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Living with Autism


March 7, 2012

Warning Signs of bad caregiver or nurse

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                          8 Signs of a BAD Caregiver or Nurse:

  1. Can’t get off phone or computer. This type of caregiver/nurse is always on the cell phone. Constantly speaking or texting on phone while getting PAID to care for vulnerable patients. A few months ago, in a hospital, I saw an RN sitting down at what appeared to be her charting computer, actually ordering stuff off Amazon while a patient was screaming for help. This behavior is disrespectful and unprofessional. There are exceptions.  For instance,  say you work home health. It's a night shift. Patient is sleeping. However, since each patient needs to be monitored even when they are asleep, if the nurse is on a phone or computer, it should be while facing the sleeping patient. Not with backed turned, oblivious to respiratory status, voiding or seizure activity. Use common sense! Another exception could be during a day shift with an autistic patient, like my son, who walks up to 5 to 13 plus miles a day.  During the marathon walking, some nurses play music on their cell phone for my son...awesome! Nothing wrong with that, but again, don't be texting your buddies or checking the news when you need to be mindful of your patient! If a nurse is out in community, chat on a hands free cell phone.  Your hands need to be FREE to keep your autistic patient safe. Or, again, if it's night shift and your patient is sleeping, fine, text away, so long as you are keeping your EYES and EARS on the patient, to monitor him for seizure or SIB activity, which can happen while he's ASLEEP. (A few years ago, on a day shift, I once witnessed my son pick up leaves off ground and stuff them in his mouth, and the nurse didn’t even notice, since her eyes were glued to texting!)

2. The Lazy Caregiver/Nurse: You all know this type. This one comes in as they just fell outta bed. They've got 6 books they're gonna read on shift, cup of coffee in each hand, 12 donuts in their bag. And as soon as their behind hits the chair, the eye lids start closing, as if their on vacation, not on a job. Need I say more? 

3.    Can’t shut-up caregiver. We've only had ONE LVN like this and he was totally NUTS and is the son of the eye gouging RN caught on tape. This won't shut the F up caregiver shows up to work and the first thing isn’t to ask how the patient is doing, but to launch into a rapid flow of chit-chat about a variety of irrelevant subjects other than patient status, needs and care. This particular mental case, (whose father was later caught on camera abusing Jamey), would plop down and begin talking about personal problems. Mainly about his wife. And their sexual problems. It's terribly confusing for a parent to be in the presence of a home health nurse like this when you are exhausted and desperate for help in a system that leaves you with little choices and support. This same nurse, which I tell you about so you can compare if you have a similar nut job in your midst, would then waste 25 minutes going on about what happened in his life. The more his mouth moved the more I felt orthostatic hypotension. This nut ball used to tell me how he wished his wife would do more kinky things...yeah, I know, disgusting, as if this is what you fight for home health respite care for. FML. So beware of the can't STFU home health nurse. To them, working home health is as if they’ve just arrived to a mental health meeting. And you, the parent, are their therapist. 

To them, they are not on a job that they're being PAID to do. It’s unknown what the etiology of the can't STFU nurse is. It could be Bi-Polar or ADHD. Or just bat shit crazy. The bottom line is: A GOOD caregiver comes to work and asks how patient is doing, what meds were given, what patient health and behavioral status is. There is always time for a little get to know you talk or ice-breaking comedy after a week of hell, which is fine, and nice, so long as it isn’t burdening family members or delaying other nurses coming off shift. A GOOD caregiver or nurse is focused on patient care. Not burdening the family with their personal problems. 
Of course there are exceptions, for instance if a nurse has worked with you for several years and you become like family and the nurse is generally mentally stable and kind and is a great nurse....then, well, okay, then it's okay to sometimes listen to their problems out of respect and kindness for all the hard work they've put into helping your loved one. 

4.    Always late. This nurse always has an excuse. Either it's the weather, the traffic, the alarm clock didn't go off, they were up late at a special party for a special occasion, the line at McDonald's was too long, whatever. 
 I'm NOT talking about occasional lateness, which happens to the best of us. I'm talking about the type of nurse who is ALWAYS late. I’m talking 15-30 minutes late. You know the type. NO shame. And there is always a ridiculous, dramatic excuse, as if they’ve got an excuse list they play off until it's so worn down they have to create a new portfolio. A GOOD caregiver or nurse is nearly always on time. Ironically, the same nurse that will ALWAYS be late for their job, will always be ON TIME to send in their work hours or ask for more shifts. Oh yeah, you know the type. 

5.     Always asking for something or snooping around your house.   Can I borrow this or that from your house? Hey that's a nice tool, that's a nice pie dish, that's a nice CD, hey I like that movie and oh, what are you cooking for dinner????...These are usually nurses you will find working for a NURSING AGENCY because the agencies don't pay crap and attract the bottom of the barrel nurses.  You need to remind this type of nurse that this isn't a hospital or skilled nursing facility.  This is your PRIVATE home. They need to respect it. At some point you may catch them sitting on your couch, reading your husband's firefighter magazine, while your autistic child is sitting in a chair across the damn room. And yes, this actually happened. It was the same nurse who was always late. No longer here thank God. 
Then there's the nurse who asks can I get off early? Can I come in later? Can I pick up another shift, and well, yeah I know I'm always late and claim extra hours but I need the money and I know if you complain then the state will think there's something wrong with the parent instead of me... oh, and BTW, I forgot my lunch, do you mind if I eat some of your food? I noticed you made a pie and I already took a bite...and 

I'm going on a date after I get off, can I take a shower here? Do you mind if I bring along my friend next shift? My wife? My kids? Can I bring my Christmas presents to wrap? Can I use your air compressor, I have a flat tire? Can you drive to the nearest hardware store and pick me up some jumper cables, my battery is dead. Hey, I like that juice you bough can you pick me up some next time you go to Trader Joes? Gosh, I wish I had a home like this, you’re so lucky, wow, nice pool, wish I could go swimming.  

YES: These are actually things some past caregivers and nurses have said and done in the past. So weird. And drives you nuts. Thank God for the good caregivers/nurses. They are such a blessing. 

  1. Got no skills nurse. This caregiver or nurse is a puzzling presentation. The caregiver may have 13 years experience and a degree from a nursing school, but they don’t know how to give oxygen, don’t understand what a seizure is, can't brush hair, don't know how to properly brush a patient's teeth, don’t understand how to give medications (i.e.. they plop whole pills onto a spoon of peanut butter and stuff in patient’s mouth, with the peanut butter stuck on palate, patient gagging, and they keep stuffing more peanut butter in—just clueless). Don’t bathe or clean patient properly. Leave poop hanging off the buttocks. Then wipe it with the clean towel you just hung on the rack two hours ago. This caregiver is also the type that thinks a proper bath is a 5-minute shower where water falls off the body in the absence of soap, leaves the patient dripping wet and then sprinkles the body with powder. This type seldom knows how to change a diaper. Diaper is always half on, too loose or too tight. Or backwards. They also can’t write proper nursing notes. Don’t understand ambulation therapy (walking) with a patient. Don’t know how to assist a patient in and out bed, bath or cars. Don’t understand how to monitor side effects of medications. A GOOD caregiver or nurse has got GOOD skills. 

  1. Bad Attitude. Easily offended. Constantly depressed. Constantly complains. No sense of humor. Negative. Families who fight for in home nursing respite care are living with a disabled or elderly relative who requires constant care. We are often tired, cynical and depressed enough. We don’t need someone paid to help, entering the home and tripling the stress. Any caregiver or nurse that views the patient in a negative light or says negative things about the patient’s health status--should be terminated. Also, nurses who judge or gossip about patient or family are bad people to have around.  A nurse should be loyal to the family, especially the patient. Nurses and caregivers are expected to protect the privacy of both patient and family.  Recall HIPPA. A GOOD caregiver or nurse is positive and displays a helpful, supportive personality. Above all, a good caregiver/nurse is always the patient’s cheerleader. Cheering for hope, healing, comfort and happiness.
  2. Resents correction. Can't take the slightest criticism, even when caught doing goofy things. Looks away from you while you're confronting their goofy behavior. Twists things around. Look for this too: I caught a nurse once calling my autistic son "a bad boy." I immediately confronted him. As I tell him that his words weren't professional, he looks at me and says in  SING SONG VOICE, "Are you feeling OK today, Kim? You don't look well." It doesn't take a psychologist to see this kind of manipulative freak. He tried to flip the script, so that I would be so offended or shocked that we would no longer discuss his inappropriate words to my son. He's long gone, no worries. 

Finally, remember if you are getting nurses from a home health agency there is supposed to be a Director of Nursing (DON) who is in charge of these nurses who come to your home. Make sure you get her or his contact number in case you have any concerns. If you live in California, and get independent nurse contractors from the San Diego Regional Center, the Regional Center doesn't provide RN supervision over these LVNs, nor is their a nursing care plan in place. For some reason the San Diego Regional Center has flown under the radar with this for many years, which is interesting, because if a nurse agency sent LVNs they must have an RN supervising them and have a plan of care in place for the LVNs to follow. And if you placed your loved one in a skilled nursing facility or other residential placements, there is oversight of nurses. Not so with the California Regional Centers. They don't provide an RN to supervise their independently vendored LVNs or write a nursing plan of care. Funny how that works. 

All in all, let's remember there are more GOOD caregivers and nurses than BAD ones. It’s equally important to remember BAD ones can seriously harm or neglect your loved one when they feel they don't have to answer to a registered nurse. That's why it's important to have a Registered Nurse as a supervisor and point of contact for Licensed Vocational Nurses when they are in your home. 

On that note: A GOOD caregiver or nurse is a blessing. Treat them well. Hopefully, this list will provide insight into identifying GOOD caregivers for your precious loved one.
Kim Oakley


Laura B said...

I am autistic. I have had past caregivers that fit these descriptions. My current caregivers are the best ones I have ever had and they fit these descriptions as well. I am going to print this out and highlight which ones fit each of them. I have thought something is not right with them but I couldn't figure out what it was.

Overmyhead said...

You are an angel. I've been struggling alone trying to find good caregivers and I have been plagued by thinking maybe I was too picky - WELL, NOT. You pegged many of the types I have had. Add to the list: caregivers that do not have valid driver licenses, caregivers who are always on their laptop and - surprise - are working a second job on-line! Caregivers who always know what you are going to tell them before you tell them - and then do the job their own way - their own lazy way. How to warn other not to hire the ones I had to fire?

Overmyhead said...

You are an angel. I've been struggling alone trying to find good caregivers and I have been plagued by thinking maybe I was too picky - WELL, NOT. You pegged many of the types I have had. Add to the list: caregivers that do not have valid driver licenses, caregivers who are always on their laptop and - surprise - are working a second job on-line! Caregivers who always know what you are going to tell them before you tell them - and then do the job their own way - their own lazy way. How to warn other not to hire the ones I had to fire?

13mithious said...

Thank you so much for this list. I have moved to a new state and have had5 caregivers. I have a spinal cord injury and other major health issues. You nailed it on that list. The current care giver I have fits two of the lists descriptions. She is a really good worker, but can't take correction at all. Does things her way, even though she has been told that there is always a reason she is being asked to do things a certain way. This is a wheelchair friendly house, but she always seems to have stuff all over the floor, right in the way of the bathroom and sink even though she has been asked to not do that kind of things until later in the day so that morning routine is not blocked to wheelchair. I also suspect she is passive aggressive. She also talks about me to other people regardless of being told privacy is a huge issue and she is to talk with no one about me. There is more, but that gives an idea anyway. Thank you again. I had thought about dismissing her, but since it's so hard to find help in our rural area, I had hesitated but am finding it is affecting me health and even my own outlook on life, which used to be very good, even under the circumstances. Again, thank you for validating, and putting into words what I couldn't.

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