Sleeping Nurse = No Agency?

Specialties Private Duty

Published

We have (my husband and I on separate occasions) caught one of our night nurses sleeping. The first time it happened, DH saw her on the baby monitor (I was already knocked out!) and he didn't say anything. He just got up to the hall bathroom (even though we have the en suite) and made a lot of noise so she would wake up. I guess she got the hint, because the next morning when I relieved her she told me about how she was coming down with something and may not be back that night. Being a PDN myself, I understood and respected where she was coming from, and just told her to call the agency in enough time for them to find a replacement since I had no day nursing that day and would be exhausted. She ended up calling in sick, we got a new nurse and all was well. We never reported it, and asked her back because we assumed it was an isolated incident. We watched her, and the other nurses on the monitor as indicated for the next few days, and had no real concerns. I trust most PDNs are honest and do a good job. I know I've always tried to do a good job and I never want to be one of "those" parents. I try to see it from the nurse's POV.

Weeks later, I woke up with one of my other children and happened to glance into the room and see the nurse sleeping. Not just dozed off (which I admit, I have done in the past- but not on purpose- and never comfortably) but LAID OUT on the floor (off camera) with Gem's Minnie Mouse throw blanket over her! I took care of my other child, put her back to bed, and when I walked past again, the nurse was sitting up in the chair (red eyes, groggy looking, obviously just woke up). I offered her a cup of coffee, and asked if she wanted to sit in the living room with a monitor to have better lighting. She declined, so I kindly reminded her that there is no sleeping and Gem can turn on a dime, so we needed full eyes on at all times. I don't think I was nasty about it, and I told her I wouldn't report her because I understand sometimes it's hard to stay awake.

Third incident, two night ago (3 days later), on my birthday. I came in from my celebration and went straight to bed. I had been the night nurse the night prior and my family had my birthday full from morning to night. I was EXHAUSTED! Because I fell asleep around 9, I was awake again by 2. I got up to get a drink, looked at the monitor, and didn't see the nurse. When I went downstairs, the nurse was on the couch with the other video monitor, lights low, TV off, curled up on the chaise lounge. At this point, I woke her up and sent her home. I did the rest of the shift and called the agency Monday morning. They said they would take care of it, apologized profusely, and arranged to send more nurses out later this week to interview.

Well, yesterday I get a call from them telling me they would no longer be able to staff my case! We are foster parents. These children aren't mine legally, and I HAVE to have nursing coverage 60% of the week as part of my placement contract. I have 6 kids total. They are not going to allow a medically fragile child to stay in a home with limited nursing coverage! When I asked the nursing director for an explanation re: canceling our contract, she simply said because I overreacted with the nurse and it would be difficult to find nurses who are NEVER going to doze off on night shift. I advised her there had been other incidents, and it was NOT dozing off in the traditional sense. It was sleeping. She told me that being a nurse myself, I was already a harder case to staff because nurses don't want to work in homes with other nurses, and this was proof that I heldthe staff to a higher standard than most parents would. Whatever. I moved over to PSA full time, and some of the best nurses I've had are from there. I just wanted two agencies to try to keep my case fully staffed, which didn't work as planned, anyway.

OK, fellow nurses. Please help me improve. Did I overreact?

Specializes in geriatrics, hospice, private duty.

It is hard to staff cases with cameras in general. Pretty sure my current case has a camera and I really don't care. My case is also working for a nurse. Really don't care about that either. I'm a night nurse and I don't sleep on the job. I pace, drink 5 hour energy, do what I have to do to stay awake. Sleeping is unacceptable but I've known a lot of nurses who don't feel like it is (for whatever reason).

I actually LOST a case because I refused to "just go into the back room and sleep"! It hurt my wallet bad, but I sure sleep like a baby (in the daytime, lol).

I've lost several cases because they were dropped d/t being unable to keep them staffed. Seems to be a common thing. It's a shame.

I am trying to go independent because my patient needs more hours and my company will not give her over 30 hours nad she needs more care but I can't seem to find any information on it...

Just a few of quick thoughts on this:

1. Usually companies give nursing hours based on what insurance approves. If you did take on hours above that, the family would have to pay you privately and that could get complicated/messy.

2. Most companies have strict policies against working for patients that you work(ed) for while on their staff. Even if you were to go independent, you most likely couldn't take that case (usually for a set amount of time AFTER leaving your company).

3. I worked as an independent contractor and it was terrible. Taxes were a headache so I took it to H&R block and they screwed them up. I ended up owing the IRS thousands from my year as an independent contractor. I wouldn't recommend it and certainly would never do it again.

Specializes in Pediatrics.

Thank you for your reply! (Everyone else too!) We don't have the camera for the nurses, we have the video baby monitors because all of the foster children placed with us are MWO (maximum watchful oversight). The cameras are provided by the foster care agency due to issues in the past three placements. I can't really get into it, but it has zero to do with trusting the nurses and everything to do with the placement contract I signed with my private agency and the county social workers. As I mentioned, the nurse has access to the other monitor to use when not in direct contact with the children; we keep one in our room and one downstairs so it's not to watch the nurses- it's to watch the children, only. The sibling has a baby monitor in their room as well, so it's a total of 4. Not just in Gem's room. I understand how that can make people uncomfortable, but there is very little I can do to change the situation; I simply have to pray people are sent into my home understand the reasons for the monitor and know that we aren't sitting there staring at the monitor, hoping to "catch" someone.

Specializes in Home Health (PDN), Camp Nursing.

I actually like camera cases. So long as its out in the open and the camera records to a video or drive, and not just feed into a monitor. I DON'T like cases that hide nanny cams. I have worked privet security, I will find them, and then I will leave. Public cameras prevent issues, and abuse. They are in impartial whitness. Hidden cameras are a gotcha game and do nothing to stop issues before they occurr. Sorry for the thread hijack.

Specializes in geriatrics, hospice, private duty.
I actually like camera cases. So long as its out in the open and the camera records to a video or drive, and not just feed into a monitor. I DON'T like cases that hide nanny cams. I have worked privet security, I will find them, and then I will leave. Public cameras prevent issues, and abuse. They are in impartial whitness. Hidden cameras are a gotcha game and do nothing to stop issues before they occurr. Sorry for the thread hijack.

I agree. I feel like the [overt] camera protects good nurses from false accusations and it protects patients from bad nurses. Win-win, IMO.

Hello Kiyasmom, we are also foster/adoptive parents. You did not over-react at all. By not reporting her the first two times, the agency had no idea this was an issue. You could certainly file a complaint against the agency that they are being unreasonable and condoning sleeping on the job. As far as leaving you in the lurch, a phone call from the social worker mentioning how they are abandoning your case might go a long way to get them to fulfill their end of the contract.

You can also check on the tracheostomy.com boards or FB page for other PDN recommendations by parents in your area. I don't post on there but I do read it and there are several foster and adoptive parents.

Specializes in Pediatric.

I'm another nurse who's going to tell you that you did not overreact. I'm shocked at how nice you were to this nurse! I can appreciate that, having dealt with some very difficult parents. I'm appalled that she laid down on the floor. That's just strange.

I've worked Home Health for several years and have lost track of the number of times I've had to awaken overnight nurses I was relieving in the morning. I mean awaken by shaking their chair or shoulders for a minute. It happens all the time. Where I work, CNAs going to nursing school are often given cherry assignments so they can study and sleep overnight during their shift. I have never fallen asleep on shift and I agree with your actions.

But I want you to expect nurses and CNA's in Home Health to sleep during their shift. It's totally against the rules but happens every day. It's only wrong when you report it to the agency and most agencies will react the same way this one did.

Specializes in NICU, ICU, PICU, Academia.

Having been a night shift PDN in the past - I don't feel you over-reacted at all.

I have inadvertently nodded off on a case, and it scared the bejeebers out of me. I had to give up a case where the parents wanted me to sit in a darkened bedroom with their sleeping child ALL NIGHT LONG - it is virtually impossible to stay awake (I ended up standing up most of the night).

Not saying this is the case with you, but some parents are so totally unrealistic about the conditions they force the nurse to work under (sit in the dark and stay awake, no shoes, turning the heat down to 50 overnight etc....) that it makes me wonder at times about how OSHA regulations apply to home care nurses.

Specializes in Pediatrics.
Having been a night shift PDN in the past - I don't feel you over-reacted at all.

I have inadvertently nodded off on a case, and it scared the bejeebers out of me. I had to give up a case where the parents wanted me to sit in a darkened bedroom with their sleeping child ALL NIGHT LONG - it is virtually impossible to stay awake (I ended up standing up most of the night).

Not saying this is the case with you, but some parents are so totally unrealistic about the conditions they force the nurse to work under (sit in the dark and stay awake, no shoes, turning the heat down to 50 overnight etc....) that it makes me wonder at times about how OSHA regulations apply to home care nurses.

YES! ^^This. I have worked to optimize the conditions to be condusive for work and sleep. I do have a unique perspective because I have worked PDN nights and I've been on shift in homes where it's pitch black, white noise, working by penlight. Really????! I also allow them to go downstairs if she's stable and IF the camera is on the monitors and the monitors are turned up. I know people work differently. One of our newer nurses from PSA likes it dim and she brings her iPad and earphones. I'm not a fan of the earphones so much but she's proven she hears the slightest change in breath sounds so I allow it even though I initially thought it would be problematic. I even allow access to coffee all night and supply sodas, water, juice, and snacks in a small pantry/dorm fridge in the closet. I try to be the best mom I can be and provide a great working environment... but sometimes it's not enough and some people aren't great fits for every case. She was a good nurse, when she was awake. She'd make a STELLAR day nurse... on a unit... with other nurses. ;) I totally filed a report and made some calls though!

Nope, you did not overreact at all. Coming from a guilty accidental dozer! :sleep: :wideyed:

You did not overreact at all! I work PDN on nights and although it gets hard sometimes there is no reason why someone can't get up and move around. Plus you go over and beyond with providing drinks and snacks for the nurses. Judging by the fact she was laying on the floor and then on the couch she purposely put herself in a position to sleep, it wasn't accidental. As for the headphones. I use mine at work, but I only put it in one ear so I can hear everything fine with the other :) sorry you had to deal with a ridiculous supervisor and I hope for the best for you! Your doing a great job! I hope to be a foster parent for medically fragile children myself someday :)

I've always been taught falling asleep is patient abandonment. Immediate termination for it in all the places I've worked.

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