A Letter to a Home Care Nurse.

Against our better judgement Karin and I agreed to allow a precepting (training) nurse into our home to fulfill her 24 hour(3 x 8 hour days) trach and vent skills training and assessment with the agency preceptor who happens to be Liam’s daytime nurse. (4 days a week, 6 hours a day). We have had precepting nurses here before but it has never been a pleasant experience so we made this a no teaching household for about a year. The agency recently played the “but we have a family who needs their nursing hours waiting on this nurse” card which in light of past practice of their handling of MY OWN FAMILY’S nursing needs, is both manipulative and insulting. But at least we have SOME nursing, and if it’s true then we don’t want to be the only reason another family and child is going without the help it needs. Plus it also gives Liam’s nurse a nice little bump in pay for those hours and while that is hardly my concern or priority, he has been with us for almost 2 years so it’s nice to help him sometimes too. More importantly though, there is always the possibility that the new nurse in question could be capable and confident and we might find ourselves a quick fill-in nurse who would then have knowledge of Liam’s case and needs. We wouldn’t be allowing it if it didn’t benefit Liam in some way. He’s a little boy not a training tool.

So we gave in. The Liam Olson School of Nursing opened it’s doors for one more student.

She will be its last.

Here then is an open letter to our most recent attendee (I won’t exactly call her a graduate). I post this here not only in the hopes that any future home-care nurses out there may stumble across this and learn from her example, but mostly because it’s a more interesting way to tell this story than a straight chronological narrative.

**************

Dear new nurse,

I hope that you are able to give whatever family gets stuck with you the help that they need. I will not be allowing you to ever work in my home with my son ever again. You may have been able to show that you can perform the tasks involved to care for a child with a trach and vent (Once. With an experienced trainer standing behind you. Good for you.) but you’ve got a long way to go before you’ll instill confidence in any parent longing for the ability to not worry about their young child for enough time to take a shower or a nap, or a quick trip out to the store. If they need to assist you with the little things then you aren’t helping at all and isn’t that what you are there to do?

Anyway, this isn’t about your clinical performance since I’m sure that will be well covered by the report your preceptor will give to the agency. This is about the rest of your job.  Let’s call it your inter-personal skills assessment. I can only asses you on behavior that I have seen so this will be specific to my house. While I can’t speak for anyone else, based on my friendships and interactions with other families that have home nursing, I think that our approach is fairly normal and probably more easy-going than most so you can probably take much of what I write to any other case. (besides this is all just me trying to be too clever turning what happened with us into a blog post.  You’ll never even read this.)

Understand that when you work in this house caring for my wonderful son you are still a guest in my home. Karin and I are more than capable of taking care of Liam which makes you expendable. I refuse to be made uncomfortable by near strangers in my own home so please act in a manner that makes everyone in this working relationship comfortable, most of all Liam. We, for our part, will extend to you the same courtesy. I am not saying that we need to be best friends. I’m not saying we need to be friends at all, as long as Liam is being well cared for. If you are a quiet and private person — that’s fine. Loud and talkative? Heck, so am I. No one is asking you to change who you are, we just ask that you are courteous and respectful of the fact that while it may be your workplace, this is Liam’s home.

When you say that you are coming to work please do so. Calling in sick for the first TWO shifts (a week apart) that you were scheduled to be here for was not a helpful start. We do not feel comfortable enough bringing strangers along to appointments so we planned and adjusted our’s and Liam’s schedule around the days that you would be here. I know that things happen and if anyone understands missing work because of family emergencies it’s me but it is not the first impression you want to give. I can’t ever ask you to make my family’s needs your priority and I never will, but that start to me as a manager of dozens of employees in my day job is just plain professionalism and responsibility.

When you are given the privilege to work with Liam please show him the respect that he deserves as a person. You were here for three eight-hour shifts and you said more to my cats than you did to my son (not a joke). My adorable son, who you were supposed to be here to care for, training shift or not. He may not respond all the time. Hell, since you are a stranger he probably wasn’t ever going to respond to you in all three days but you didn’t exactly give him much to go on now did you? If you were working with a three-year old without developmental delays you would probably talk to them and let them know you were about to suction them or lift them right? Show Liam the same. He deserves it.

The unfortunate and unfair part of all this is that you never had a chance with me. I knew before you and I even met that if you were to make it through the three-day training with Liam’s daytime nurse that you would never be working here again. Kids like Liam and any other trach and vent kid you may get assigned to, they head in and out of the hospital all the time. During those times you may need another case you can fill in for here and there to keep your paycheck rolling in or maybe even make a little extra cash if another family needs some nursing hours. You lost the option to do that here with this amazing little boy within the first three minutes of meeting my wife.

Is that really fair? I’d say so…

You are lucky actually, that it was Karin’s morning to make the coffee since she was the first one downstairs. She is much more patient, and kind than I am, especially within minutes of waking up after only a few hours of sleep. Instead of pleasantries and maybe a minute or two of small talk with her, your boss for this 24 hours of training, you figured that questioning her parenting would make for a better first conversation.

“What time do you put him to bed for him to still be sleeping this late in the morning?” now you see, I’m exceptionally impressed with your ability to question our decisions while also implying that Karin and I are lazy, seeing as how if it’s too late in the morning for a child to be sleeping it’s probably to late in the morning for his parents to be rolling out of bed. I believe many people call that chutzpah. Or balls. Big brass ones.

As I mentioned Karin is a much nicer person than I am. So she explained my unorthodox work schedule and how if he didn’t stay up until eleven I would never even see Liam awake during the week. She didn’t explain about Liam’s med schedule which dictates when he is at his drowsiest. She did not mention that his night nurse schedule of only a few nights a week is jarring enough that trying to start a routine any earlier than eleven is pointless. Or that with his early afternoon school schedule he is more alert and productive at the time we need him to be if he sleeps until about 10am. She didn’t explain these things because she shouldn’t have had to explain herself at all.

“Oh, well I’m pretty sure that’s not very good to keep a kid up that late. I don’t think you should do that.”

That’s what you said to her. Think about that. That’s what you said to a complete stranger while in her home.

In her own home.

Did I mention that you were lucky that Karin came down first and alone? You see had I come down with her and heard that? You would have been told to leave my home immediately. How dare you question the parenting decisions that we make as a family while sitting in my own home. I don’t care if the initials after your name read RN, LPN, MD, PhD, NYPD, or POTUS you do not come into my wife’s home or anywhere else for that matter, and question her parenting decisions and ability as a mother ever. EVER. Not in your first conversation. Not in your 1,000th conversation. In the 2 years that our daytime nurse has worked for us he has never questioned our role as Liam’s parents and you would be better for it if you get that right as soon as possible. Other parents might not be as forgiving and compassionate as my wife is. Like I said. You got lucky.

Instead Karin just left. She came back upstairs and explained to me what happened. Then she told me that since she had already made a commitment to the agency and to your preceptor to allow your precepting here, she asked me to be nice. That’s the type of wonderful person that she is. And so I was.

Is it fair that I wrote you off before ever giving you a chance. Nah, guess what? Life’s not fair. Like I said, working with Liam is a privilege. One that you neither deserved or appreciated. Perhaps there is a family out there that will have a better chemistry and fit for your personality. This one isn’t it.

Home nursing is more than changing trach dressings and administering medicines. It’s about care. Care not only for the medical needs of the patient but to ease the burden on the parents stretched thin by stress and exhaustion. I don’t know about you but I get stressed when I have strangers I don’t like in my home. When you add to a family’s stress you are not helping. If you’re not helping then what are you doing there?  Just collecting a paycheck? Not on Liam’s dime you’re not.

Sincerely

Eric.

10 comments

  1. Ugh. This is a pretty accurate account of why I don’t like having nurses in my home, either (although I don’t breathe with the help of a trach or vent so the technical details are a bit different).

    Please, Eric, send this to the nursing student. They need to be told this stuff. One way or another, someone needs to actually tell them “you know that thing you said to Karin? About Liam’s bedtimes? The first day you met her? Yeah, that was BANG OUT OF ORDER.”

    Hope you guys haven’t been too scarred by the experience. I’m not surprised but I am sorry that it was such a letdown.

    If you find yourselves doing it again (I know – unlikely – but perhaps one day far in the future it’ll somehow feel like a good idea again) then I wonder if asking the nursing college for their standard of conduct would be a good start, and then add your own or borrow someone else’s.

    1. I’m sure that someday we’ll end up allowing it again. When the memory of this feeling of anger and frustration fades a bit.

      As for letting the nurse know my feelings, I’m afraid that I’m just too bitter at this point. We used to call the agency and give all sorts of feedback every time we had a new nurse. We did this even (or especially) when the performance was great! this was not an endless stream of criticism but of honest feedback. I’ve often gotten the impression that I was just wasting people’s time. The agency doesn’t care. As long as they are filling hours and collecting insurance payments they aren’t really concerned about personality conflicts.

      I know it’s not fair of me to make it someone else’s problem to explain it to her but I’ve got enough to worry about than being worried about them any more than I should.

      Thanks for reading and for commenting!

  2. The sad thing is that most Home care sucks. The pay is bad,m and when pay is bad it doesn’t attract quality people. Even ones that buck that generality, like the one we have had for a long time, can turn. Like the one we have had for a long time. She is starting to get to a place where I am thinking ‘Eh, maybe I just don’t need her anymore’, since I end up doing a ton of the stuff she is supposed to be doing.

    That’s a great letter. I don’t agree with the person above though. Sending it is a waste of time. There isn’t anything in that person’s head that you can reach. Why bother?

    1. Yeah, I’m not going to bother. It really was just kind of a way to frame the story. There was a time when I would have but you’re right. Why bother? She’s out of my house and my life and I have enough to worry about without taking on her future as my problem.

      The cool thing is that we are happy with our two regular nurses right now. They both are confident, capable, and fit in with my family and household. Over the course of 2.5 years and a couple dozen nurses we have seen the incompetent, clueless and rude outnumber the opposite which scares me. It’s why we are so picky about who is allowed to come back here.

  3. Eric and Karin I have been a nurse for awhile and did lots of home care. I worked for VNA and was a clinical supervisor at another agency. Rule #1 you are there to help not preach and judge anyone in the home least of all the caregivers who know the drill day to day better than anyone. #2 RESPECT and treat every patient/client as you would wish to be treated in your own home! #3 First rule learned your first day in clinical you talk and explain to every patient what you are doing and why. Even if a patient is comatose you talk, you comfort, you get to know them in what ever means necessary to make that person feel at ease with your presence. #4 Whatever the medical issue or reason you are there as a nurse that is a person in that home and she apparently broke every rule! I’m sooooo mad I could spit, she gives my profession a bad name and she better hope and pray she is never on the receiving end of the poor nursing care she gave both of you and worst of all Liam. So sorry you had such a negative experience. As always in my thoughts and prayers. Lindsey

    1. Thanks Lindsey!

      Don’t worry. We have never let the lazy ones spoil our opinion of nurses as a whole but it is true that she isn’t the first nurse we’ve encountered to behave this way and I’m sure she won’t be the last. It’s ok. It’s why we are so picky about who is allowed to work here and believe me I am very comfortable with calling the agency and giving them fair and honest feedback in a professional and rational way. They know me pretty well over there.

      Thanks for commenting!

  4. I believe that there are still good nurses or home caregivers around like Lindsey. It’s just too bad that you got one of the rotten apple, so to say. i just hope that the next time you do allow a nurse at your home again, that you will be able to get the best one to care for Liam. This is a very enlightening letter that I hope will be read by a lot of home caregivers because there are lessons to be learned in this letter of yours.

    1. Thanks for reading and commenting Cindy!

      I agree that there are some wonderful home care nurses out there as we have been lucky enough to find a few. We have two very good nurses right now. The letter was in response to a nurse who was only training in our home. She wasn’t going to replace any of our existing nurses anyway. While I don’t think we’ll be allowing any more training in our home for a long time, nursing will always be a part of this household and I’m sure we’ll break down and help again someday.

      Thanks again for reading and for seeing some value in the letter.

  5. It’s hard enough being a new grad nurse, especially when nobody will hire you because you don’t have experience. A lot of new grads take whatever they can find. Most of these agencies will hire them promising that they will take the time to orient them and then don’t. Why? Because they don’t care about the nurse or the families they are supposed to be taking care of. They only care about money, and they know new grads will always apply because they can’t find a job anywhere else. Instead, they have another nurse who is working the case “train” them. This would be fine if the nurse had actually been working the case for more than a month and wasn’t also a new grad herself. You are given 2 days of working with this other nurse, and then your left on your own. That really isn’t sufficient time to get used to working with the child and their care or getting to know the family. Without that, you are set up to fail.
    Why am I saying all this? Because I too am a new grad who couldn’t find a job. I found a job after 2 years of searching and it was for a pediatric home care nurse. I had my reservations, but I thought could do it. After all, the company promised to provide extensive training on the job until “you felt comfortable to be on your own”. I told them I had no experience working in pediatrics (I’d been working 2 years doing non medical home care with geriatric clients at my old job) nor did my nursing program have a pediatric clinical rotation, but I was assured it “it didn’t matter”. I was talked into taking on a bunch of cases that I now know no new grad has any business working on. When I asked if I could have more time to learn about a new client I was orienting with (I was given only 2 days for 3 hours each) they told me it wasn’t necessary because I had already gotten 2 days of training with the other nurse- The other nurse who was also a new grad and had only been working there for 3 weeks and had never oriented anyone before!

    I decided to quit after a month because I just didn’t feel like I could safely do my job without anymore training, and I would feel terrible if something happened to the child I was caring for. I don’t even know how I’d live with myself knowing I’d done something to harm a kid. I also felt bad for the way the agency treated the families. They didn’t give a darn who they sent out to someone’s home as long as they had a license and would cover a shift they couldn’t find anyone else for. A family deserves to have a well trained and confident nurse who can give excellent care to their child and be a good match personality wise. I was horrified to read about the things that nurse said to your wife. New or not, you never ever say anything about someone’s parenting skills. The fact that he or she didn’t even greet your son or wife first when arriving is a warning sign. It’s been over 2 years since this blog post and I don’t know if you will read this or not but I hope you were able to work things out. Hopefully you weren’t forced to precept anyone else!

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