A Bit Annoyed

LadyFree28, BSN, LPN, RN · Sep 9, 2014

I'm not understanding the issue of not going out of state to an appointment that is benefitting the pt you are caring for-I understand the not being told; but then again, if they didn't know about it, and now they know, you have an option not going; but may be either missing info or missing the opportunity of giving information that will help guide your pt's plan of care.

I have never had issues with going to appointments with my clients; as nurses, we are the bridge to the PCPs and he parents; sometimes us being there gives a better picture to our families in terms of roping them understand concepts of their child's illness; if it was out of state, I had no issues not going; if I couldn't go, it would be up to the agency to find someone, not my issue. :no:

meanmaryjean, DNP, RN · Sep 9, 2014

Will you be leaving and returning from said appointments within the hours you agreed to work? If so, what exactly do you take issue with? If not- what is the time frame they are asking you to work? Is it terribly unreasonable?

JustBeachyNurse, LPN · Sep 9, 2014

I'm not understanding the issue. Most of my patients have specialty teams in the next state. We don't accompany when it requires multi day travel or by air for the specialists 6-8 hours or more away. But the specialists a 60-90 minute drive in the next state are no different if the specialist was in the northern part of my state which is 90-120 minutes away. All appointments are started and finished during my scheduled shift. Only one ran over by 10 minutes due to traffic. My agency compensated for that short over time.

The only issue lately is if both parents are competent caregivers and both are attending the appointment then insurance and the agency question the need for a nurse. Often it's mom, patient & me. Mom drives I care/monitor. I can get orders signed in real time if needed so it's win win

Do you not go to any appointments? Are you concerned crossing state lines for a couple of hours?

nycRN3 · Sep 9, 2014

@ ladyfree28 @meanmaryjane

That's the thing I don't know anything. I don't even know how the family plans on getting there. I know that it is a 4 hour drive.

I'm just not comfortable going out of state if the agency told me this I would have never accepted the case.

I'm also confused about the legalities of practicing out of state.

nycRN3 · Sep 9, 2014

@justbeachynurse

Yes, crossing state lines the mother told me they just had to do paperwork but no one has ever spoke to me about it.

I don't know a bit of it is nerves I've never really tRaveled with a family. I've been to many doctors visits but that was within nyc.

JustBeachyNurse, LPN · Sep 9, 2014

For day trips of a few hours we are covered under the 485. Anything longer (like my patient that was considering bringing nursing for a 4 day trip out of state including 3 outpatient medical appointments) the office has to follow through with the BoN of each state.

If it's a 4 hour drive each way, do you work a 12-16 hour shift?

JustBeachyNurse, LPN · Sep 9, 2014

Some states have a temp walk through if you are going to be there for a day or two. Your agency should assist with facilitating the licensing issue. 4 hour trip with a family each way can be a bit much. My max so far has been nearly 3 hours each way due to traffic, but otherwise 2.5 hours travel each way. Lots of fun to do bolus feeds at rest stops!

nycRN3 · Sep 9, 2014

@justbeachynurse I work a 12 hour shift. I guess a bit of me doesn't want to travel for 4 hours going and coming and then it takes me 2 hours to get home

**Elektra6, ASN, BSN, RN** · Sep 9, 2014

I never thought of this! I travel with my patient out of state every month! (It's 15 min away). I wonder if I should apply for the license?

JustBeachyNurse, LPN · Sep 9, 2014

Then ask to transition off the case. I'm guessing the specialist is in Boston? Are both parents competent & going to the appointment? Is this "basic" or high- tech (trach/vent)? If a basic case & both parents (or two competent caregivers) are attending insurance may not cover nurses. We had this issue when one of my agencies called to get authorization to extend an 8 hour shift. It was the 7 hour mark and the child was still waiting to see the specialist who was 3 hours behind. The Medicaid HMO asked who also was with the patient (some patients go only with the nurse using medical transportation such as a van or ambulance). If it was nurse, patient & medical driver then it would have been authorized. Since mom & dad were both there the whole shift was flagged as ineligible for reimbursement as it did not meet the criteria for skilled nursing reimbursement. (Since they weren't getting reimbursed the agency sent a satellite office staffer to pick up the nurse and bring her home)

In this scenario I can understand not wanting to go. I'm not sure Id be willing to go for a 4hr each way drive to see a specialist. At this point the office is responsible for coverage. I wouldn't get into it with the parent. If just say it's not on your schedule. If if becomes uncomfortable, ask to be removed from the case. Not worth it.

brillohead, ADN, RN · Sep 9, 2014

I don't see the issue, as long as licensing has been covered, which your agency should handle for you.

Are you afraid to ride in a car with the parent driving?

The two hours it takes you to get home is a non-issue, IMO, because you would have that trip home regardless of whether your shift is in the home or at the doc's appt.

If you have issues with motion sickness and simply can't travel, that would be one thing. But since you're capable of traveling two hours, it would seem like four hours wouldn't be a hardship.