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.