Coverage when out sick

renerian, BSN, RN · Dec 8, 2004

I have seen this happen in agencies when they don't have enough contingent staff to cover patients/a back up plan so to speak.

How is your dtr now?

renerian

hoolahan, ASN, RN · Dec 8, 2004

If you call out sick, you call out sick, period. It is the agencies problem to cover your pt's. Naturally, they can triage them, but if they can't do the admit, that is NOT your problem. They need to triage all the other nurses pt's as well. I can hardly believe that EVERY single other scheduled visit is emergent!!

If your agency has HR, I would file a complaint, that or a grievance commitee. That is ridiculous. You have every right to call and sick if your child is ill. It's not like you called out to go Christmas shopping. You cannot possibly leave a $-year-old home alone, even when well, what is WRONG with the people at your agency??!!

You need to say very firmly, I can NOT come in today, do NOT call me again or I will report you for harrassment to ...whoever...in your agency. This is one situation where I have to say, would not happen in a union facility. If it did, you could complain to your union rep. You may consider reporting them to labor board or calling your BON or the agency that certifies you for homecare, JACHO or CHAP, and report them for not having coverage. I simply would NOT tolerate that...PERIOD!! (Before you report anyone, be sure you check your P&P to see if you gave them the required notice, though emergencies happen, and they still need to be prepared!)

shammy · Dec 9, 2004

Thank you for your replies. My dtr is better now and my sister came up and took care of her today to allow her to rest without having to go to school.

Hoolahan thank you for you information. My shop is actually union believe it or not. I will follow up with P&P tomorrow when I get to work to make sure I called in correctly. I'm new at this agency and to HH and my orientation has been very inconsistent. The agency was preparing for JACHO when I started and a lot of things fell through the cracks. Most of my orientation was done on my own with P&P and me requesting certain trainings that I found out that I needed.

And I'm glad to know that this isn't the norm. I actually think the TA is just overstepping her boundries. She has in other areas as well and from the other staff at the agency she tries that with everyone.

hoolahan, ASN, RN · Dec 9, 2004

Well Shammy, I didn't say it wasn't the norm..unfortunately, I think it happens too often. But what we must do is learn to say NO and mean it. The minute you give an inch, they use you to death. Save the extra energy for the patients, they will be the only ones who truly appreciate it.

Whether it happens commonly or not, an agency MUST have a contingency plan for emergencies. What would happen if, God forbid, a nurse was killed on her way to work, would they simply say those pt's aren't covered? So, they were WRONG to do that to you, and I would count those calls as productive time.

Since you are new there, maybe don't rock too many boats just yet. Try to discuss it with your supervisor first, but be firm, that when you have called out, it is for a good reason and it is unaccepatble to you to be harrassed at home after doing so. Ask what the policy is for coverage in the event of someone having a car accident and being unable to continue their work day, or becoming ill or injured on the job. There has to be a plan. It is unacceptable practice to not have a plan. If it happened again, I would mosy cetainly write her up. I've done scheduling, and believe me, it is a thankless and difficult job, but that is why NURSES should be triaging and making schedules, not computers and secretaries!

Whew, I really need to get off this soap box.

kbettencourt · Dec 9, 2004

Dear Shammy

Where I work, when I call in sick, some patients can be put off until another day, we give ourself a five day window for recerts, and for all the pt's that need a visit, we have per visit Nurses that can be called, and that are scheduled, per visit nurses do not have a case load of their own, that is what they prefer. Sounds like you need better nurse managment to take the lead and do their job in scheduling.

Sick Family is first priority.

renerian, BSN, RN · Dec 9, 2004

Home health is so different that in many cases you have limited staff to call and it is also different in that it follows you around meaning you still do things for your patients if you are off the clock. I have done that and I am sure everyone in home health has as well. Unfortunately it is not a job that can be forgotten if your home/people still call you even if your sick. I agree stand your ground and care for your family. Don't be bullied.

How is your dtr today?

renerian

Traveler · Dec 10, 2004

That's pretty awful. When you are not able to come into work for whatever reason that should be the end of discussion. Your patients should be seen by someone else. Where I work we absorb the patients of the person who was out amongst the rest of us. Of course it's extra work, but that's home health. Some days are easy and others throw you for a loop. The patients need to be seen and if you can't do it, someone else should. I hope you didn't feel guilty. Your child is the most important thing. She will grow up one day. Do what you need to do for her. Your job should support your family obligations as well. I know you feel you have a resp. to your patients, but they are the agency's patients so it is the resp. of the agency to have someone seeing the patient.

shammy · Dec 10, 2004

Thank you for all your replies. I appreciate it.

I wasn't bothered with the first call. I expected that. I know who on my caseload needs a visit that day and who can be pushed. But the TA didn't like what I told her. So she instead sent someone out to see a not urgent repeat instead of an admit or recert that needed to get done. And yes we do the 5 day window thing but this pt's window fell over my day's off so I couldn't do it on Sat or Sun and both Friday and Monday the pt had unplanned MD appts that came up, leaving Tues the day I was out.

I just was feeling very bullied on Tuesday because I repeatedly received calls just to say my pts weren't being seen. And then when I called to ensure that ATLEAST the lab on the admit was done and consent signed the person who answered didn't have that answer and asked the TA to call and let me know, which she never did.

Wednesday I went to work mad still and was honest with people that I wasn't in a chit chatty mood, I was mad/upset and just wanted to do my office work and get out to the field.

Well today same TA tried to pit me and another nurse against each other and be all passive aggressive with me. I guess some one should have told her that then I just look for opportunties to talk sweetly to her. Kill'em with kindness.

But according to some of the other office staff this TA is having problems with a number of people not just me. So I think she may have something else going on.

Claver · Dec 10, 2004

I've worked in home care for four years as a fee for service RN,and sometimes it would seem that your patients are your children - you are totally responsible for them. But let me offer a few suggestions:

1. If you have weekly prepours or insulin injections - I always pour one or two days extra medication and 1-2 days extra insulin prefills.

2. Look at your case load and see who can be rescheduled for the next day - e.g if it is a home health aide supervision.

3. For recertifications I try to write them up on the first day if possible and I also try to schedule them so that I do not have to visit twice in the same week. Most of the information can be filled in ahead of time - leaving things like medication and vital signs for the actual time.

4. You can insist that your agency have some back up plan for coverage, but many times the offices are closed and you are speaking to an oncall service. sometimes even the oncall supervisor is unable to provide coverage, as she does not have a full schedule of who is available.

5. Try not to become frustrated, but try to work things out with your supervisor. Good luck.

OK I am venting here.
Today I am out sick not because I am sick but because my DD has been up with a stomach virus (aka vomitting) since 1am and so I needed to stay home with her.
I called into the office right when it opened. Actually started prior to opening just incase the TAs were in early. I tell them my delimma and say I won't be in today.
I get told well we can't cover your pts. I say sorry but I can't leave DD she is 4yrs old and continues to vomit. I get told they will see what they can do. Well since 8am I have been called 3-4 times with well we can't see your pts. I am really feeling torn. It is bad enough to be home sick when you are not sick but I can't exactly leave my DD home to take care of herself. But I find them calling me is really bothering me. I don't think I should be called repeatedly after calling in saying I won't be in.
Not to mention I have a recert due today that is not getting done so I will be discharging today and then readmitting tomorrow. Not that I left it til the last minute the 1st day to do it was Friday and the pt ended up with an unscheduled MD appt, same with Monday. So my original plan to be ahead has not happened which is why I don't normally leave my recerts until the last day. And my admit is not getting done. I don't know if they are getting the lab done on him or not. I guess I will check then I'll do the admit tomorrow.
But is this normal for HH CM's? I'm new to HH and to CM.
Sorry this is long but I am really frustrated.