Vol. 4 Issue 3
Boundary Issues: Home Health
Can I do dishes? Settle arguments? Give a gift?
Uncertain Burton, our very confused little nurse, has struck again. This time, he's working in home care and is concerned he might make the wrong move with a new family.
To give Nurse Burton a little help, ADVANCE spoke with four home health experts for some advice. Some of their answers may surprise you.
Uncertain Burton: Should I do dishes or help clean up a house?
"Only patient-related cleaning must be done by the home care nurse. The nurses go to the home to give skilled nursing care. The nurse is not a maid or housekeeper," said Larissa Davidson, BSN, RN, clinical education and accreditation manager for Loving Care Pediatric Homecare in their Fort Lee, NJ, office.
Holly Smeekens, MHA, BSN, RN, sees it differently.
"I think each family has different needs. If the nurse has the time and is so inclined, absolutely do the dishes," said Smeekens, the director of professional services for Home Health Specialists, based in Media, PA. She added that the nurse should stay near the patient, though, since that's where her primary responsibility lies.
Deborah Boroughs, MSN, RN, offered a particularly unique perspective. She adopted two children who needed vent care from a home health nurse. Based on that experience, she decided to become a home health nurse.
Boroughs recommends that a nurse do the housekeeping tasks associated with the care of the patient: picking up in that immediate area, washing dishes from feedings, taking out the trash at the end of the shift. However, doing more can cause problems.
"A lot of families take advantage," explained Boroughs, who is administrative director at the Ventilator-Assisted Children's Home Program in Pennsylvania. "Before you know it, the nurse is watching other siblings while the parents go out."
Bottom line: if you're comfortable doing a few extra duties and your employer doesn't mind, then do it. But don't let your patient's family take advantage of your kindness.
Uncertain Burton: Should I ever run errands for a family?
No! The home health experts were unanimous on this question.
"The nurse is not allowed to leave the house during their scheduled time and leave the patient unattended," Davidson cautioned. "Nurses are not allowed to leave the patient in anybody's care. They're also not allowed to take the patient out to take care of their own needs."
Uncertain Burton: Should I try to settle family disputes?
Having an ill family member often raises people's stress level, which can spark tempers and lead to disruptive arguments. Boroughs recommends that nurses proceed with caution and try not to intervene if possible.
"Don't take the side of one parent over another parent," she advised. "Let's say mom goes to the nurse and has been friends with her for a while and brings the nurse into some marital problem. The nurse really should say, 'I'm not comfortable hearing personal information like that.'"
The nurse runs the risk of dividing the family – with herself in the middle. The care of the patient should come first, explained Bill Edwards, MS, BS, RN, vice president and chief clinical officer for Housecall Medical Resources, which offers home healthcare in several states, including Florida and Virginia.
"Where it begins to impact the rehabilitation or the recovery of the client, then we need to intervene," Edwards said. He suggested the nurse discuss the problem with a manager so that social services or other resources can help.
Unless an argument could upset the patient's recovery, it is generally best to let it happen and call your nurse manager's attention to it later.
Uncertain Burton: If I notice a health problem in another family member, should I bring that up with them or care for them in any way?
"We look at the entire nucleus of the family. If there are other individuals in the home who appear to be in need of some type of intervention, that's reported to the supervisor or case manager," said Edwards, who was careful to add that a nurse should not actually give care without physician's orders.
Davidson said her nurses are encouraged to talk to a family member about a sign or symptom they notice.
"Nurses can always say 'I would suggest you call your doctor. It's worth looking into,'" Davidson said. "I would certainly not scare them or give them any information about what it might be or what it might lead to."
Uncertain Burton: Is it OK for me to go to family events like a birthday party off the clock?
"If the nurse feels that it is a situation where she has been working on a case for a while and it's appropriate for her to attend the party, then we don't get involved," Davidson explained.
"If the employee is invited to participate in something, what we would encourage is that they discuss that with their supervisor or case manager, particularly if they have concerns that they could be called upon for nursing activity," Edwards suggested.
Boroughs gave an example of a reason attending a birthday party can be positive.
"When our son came home from the hospital where he had lived for 4 years, the nurses were very attached to him. A lot of the nurses at the hospital came to work a shift or two per week. That was an important part of the transition for him," said Boroughs, adding that she invited those nurses her son connected with to his birthday parties.
"For the child, that's a little reunion of everybody who cared for him, and that's important in that child's life," she said.
Uncertain Burton: Can I accept a gift from my client or bring a gift for my patient?
All our home health experts agreed that small gifts were appropriate to both give and receive. But Boroughs recalled the time a nurse in her home kept bringing gifts for her child.
"We had a nurse where every time she came, she brought something and not just for our ventilator-dependent child but for our other children," she said. "This was just a cover-up. She was just so inept. Supposedly she had a master's degree in nursing. Turns out she stole someone's license and put her name on it."
Whether your skills are poor or not, a family may perceive frequent gifts as a way to butter them up because the care is not good, Boroughs explained. The experts agreed the best idea is to limit gift-giving to birthdays and winter holidays. All gifts should never cost much and should always be appropriate.
Other pieces of advice?
Boroughs and Smeekens shared a few other tips for nurses to keep in mind:
• If you're caring for a child, don't enter the parents' bedroom unless that's where the patient is.
• Bring your own food and drink, even if the family encourages you to eat food in the house.
• If you don't know how to do something, get the training. There's nothing worse for a family than not being sure if the nurse knows what she's doing.
• Never sleep on the job or make long-distance phone calls.
• Communicate with the family what is working and not working. Doing so will make things easier for everyone.
• Remember, your role is to educate the patient and family on treatment options, but it's their decision which one to choose.
• Always ask yourself if you'd do something if your manager were watching. Would you show up late for your appointments? Not observe universal precautions? Dress poorly?
Emily Wengert is assistant editor at ADVANCE.