Do I go with client....or go home?

[Mabel 29]

Hi all. I'm new to pediatric private duty and I work for an agency, 7a - 3p. My current case is a child who is a patient at a Children's Hospital two hours away from the home. Recently the child had an emergency, and the hospital told the mom to bring the client right in for treatment. It was during the first hour of my shift, and mom said pack up and lets go. I cared for the child in the car on the way to the hospital while mom drove, and cared for the child during the entire 9.5 hours that we sat at the hospital. The treatment receivced at 7pm only took 25 minutes! The agency was kept informed of the progress along the way, but seemed upset that I went. (This was not my first trip to the hospital with the child.) Now they say that I should have come home and let mom go by herself. I did not return to the child's home until 9:30 pm, which was 6.5 hours after my shift ended. I didn't dream that we'd be gone that long. Now I'm told that I may not get paid for the time. What is the policy of your agency in a situation like this?

[Jolie, BSN]

I have no HH experience, so this is simply my opinion.

It seems as though you should have accompanied Mom and Child in the car, as she can't be expected to drive and tend to the child. But once the child was signed in at the hospital, I believe your duty ended. He was in the care of other qualified healthcare professionals, and I don't know of any insurance plan that will pay for 2 caregivers from different agencies and/or facilities at the same time.

Could you have called the agency for a ride back to your car at that point?

I don't believe that they can legally refuse to pay you, especially since you were in touch with the agency at the time updating them, unless they told you then to leave.

[Mabel 29]

The child was not really being cared for by the hospital. We sat in an exam room for 6 hours, seen for 5 minutes by NP and then 3 minutes by Chief of Surgery. Other than that, no care given by hospital staff. Surgeon trying to "figure out what to do" with another surgeon in Interventional Radiology, who was on a lenghty case herself.

As far as riding with them and then reporting off, I'm two hours from home with no car, and agency surely will not come for me. I thought of calling Greyhound, which is what I would have done if the child had been admitted. Personally I would have much rather been somewhere besides the hospital for my entire evening, as I had plans with my family, but I thought once I left with them, I was obligated to follow through.

[Jolie, BSN]

the child was not really being cared for by the hospital. we sat in an exam room for 6 hours, seen for 5 minutes by np and then 3 minutes by chief of surgery. other than that, no care given by hospital staff. surgeon trying to "figure out what to do" with another surgeon in interventional radiology, who was on a lenghty case herself.

it really doesn't matter that he was sitting in an exam room. he was officially under the care of the hospital staff at that time. if there was care that was needed, such as suctioning, medication administration, adjustment of medical devices (picc line, g-tube, trach, etc.) it was their responsibility to provide it. if they were failing to notice his needs or provide for them, his mother should have called it to the staff's attention.

as far as riding with them and then reporting off, i'm two hours from home with no car, and agency surely will not come for me. i thought of calling greyhound, which is what i would have done if the child had been admitted. personally i would have much rather been somewhere besides the hospital for my entire evening, as i had plans with my family, but i thought once i left with them, i was obligated to follow through.

i understand and sympathize, but "following through" amounted to giving report to the er staff. at that time, he became their responsibility. did you ask the agency to arrange for your transportation home? did you ask the er staff if they could provide a way home for you? what did the agency say about helping you return home when you let them know that the mother and child had arrived safely in the er? as i said, unless they offered you a way home at that time and you refused, i don't think they can with-hold pay for the time you spent there. but i do understand their argument that you shouldn't have stayed, as they will not likely be reimbursed for those hours.

[nocangel2]

Been there and learned from it.

They do have to pay you, and you are correct that once you left with the family you had to stay, if there was not another RN to assume care. Otherwise you potentially could be liable for abandonment if something happened.

Next time, my advice is.. if it truly is an "emergency" call 911 for the transport to the nearest ER and report off.