Coworker Politics v. Endangered Patient

[atxgirlrn]

I work for a home health business in Austin. There are too few employees so many of us are pressured to work double & triple shifts, 24-36 hours without any relief. Sometimes RNs and CNAs will call in, which leaves the office calling and texting employees, begging for me to cover other's shifts, or patients will be alone. Is this legal? To be expected ?

Many patients lack insurance to bump up the per hour that CNAs earn, and I'm worried this is effecting the quality of patient care, also employees working 24-36hr shifts. Many of the stories sent among employees and shift report notes are troubling me.

Some patients languish for days without care when employees are unavailable, do not show up for their shift, or scheduling errors occur. Three elderly patients have been dropped on their heads from bed. One was sent to the hospital in critical condition afterwards, yet the CNA on duty at the time was not reprimanded. Another patient, with dwarfism, has a reputation for being difficult, critical and combative with his care givers. A few employees have admitted to heated cussing arguments with very hateful statements exchanged, threats and getting slightly physical pushing him. The patient is verbally abusive and delusional with female care givers, often developing romantic attachments and angry when paired with males. I have had no shifts yet with this patient, so all this is from talking with other employees and shift report sheets.

The blame in this situation seems ethically hazy. Who needs to be protected? Am I obligated to do something, and if so, what and to who? I do not want to be fired or have a difficult transitioning to another company, so discretion is key if possible.

Maybe these conditions and situations are common and I am showing my "greenness", so advice from others in the field is appreciated.

[jadelpn, LPN, EMT-B]

If someone is not functioning well at home, then in fact, there needs to be another plan put into place for care. And that may mean a facility. Whomever you social worker/case manager is needs to re-visit these patients and come up with something different.

If you go into a situation where a patient is obviously neglected, you are mandated to report that. That you are the first nurse to go into a situation where there has been no care for a few days, and the patient needs a 24 hour caregiver, you need to report what you find.

If you are asked to stay over for a 36 hour shift, I would report all of this to the state agency who licenses this care agency.

With combative patients, again you need to discuss this with case manager/social work. Perhaps a skilled care facility may be a better option for this patient. Dwarfism in itself is usually not a 24 hour care situation. This patient obviously has co-morbidities. This needs to be discussed in a care team meeting.

This is not your '"green-ness". This is really poor practice all the way around. I would run, not walk, run. I would report all of this to the state agency who licenses the agency you work for. The local omsbudsman. The local elder services.

Do not get into a situation where you are "abandoning" a patient that you are stuck with for 36 hours without relief. That would be the very last time I EVER worked for them. Period.

[Esme12, ASN, BSN, RN]

In home care, in Texas the law is kind of blurry. If patients are being neglected...you need to file an abuse neglect report as a mandated reporter. You need to call the states attorney general office and ask these questions as well as your state BON. If you have malpractice (and you should have malpractice) insurance call them immediately. Your license may be at risk.

[xoemmylouox, ASN, RN]

What a frustrating, sad, and dangerous situation. Did you have a max exodus of staff or does your company just plan on continuing with this low number of staff? You need to get malpractice insurance if you do not have it already. If you already have it you need to call them ASAP. Things must be addressed. Your patients rely on you to keep them safe.

[OCNRN63, RN]

When you're at a patient's home 24, 36 hours, you're not working. You're being held hostage by your employer. No job is better than a job that puts you in that kind of situation.

[toomuchbaloney]

Report them to any and all appropriate authorities.

Let the local media know of the health agency that takes patient money but does not provide safe care because they have inadequate staff.

Dust off your resume, renew your malpractice insurance and find another employer.

Good luck.