Published Apr 30, 2012
Hi everybody. I have recently started working at a home health nursing agency in Pennsylvania. I have a problem and wanted to post this for any other nurses who might be in a similar situation.
There is a new case that was presented to me; the patient is a little girl with multiple needs. After meeting with the mother, I was told that she needed me to drive this child to and from school and also to some various appts. Well, I didn't have a problem doing it if the company was ok with it. The company said it was fine if I signed a waiver. That got me thinking I had better check with my insurance company to make sure I would be properly covered if anything were to happen with this child in my car. My car insurance company told me that I would need a commercial policy to cover this type of situation. They even went as far as to give me the names of two other insurance companies because they themselves could not provide me with the proper policy. HOLY CRAP! This nursing agency never told me that I needed a commercial policy, and they are acting like they had no idea. They have many nurses who transport patients from what I've been told, and these nurses apparently all have normal personal policies. WTH?
Has anybody ever heard of this before? I obviously won't be signing any waiver or changing my policy, so I will probably have to decline the case.
Double-Helix, BSN, RN
Good for you for being thorough! Yes, if you are using your car for business purposes (such as transporting a client while on the clock) then you need a commercial insurance policy to cover you while you are using your car for business. However, double check with your employer and see if they have an insurance policy that would cover you for this.
I'm going to guess that the other nurses in the company never bothered to check this with their insurance company. After all, they are covered if they are driving a friend, so most people wouldn't think there would be a difference if it's a client.
What exactly does that waiver say? I bet it includes something about not suing the company if you're in an accident and your insurance doesn't cover it. The reason that they have you sign the waiver is to cover their butts when your insurance company denies your claim.
Clearly there is a decision for you to be made here:
1. You can accept the case, and transport the client with your current insurance policy, knowing that you won't be covered in the event of an accident.
2. You can switch carriers and pay for a commercial insurance policy. (Check into whether you can write this off in taxes as a business expense.)
3. You can explain that you can't transport the client and probably be passed over for the assignment.
KelRN215, BSN, RN
I worked skilled visits for my agency but they also do private duty. It is against the company's policy to drive patients in one's own car. I think that makes sense- it protects everyone and you're there to be a nurse, not a personal driver. If the child needs a nurse to accompany her to school, a nurse should be riding the school bus with her. I know my agency supplies nurses for this purpose and I did something similar when I served as a "bus monitor" for a child with autism.
Thanks both of you for your input. The waiver basically says that the agency's insurance can only be claimed against after the nurse's personal insurance has been exhausted. It also says that the nurse is affirming that he/she has coverage in accordance with the laws of PA. I agree! I am there to be a nurse, not a chauffeur. I would be happy to ride the school bus with the child and accompany her to school, but that's not being given as an option. Oh well. I thought home health would be great but it's not looking that way so far.
Does this child actually need supervision in school- or does the mother just want her to have a ride? Would you be bringing her to school and then picking her up in the afternoon, or staying with her all day?
I ask because, if she doesn't need supervision, it would be difficult to you to ride the bus with her and then have to get transportation back to your car to go home.
Mom may not want her kid to ride the bus. Sometimes parents of chronically sick kids... well, they have their way of doing things and they don't want anyone to rock the boat. If you have a serious conversation with your agency about this, they may be able to work something out with her. Or the mom may want to wait for a nurse that doesn't mind driving the client, and you'll have to wait for another case.
Good luck. :hug:
The way my agency explained it is rthat if the child requires skilled nursing care how are you providing care from the driver's seat with the patient in the backseat? How can you monitor and/or assess the patient while driving? What I'd your patient has a seizure or requires urgent intervention. Needless to say my agency specifically prohibits exactly what they want you to do. My car insurance response would be the same as your's responded. My current patient ruequires transport to various therapies. When mom is home, she drives us...when mo is not home a second caregiver comes to watch my patient's siblings and the sibling's babysitter drives my patient and me to the appointment. Thus I am able to care for and monitor my patient at all times.
I don't think I would like having to transport pts in my personal vehicle, at least not on the regular.
Many moons ago, I had a HH pt who had an elevated temp and needed a ride to the emergency room....it was 1/2 mile away, so I took her. But before she got out she p*SSed in the seat. i had it cleaned but every time it got really hot, it smelled like uti
The previous posters very wisely provided great information to be heeded. I did notice there was no mention/offer of travel reimbursement (provided for legitimate business expenses). Hmmm..
txredheadnurse, BSN, RN
This topic was discussed before in the private duty forum. What you have been told about having to get a commercial policy is correct and good luck in actually getting the employers insurance to pay if there ever is a claim filed. Why? because generally when an agency has auto insurance for transporting clients/patients it is soley for transporting the patient in a COMPANY owned vehicle. It is very common for the employer policy to specifically exclude coverage for the use of a personal vehicle even in the performance of your job.
In addition as a previous poster wrote you can't appropriately monitor the patient and also safely drive. If something happened while transporting the patient by yourself in your personal vehicle you couldn't say that that decision was one that the "reasonable and prudent nurse" would have made. Being compassionate and a team player are good things but allowing someone to exploit you and place you in an untenable situation is not in your best interest.
All agencies I've worked for have expressly forbid this practice. I've only known of two nurses who drove the patients anywhere. They used the patients' special vans. I do not believe that either one had the permission of the employer. One of them was driving the family regular cars too. She demolished one of them in an accident. I would never drive a patient anywhere in my car. I would call an ambulance or a cab in an emergency, but I would never put myself in that position, by using my own vehicle.
They do provide mileage reimbursement, but I'm not sure exactly how that is determined. Regardless, my main concern was the coverage issue. The agency must have been aware that I needed a commercial policy to be properly covered in case something happens. They never mentioned this to me, and after I mentioned it to one of the office "client services managers" he told me he had never heard of that before. It makes me want to hand in a two weeks notice right now, but I won't make any rash decisions.
Just to clarify a bit, the mother wanted me to transport the child to and from school then remain with her until evening in the home.
It's not a good situation to be in, I realize that even moreso now. I will never provide this type of service while working in the capacity of a nurse.
The child does have seizures, so I had wondered about how I would deal with that while driving. I had thought that I would need to pull over and wait for the seizure to resolve. You all are right though...if there was an emergency or the child went into distress while in the car, I would be in trouble. You can't see too much from a rearview mirror.
Yes, I had thought about the possibility of the patient peeing in my car. My car is new. I would not have been happy about that.
The child does have seizures, so I had wondered about how I would deal with that while driving.
is exactly why you (and your agency) should be saying NO! it is not safe, it's no the standard of care. You absolutely CANNOT monitor or treat an epileptic patient while driving. What happens if you are going 60 miles per hour down the freeway in traffic and you catch your patient in an active seizure turning blue in the back seat? How are you going to protect her airway? How are you going to keep her from harm?
Worst case scenario-Turn your head & the wheel into oncoming traffic and cause serious injury to you, your patient and other drivers? Yeah, that's not the standard of care. Your license and your life would be at risk. You can bet your bippy the agency will not support you in this worst case scenario. Even if you safely pull over, the minutes or even seconds spent with a compromised airway/reduced respirations of a post-ictal stage can be life altering. Plus it is not uncommon for a patient in an active seizure to lose control of bowel and bladder. Not a pretty picture with a new car.
Are you staying with the child at school? Caring for the child before school? Why cant the mother drive to school? Usually transportation is a related service when it comes to children with special needs (generally a child that qualifies for skilled nursing qualifies for an IEP, 504, or at minimum an IHP from the school district that includes appropriate transportation services)
Usually the standard is a $1,000,000 umbrella policy that is NOT a cheap policy. It may or may not be deductible on your taxes as a business expense.
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