[nikkitd]

I am a self employed private duty RN and work 12 hour (7a-7p) shifts with a C1 quad who is vent. dependent requiring 24 hour RN care. Recently the night nurse did not show up for her shift. I tried contacting the other nurses on the case for relief to no avail (there are only 6 total as per the patient, she does not want an agency involved) and had to work the entire 24 hours which was virtually impossible for me as I desperately need my sleep but obviously could not leave the pt unattended. I am upset that I was put in this situation and feel the conditions were dangerous to both the patient and myself as making a stupid mistake due to exhaustion could have put my license on the line. What would you have done? What are the legal ramifications?

[Daytonite]

I worked private duty for several years and my mother owned and ran a registry. I am aware that the patient may be alert and making decisions, but they are not getting OOB and able to care for themselves without total assistance, so they are dependent on others for help. That doesn't include abusing the legal obligations of their licensed nurses. Their nurses are in a business agreement with them as well as an agreement for care. I don't think you had much of a choice legally but to stay with the patient. Who is the person who hires and/or pays you (signs your check)? I would have contacted that person immediately and nicely told them they needed to get a relief nurse there ASAP or you were going to call the patient's doctor (remember the doctor is always the captain of the ship on a case), advise him of the situation and suggest transfer to some sort of nursing facility so the patient could get care and you could go home. I also would have called every relative or friend of that patient and tried to get them to that house and looking for a relief nurse. Everyone close to this patient needed to know and be involved with this problem and not sleeping cozily in their beds at home. Who ever is managing this patient's affairs is not doing a very good job of it (probably trying to save a few dollars) and needs to know this patient was in an unsafe position and it wasn't your fault. I also would have documented everything as specifically as I could and included the names and numbers of people I had called just for my own protection and made a copy for myself.

This is a problem when working for patients who are in their homes. They don't think about and aren't always prepared for emergency situations like this. Can you imagine the fallout if this patient had run up against a crazy nurse who had said, "Too bad, I've got to get home", left her unattended and she ended up tragically dying? Some people don't think that scenarios like that can happen to them. There needs to be someone, a nurse or guardian, that is doing an overall managing of the services being provided for the patient and they need to be available for contact on a 24-hour basis. People don't realize that this is one of the functions and services provided by hospitals and nursing facilities. The public has emergency preparedness laws that protect them in case of emergency situations in public facilities. Nurses working in homes doing private duty don't have that safety net and have to plan for it themselves when they are on a case.

[caliotter3]

This happpens, even when an agency is involved. But you can call the agency and they will have the ball in their court. Normally the patient is left in care of the family as per the contract. I hope you have resolved this with the patient and family. In the future, have this situation addressed in your contract. Daytonite pretty well covered what steps to take when this happens, but you should have these problems addressed in your written contract when you start the case.

[Daytonite]

Well, that's assuming the patient or the person setting up the care even bothered to have anyone sign contracts. Some of these patients are so cheap that they are handling these things themselves trying to pinch pennies and that's when a problem can turn into a real mess. Nurses working private duty without agency backup have to be very savvy so they don't get into a sticky situation that could end up costing them their license.

[caliotter3]

Originally Posted by Daytonite

Well, that's assuming the patient or the person setting up the care even bothered to have anyone sign contracts. Some of these patients are so cheap that they are handling these things themselves trying to pinch pennies and that's when a problem can turn into a real mess. Nurses working private duty without agency backup have to be very savvy so they don't get into a sticky situation that could end up costing them their license.

Agree. When an employer is involved, if anything bad happens, they go after the employer's deep pockets as well as the nurse. When only a nurse is involved, they will go after the nurse, figuring that they can get something, if only revenge. The same person who won't draw up a contract at the outset will be the one yelling the loudest and ready to go to court and complain to the Board when there's a problem.

[DDRN4me]

Have to agree with Daytonite; there needs to be a "go-to" person who can be called in these situations. you put yourself and your pt at risk ; without much choice. Make sure that there is an emergency plan in place so this doesnt happen to you again !!