On Wednesday afternoon I received a voicemail from the nursing agency. I braced myself for the possibility that the nurse had to call out that night. The message, from the Director herself, was vague only saying she needed to speak with me. A message like that is never good. My mind immediately went to an issue with insurance coverage.
So I called back (and actually had our insurance information up on my computer). Turns out, I was way off topic. The concern was one of our regular nurses asked for removal from Ryan’s case. The reason? She felt uncomfortable; stemming from the absence of nursing coverage on Easter Sunday. She felt she was being “penalized” for not being here. More on that statement later.
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Before I get into this I need to make two things clear: 1) someone should feel uncomfortable about leaving us hanging on Easter, and 2) it’s not my fault. I am not the bad guy here. Let me explain.
The nurse who has the regular Sunday through Tuesday shift didn’t want to work Easter Sunday (or any other holiday ever, for that matter). The nursing agency granted her request, but did so without assuring it was back-filled. The result… we had no nurse. This is why I say I’m not the bad guy here. In every respect, we’re the only party that lost out. The nurse had the day off. The agency didn’t have to cover (holiday pay?). We suffered. Tell me how I am to blame?
Let me share how I would have handled this if I were the agency scheduler. It would actually be company policy… you know, I now remember reading in the agency newsletter that it is a policy. I would have told the nurse that she is expected to work her shift, but will do what can be done to give her the day off. The determining factor being able to back-fill the shift. If no one else picks it up then the regular nurse must report. Problem solved. Better yet, it’s solved internally and has no client impact.
[Fast forward to last Monday]You might recall from my Tuesday post, Sleep! Who Needs it?, that I was exhausted. So exhausted that I crashed on the couch the instant Sue came home from work. I really didn’t spend time with the nurse that night (because I was gone to the world). Tuesday night was roughly the same. The difference being I was able to help Sue and the nurse with Ryan’s shower and get him settled into bed. Once this was done I immediately plopped down on the couch in the adjoining room. Except for a brief, thirty second discussion about some expired medicine, I didn’t interact with the nurse.
So, imagine my surprise when the agency tells me the nurse is “uncomfortable” with me and felt like I was “penalizing” her for not working her shift. My opinion? She felt guilty and mistakenly took my exhaustion as frustration toward her. I heard she read my post from the night before (and it was confirmed by a disjointed comment left by her family under the alias “Larry”), It’s Just too Much… Too Often and probably saw the truth in it. Granted, I was not my usual hilarious self when she did return to work. In my defense, sleep deprivation tends to make me a bit less jovial. You know, like everyone else in the world.
I suppose — and I’m reaching here — one could argue that I penalized her by being less entertaining. Hey, it wasn’t like I replaced the comfy sofa we provide for her with a bed of nails. I didn’t even deny her internet access through our wireless network (which really would have messed up her smartphone compulsion). The ONLY thing that changed was my level of exhaustion. I actually have video surveillance of me just lying around (and her on her smartphone both nights), if the agency needs any proof I wasn’t acting like I was the law. Hey, it’s not my place to impose punishment for job performance since she doesn’t technically work for me. Besides, everyone who reads this blogs knows I handle issues directly and quickly (“plow through them”), trying to be non-confrontational when possible. I don’t play around when it comes to my children. If I were going to dole out discipline, she’d know it. I’d leave no doubt (and would flat-out tell her she is in trouble with me). Real and raw, baby!
As a side note, I asked my harshest critic (Sue) if I seemed pissy. She’s always quick (and oddly, happy) to point out my shortcomings. She said, “No. You were exhausted. I don’t understand it”.
So, where do we go from here? I would expect the nursing agency finds an immediate replacement without any lapse in coverage. If they can not, then they should make this nurse complete her assigned shifts with Ryan for the month (it is their policy, after all). If this doesn’t happen then I would probably need to create some awareness at the firm’s national office. I really don’t want (or expect) this to happen, but I’m preparing myself just the same. I would likely suggest they be brought up to speed by reviewing this blog and speaking with the Regional Director before we actually chat.
By the way, it’s my opinion that it’s quite unprofessional to leave without adequate notice… typically two weeks. I would hope the agency is even more upset since they are really the ones scrambling here (so far it’s had no impact on us). It’s not like she was in a dangerous environment or being harassed. If you break it down, her claim is I was unpleasant. She contends that my lack of interaction was penalizing her. Hardly a reason to screw both the client and employer, yes? I just wish she would have asked my if I were angry. I would have answered her honestly that I’m not angry, just exhausted.
Let me just make one thing clear. I love the nursing agency we use, particularly the Regional Director. They have been nothing but great to us. Even when they make a mistake they own up to it and try to make it right. It’s a tough industry to find an adequate supply of nurses, let alone top-notch ones. The nurse that is leaving us, although average in nursing skills, was very nice to us. Our only reservation was she never took a deep interest in Ryan (he was a job to her), but this is not a job requirement and I had no grounds to complain (or penalize, as it were). There are no hard feelings toward her on our part. Especially since I knew she was prone to poor judgement from her sharing life stories. This rash decision merely confirms it.
She really did have a nice set-up here. I doubt she’ll find another case where the parents are this involved, have burgers grilled or take-out for her, allow her to arrive late every night and leave early when needed, watch the television shows she likes, calm her fears (she’s afraid of the dark… and everything else), and laugh this much. But, with her just able to walk away from Ryan like that we would never entertain the idea of bringing her back. Good riddance, I say! We do these favors for the other regular nurse too. She is, in every respect, the best! If she left then we really would have a problem. Last night I asked her to do two things: 1) Please let me know if I appear angry at her, and 2) Please don’t just quit on us without discussion. Her answer? “Of course”, she said, “that’s only fair”. You see, this is how responsible people handle things is the adult world.
Anyhow, This nurse that left has single-handedly caused me to review how I want to manage coverage going forward. I feel like I need to bring it more under my control. As a replacement is being sought out by the agency I will begin seeking a more permanent resolution. I’ll see if Sue will check with our insurance to see how much we can pay out if we hire privately. I’m also curious if they need to be nurses or can we hire and train a caregivers?
If we can hire and train ourselves then I know there is a community out there that is more than willing to help.
I really got a lesson on how this all works, and you described it exactly. In practice, nursing agencies are much like Temp Agencies. They contract nurses on a per diem basis. They have, essentially, no authority and exist to broker the wants of the nurse with the needs of the client. It’s a tough situation that is made tougher when agencies tolerate poor performance/decisions for the sake of retaining personnel. It’s easy to see how this might lead to mediocracy.
Dear Ken,
I am a living example of being cranky when exhausted, you had every right to be. I am not sure if you are aware that almost all of these nurses do not specifically work for these agencies, but are sub contracters. They may work for several agencies as well as work at the hospital. The available nurses to hire is often limited, so they sometimes are tenuous about coming down on a specific nurse. I have had some amazing home health care nurses, and some that I would not hire to work at McDonalds. (No offense to people that work there).
Please let me know how I can help. We are moving this week, but only a few miles away. Can I make phone calls, or write letters on your behalf? I am here to help you in anyway.
Hi Ken,
I don’t go through an agency. I use to but had too many problems. Medicaid pays for caregivers that I choose to hire. I try to always hire nursing students. I train them. I don’t know if Ryan has Medicaid, but he should be eligible. I have hours through the county and the state. I use to have up to 22 hours a day coverage, but they recently cut back. California is going bankrupt! Ask your Social Worker about IHSS(In Home Support Services) and IHO (In Home Operations). This is what is called in California, it may go by another name in your state.
Hoping the replacement nurse is an upgrade from what you had….and also hoping he/she is more reliable too. Good luck and keep us posted. God Bless you.
you are right. My daughter had a nursing shift, and if Sunday was their day, holiday or not, they worked. OMG……some people have guts.
Ken, As a nurse since 1976′ I can tell you that “nursing” is not what it used to be. Even in the job I am in now, it seems like management wants quantity over quality and I was not trained that way nor do I think that way when I am dealing with someone and their health. My new boss is always telling me that I am taking to much time double checking the machines when I put patients on. She says to just get them on and move on to the next. Nursing is not what it was, and when you do get a good nurse bad nurses are in management. Good luck finding a good caring nurse for Ryan, I am praying for you to be successful.
Ken Diviney, you are a beautiful human! Fair, rational and to the point (with that patented dry humor). That’s what I love about you!
I am so sorry to hear this. Life would be so much less complicated if people would just make the effort to communicate their concerns instead of making assumptions about others. Ryan deserves nothing but the best caregivers and we’re praying that you and Sue will soon have someone reliable who is willing to work alongside you for those night shifts.
Ken ,Hoping this situation can be solved simply and you don’t have all this aggravation again. Wish you could train caregivers ,you would have many,many,many on call any day or night.And if I were closer ,you can bet I’d be one of them!!! Ryan has gotten into all our hearts and we care so much for him and want only the best (which he gets from you and Sue) Hang in Ken and praying problem is solved real soon. Give Ryan my love and a big hug Gail
You are welcome to share anything and all with us, Ken. We are here you, Hon! Believe it! Sending Paula her cap and pin — today!
You are welcome to share anything and all with us, Ken. We are here you, Hon! Believe it! Sending Paula her cap and pin — today!
You are welcome to share anything and all with us, Ken. We are here you, Hon! Believe it! Sending Paula her cap and pin — today!
Seems she was too immature anyway. Hence the reason she quit. Ryan couldn’t be in better hands.
As he is with you. I admire your determination in every aspect of Ryan
You are his guardian Angel. With an iron fist. DON’T STOP
Hello Ken,
I’m really sorry you and Sue have to go through this. How anyone can miss the suffering you both go through on a regular basis, between lack of sleep, loss of freedom, financial hardship, emotional and physical distress — it’s just beyond me that anyone could miss this. You don’t even have to be a compassionate or empathetic person to get it — you just have to have eyes, ears and a heart.
I have to say, it would hurt me terribly to see a caregiver treat a child as just a job, with no real emotional investment or genuine concern. Ryan is a wonderful human being who has endured an inordinate amount of suffering. He has also demonstrated extraordinary strength and determination to get better. And he is making progress! He deserves the very best we have to give him, including our respect, caring, understanding and most of all, love.
It puzzles me that a professional caregiver, especially a nurse, cannot recognize and understand how to deal with a sleep deprived person — especially one who is covering the night shift!! He/she must understand that you have been providing care all day, every day, and require sleep in order to function. Professionals who work with heavily burdened clients are usually trained and equipped to handle this. A family member who is the primary caregiver for a loved one sacrifices so much — they deserve to be treated with care and respect too.
You’re a wonderful Dad, Ken, and your only aim is to protect and take care of your family. Clearly you need to be as healthy as you can to do this, and like all us humans, you need an adequate amount of sleep to do what needs to be done. I am praying the agency you’ve been working with is able to find a professional who understands these things.
Meanwhile — I’m thankful for the other nurse who helps Ryan. She sounds like a rare treasure. God bless her for all that she does. I believe Ryan must sense her genuine caring for him and is grateful for it. I know you and Sue are, too.
Sending you hugs, love, prayers for a peace filled day
Paula
Home nursing is not what people think it is, there is lots of room for improvement. We too are learning more than we ever wanted to know.
I know there is a way to take over the hiring yourself. I have a friend that does it that way, and she uses an aide, not an LPN which is what most of the home nurses are. She could not be happier, and her aide does care about the patient. It is more than a job for her. I am hoping to do that as well.
Yes I was completely surprised at how these agencies deal with their nurses. We too have had several that just left, no 2 week notice happening here!
🙁
Jo, I mostly only share the outrageous ones.
Shock! Plain and simple! Can’t believe the s#@t you have to deal with! Good grief!!
I need to get a friggin nursing degree.
I am right there with you. In the early years with Thomas we looked into opening our own nursing company to avoid such issues and to “do it right”. You could do this (in your spare time) haha! If you look into the exact dollar amount that the insurance is paying the agency per hour for the nurse and what they in turn pay the nurse…..you could actually make tons of money along the way.
The nursing company that we have used for 15 years was started this way…by a family for their son……they grew and somewhere lost track of why they started it and only see the $$$$$ now……but their intentions in the beginning were good.
I feel that if the scheduler was a parent who has lived this situation, that she would find a nurse for every family every time…..or at least try EVERY possible scenario. I have each nurse programmed into my phone (against co. Policy) and I text/call each possible nurse to verify that they were contacted. I, me, I can usually fill the shift about 90 percent of the time. The squeaky wheel gets the grease here!
Wow, Ken. Just wow. I will pray that you guys can do the hiring and training yourselves. I’m sorry you’re left in the lurch like this. I sus pect that this will ultimately turn out for the better both for you guys and for the nurse who wasn’t really the best fit.
Wow Thanks for such a thorough update! You amaze me every time I read your updates. That nurses loss. I hope your ins says go for it and you are able to move forward with something more permanent! Hope your day goes smoothly!
Sounds like you have thought things through pretty well, as usual. I hope you can find a solution. I know in my job if I can’t find someone to cover for me, I have to go in. Seems like someone in the nursing profession should be required to do the same for goodness sake….You are NOT the bad guy. You are the heart-broken, exhausted, loving father. Keep us posted.