How many hours is too many

caliotter3 · Mar 19, 2015

For pete's sake, update that field chart at once. Get the latest 485 and copies of any signed orders since the 485 was last signed. What in the world is the clinical supervisor looking at when she does her visits? You need to discuss this entire situation with her as well as the condition of the field chart. You can update the field chart yourself simply by going to the office and getting the required paperwork, but you should bring this to the supervisor's attention.

There is nothing wrong with the patient being alone with the nurses (if not prohibited by the 485) while the family goes away as long as all are informed and a definite plan is in place for emergencies.

meanmaryjean, DNP, RN · Mar 19, 2015

I've had clients whose parents have gone out of town and nursing stayed 24/7. No biggie as long as the POC is updated. Surely to goodness these people have respite hours, right?

mb1949 · Mar 20, 2015

Thanks for your input. I will stop by agency office tomorrow and get copy of 485 andBoth pare

caliotter3 · Mar 20, 2015

Since the other nurses on the case have been neglecting the upkeep of the field chart, you should take the initiative to take care of this task yourself. The nursing supervisor may appoint you as the primary nurse for stepping up. Somebody should be keeping on top of this, it looks like you are the one that is willing to take the responsibility.

smartnurse1982 · Mar 22, 2015

I do not understand the OP and the question.

How was the OP doing overnights with the pt without the 485 in the first place?

The 485 contains the meds that are used(along with the MAR)

caliotter3 · Mar 22, 2015

On occasion you will find a case where the field chart is not around or is in disarray or the 485 is not up to date. My most recent agency did not bother with a MAR, much less an up to date 485. When I asked about it on my first case, I was told that the nurses just gave the meds as instructed by the parents. Good agencies will mail up to date 485s, as well as copies of signed orders, and blank forms, on a regular basis to the client's home. The nurse on duty places these items in the book or where the forms are kept.

SDALPN · Mar 27, 2015

Sometimes families get hours authorized for emergencies or whatever and can get 24 hours if coverage while they are out if town. The main concern is that you should ALWAYS have a 485. Not all orders or instructions are on the MAR.

brillohead, ADN, RN · Mar 28, 2015

For my cases, the hours are "per week" and the parents can decide when/how to use those hours.

Most of my cases have 12 hours / 7 days a week for a total of 84 hours a week. The parents could use all 84 hours in a row if they were going to be out of town, or they could get 16 hours some days and just 8 hours other days, however worked best for their schedules and/or nursing availability.

But there is no way in heck I would work in ANY situation without a careplan in place. I've seen some really disorganized field charts (and I'm the one who always ends up taking EVERYthing out and putting it back together again and notifying the office of what is missing), but never one without any type of careplan / physician orders.

mb1949 · Mar 29, 2015

The patient has no meds. Just vent dependent and g tube

PerfectlyPlump, ADN, RN · Mar 30, 2015

It surprises me that your agency is so loose about all this. As a licensed nurse, you need orders just to be in the home, according to my understanding! This is what protects the public and the nurses. Call it Plan of Care, or 485. You surely need MD orders for all the vent settings, to give tube feedings, when to report vitals out-of-range, etc.

And BTW, you can't take orders from the parents. I am so glad my agency stresses this fundamental.

caliotter3 · Mar 30, 2015

Some agencies allow a nurse to transcribe an order taken from a parent onto an MD order form to be sent forward to the MD for signature, provided the nurse is comfortable with the information provided. The endorsement line states that the parent received the order from the MD and is transmitting the order to the nurse. Other agencies do not allow this at all and require the usual chain of information when the nurse does not accompany the patient on an appointment to the MD, or is not in the home to take a phone order from the MD. At any rate, a copy of the signed order is required to be in the home along with the current 485, except for that one agency I worked for that did not care if their nurses knew what was on the Plan of Care. Just asking for trouble.