WAS new HH RN now not, LONG but please advise

[JentheRN05, RN]

As recently as 1 month ago I got my first HH job, and as recently as last week I lost my case. Stupid reasoning too. I was taking care of a child with a dire diagnosis, who wasn't expected to live 6 more months, yet still attended school. After accepting the position I found out the city it was located in (yes after I was hired) and it turned out to be 1 1/2 hours away. I was to go in twice a day 3 days a week, and once a day the other two (only worked weekdays). Well the going in in the AM for 2 hours before school was just not cost affective and I called my manager (so did the mother of the child) to insist I get someone to cover the AMs so I could work just the afternoons. Supposedly, after both myself and the mother called my boss, she misunderstood what I was saying and hired an LPN to take the entire case, without me even knowing. Then the LPNs CPR was expired so I had to wait for her to get started. But I was told she was going to start the Monday of the next week. The night before my boss called to ask me to continue the case for a few days (in the AM) because the LPN had no valid CPR card. I had in the meantime told my kids I would be home in the mornings and they were excited, and I'm not one to go back on my word. Upset obviously about this I said I'd have to think about it. She called back and offered me mileage both ways! Well of course I waited and talked to my kids, and explained that it should only be a week. So I agreed, got it in writing, started counting up the miles. They made it retroactive to the beginning of the first week. So I added up mileage for only the AMs because that was my understanding of what I was being replaced for.

Well last week I go in in the AM for my last AM shift. I am training the new girl who again is an LPN, (no I don't have a problem with LPN's but I will explain it's significance in a moment) and as I am telling her the in's and out's, the childs quirks and so on, she keeps asking me about the afternoons. I explained to her not too worry too much about that because I would be doing those. She said, "ummmm.... no that's not what I was told, I was promised 30 hours a week, my unemployment is about to run out and I need at least 30 hours a week" I'm looking at her like "WHAT???!!!?" She told me that she was promised 30 hours a week. I in turn called the mom, and asked her if she knew anything about this, she said "WHAT?!?! - NO!!! I specifically told Sandy (my boss) that you were only needing a replacement for the morning. And she said call your boss and find out whats going on! I do NOT want you to leave!" So I did. My boss said, "hmmm....now this is strange because it was my understanding that you quit." Again "WHAT?!?! - I ONLY asked for help with the mornings because it wasn't cost effective to drive 3 hours for 2 hours worth of work!" She said she'd have to think about it and talk to her supervisors and get back to me at noon. So I go home in total shock. I had become very attached to this patient and was just devasted at the possibility of NOT being her nurse anymore and so was her mom! I spent all morning, that I normally would've been sleeping waiting by the phone (would've been sleeping because I got up at 4am everyday because I had to be there at 6:30 am). At 2pm she finally calls. The LPN gets the job! Now mind you this child who looks normal on the outside is slowly dying on the inside. The day before I was let go her mom was given some devastating news about her most recent labs (which were EXTREMELY poor in her particular case) and truly she needs an RN on the case because she really needs DAILY assessments to monitor for any impending signs of shock (yes it's that bad). Not having been in HH before I thought HOW IN THE HECK CAN AN LPN TAKE CARE OF THIS LITTLE GIRL WITHOUT AN RN OVER HER????!!!

Only to find out that the "RN" over the LPN is probably my boss 'Sandy' at the office 2 1/2 hours away who only sees the little girl maybe once a month! HOW IN THE WORLD CAN THIS BE????

Can someone explain this to me? Is this right? I truly don't understand how an RN can be considered on the case when she doesn't see the patient and the LPN can't make accurate assessments (She didn't even know what was wrong with the little girl the day she came in for me to train her!). HELP!!!

[renerian, BSN, RN]

What state are you in and what does nursing law say about LPN evaluations? I have seen this happen alot and have for many years. May I ask what the patient's skilled needs is in terms of tasks? These questions are just a starting point to get more information.

renerian

[JentheRN05, RN]

Indiana requires an RN to oversee and LPN in all care settings. The biggest thing right this minute, is the possibility of seizures and possibility of shock at this point. Needs to be watched carefully for these things and has medication for seizures. This may not seem that bad being a 'possibility' but with her current labs it's almost a certainty and very soon.

[JentheRN05, RN]

bump

[renerian, BSN, RN]

Was does your RN super say?

renerian

[JentheRN05, RN]

Funny thing she says NOTHING. I even WROTE an actual letter, so did the parents. She just avoids talking about it. I'm slowly dealing with it. But it's still irritating