea of how long you've dealt with this to give an opinion about switching to another agency or just insisting only certain nurses treat your son.

Only the agency can fire the nurse as we are not employed by the family (for those of us that work agency). But the family does have the right to hand pick nurses as well as the agency they use. The family can even find a nurse through craigslist or wherever and have them apply for the agency they are with. But the nurse still works for the agency. But no family is forced to have someone they don't want in their own home. I hope that makes sense.

Nibbles1 · Dec 29, 2014

It was so bad on my last case that during the meet and greet, I had to watch them turn on a Kangaroo feeding pump. I was watching a nurse trying to give the meds via g tube on the side where you inflate the balloon. Really?!? I have seen some nurses that I truly have no clue how they got a license.

caliotter3 · Dec 29, 2014

The only thing you can do is as the first poster suggests, send the nurse back to the agency when you determine they are not qualified or do not have a good work ethic. You are responsible enough to know the difference. If you need to find a new agency, then look for another agency. For that matter, you should always have your next agency in mind in the case that the agency can no longer provide the minimum of coverage. Over the years I have seen the fallout from these less than stellar employees over and over. They cast a negative light on the rest of us. When you find a good nurse, hold onto that person for dear life. They will appreciate not being treated as if they are not just the next person to audition. That is how good nurses get a stable home health job that lasts decades instead of weeks or months.

caliotter3 · Dec 29, 2014

There was a statement several posts ago that stated that perhaps nurses go into home health care who can not cut it in the hospital. My supervisor who had approaching sixty years experience in nursing, insisted that when she started out, that was the gist of it. Nurses who developed a reputation for not "cutting it" were relegated to home care. They did just enough to get through nursing school but excelled in nothing except a bad reputation. The good nurses always were the ones who got jobs in hospitals. To be quite frank about it, in more than two decades of doing extended care, I have run across far too many subpar, very subpar, nurses to consider it to be a coincidence.