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Forced 24 hr shift

Sorry for the long post ahead of time. I work 12 hour shifts with a vent patient who's family has refused to learn to care for him. That requires a nurse to be with him 24/7. I've been on the case 9 months, and while it has not yet happened to me, it has happened to others. A call off with no backup. Three times in the last month alone a night shift nurse has been forced to stay for 24 hours. I don't really understand the laws with private duty nursing. How is this ok? How is it lawful at that? He's a ventilator patient with no trained caregiver at home, so a nurse cannot get even one break in that 24 hours. I'm scared to death of it happening on my shift.

It almost did a few days ago. I was notified in the morning that they didn't have a night nurse after me. I said I was already sleep deprived (hadn't slept since the night before) so to please please please do what they can bc I CANNOT stay. They got someone in. Side note* I get that call offs happen. I've stayed a few hours past my shift. But I found it interesting that the schedule for that night read "open." So to me it seems it wasn't a call off, but that they hadn't been able to schedule someone to begin with.

I found it interesting that a week ago our quality assurance manager told me that she took care of this patient once. For that to have happened, the only way I can imagine it was if a nurse refused to stay and they got her, the QA manager to come in. So it sounds to me if a nurse puts his/her foot down, then they would get someone here. What should I do if I'm ever put in this position and absolutely cannot stay? The sassy part of me wants to say "do what you need to do. Get a manager in here or something, or I'm calling 911 and reporting off to them so I can legally leave." The realistic part of me wants to keep my job. ☺️

My severe anxiety issues are keeping me from doing orientation for any other case. I have anxiety with "newness." I don't particularly like this case. I think I'll tell some horror stories in another thread about this case. Such as the wife accusing nurses of taking her kid's benzos and drinking her alcohol. 🙄

I'm confused by this entire post because there are absolutely zero hospitals that will discharge a patient without a fully trained caregiver (parent, foster parent, guardian, grandparent, whoever) in the home. Many children's hospitals require a second person to be trained. Training includes trach care, medication administration, nebulizer treatments, suctioning, ventilator circuit changes, cough assist and/or CPT/vest, tube feeding, etc. Training also includes independent overnight stays with no nursing assistance.

When a family signs up with a nursing agency, the FIRST thing the agency does is have the family sign a document that states that nursing is provided as best as possible as scheduling allows but that the FAMILY is ultimately responsible for the care of their child.

Alex Egan, LPN, EMT-B

Specializes in Home Health (PDN), Camp Nursing.

What state are you in. That’s the most important question. In PA you cannot be mandated to do more than 16hours (18 in a declared emergency)

I'm in Illinois, and this is an adult ALS patient.

17 hours ago, ventmommy said:

I'm confused by this entire post because there are absolutely zero hospitals that will discharge a patient without a fully trained caregiver (parent, foster parent, guardian, grandparent, whoever) in the home. Many children's hospitals require a second person to be trained. Training includes trach care, medication administration, nebulizer treatments, suctioning, ventilator circuit changes, cough assist and/or CPT/vest, tube feeding, etc. Training also includes independent overnight stays with no nursing assistance.

When a family signs up with a nursing agency, the FIRST thing the agency does is have the family sign a document that states that nursing is provided as best as possible as scheduling allows but that the FAMILY is ultimately responsible for the care of their child.

The only person in the home is the patient's spouse who refuses to care for him.

It is not your problem that the agency took on such a case. If the agency won’t rectify this, you are better off looking for a new employer. I have worked as much as 21 hours on a case when a new agency didn’t have nurses for relief. The agency however made an effort to hire sufficient nurses and took care of their staffing problems. Your situation sounds as if the agency is not willing to do what is necessary to safely staff the case. Take care of you.

If the patient isn't safe, then call Adult Protective Services.

1 hour ago, ventmommy said:

If the patient isn't safe, then call Adult Protective Services.

I'm not sure where you're getting that from. Anyway, I'm specifically wanting advice on how to tell my employers no if they try to make me stay 24 hours. It has not happened to me yet. The other nurses just rolled over and took it. I'm uncertain what is reasonable for me to request. I think 16 hours is the limit I'd tell them I'd work.

I'm not quitting the agency due to one case. I'm signed on to 3 agencies, and I'm honestly relatively impressed with the company. Education is outstanding. Professionalism is great. I make $5/hr more here. I'm not looking to change cases right now due to anxiety issues with new cases. If I'm made to stay 24 hours, then that will change things. But for now, I just want advice on how to word "I'm not staying past 16 hours." I'll just word it that way I suppose.

Edited by Orion81RN

Elektra6, ASN, BSN, RN

Specializes in Home Health, LTC, subacute.

I’ve heard of this on some cases. Two cases had a patient living alone. One was vent, one wasn’t. Crazy.

5 hours ago, Elektra6 said:

I’ve heard of this on some cases. Two cases had a patient living alone. One was vent, one wasn’t. Crazy.

Yeah. Luckily I think it's only happened 5 times in the 9 months I've been there. So about 5 shifts in about 500 shifts.

On 6/12/2019 at 6:10 AM, Orion81RN said:

I'm in Illinois, and this is an adult ALS patient.

I can only guess which agency you're working for...I worked for one in IL, and they pulled this every now and then. I did one 24 hour shift and after that I was firm that if it happened again I'd sign off the case. I did end up quitting and citing that as one of the reasons. I got so much anxiety about being forced to work 24 hours.

Elektra6, ASN, BSN, RN

Specializes in Home Health, LTC, subacute.

When you fall asleep and something happens, the client’s lawyer will ask you why you took the shift if you knew it wasn’t safe?

Sorry but I am cursed with the ability to see everything as a future court case.

1 hour ago, Elektra6 said:

When you fall asleep and something happens, the client’s lawyer will ask you why you took the shift if you knew it wasn’t safe?

Sorry but I am cursed with the ability to see everything as a future court case.

In total agreement. Nobody looks out after someone like someone looks out for self.

On 6/11/2019 at 10:37 AM, ventmommy said:

I'm confused by this entire post because there are absolutely zero hospitals that will discharge a patient without a fully trained caregiver (parent, foster parent, guardian, grandparent, whoever) in the home. Many children's hospitals require a second person to be trained. Training includes trach care, medication administration, nebulizer treatments, suctioning, ventilator circuit changes, cough assist and/or CPT/vest, tube feeding, etc. Training also includes independent overnight stays with no nursing assistance.

When a family signs up with a nursing agency, the FIRST thing the agency does is have the family sign a document that states that nursing is provided as best as possible as scheduling allows but that the FAMILY is ultimately responsible for the care of their child.

This is spot on - child or adult - willing and available caregiver should be a requirement for any agency in my opinion (here it’s state mandated but I would absolutely make it a requirement to be on service even if it weren’t)

As all have stated, you need to look out for yourself and be able to guarantee your patient’s safety so you don’t end up making a costly error where your license or your patient’s life is at risk. Whatever your State mandate is on consecutive hours is a good starting point, but even if they don’t have one, you can simply state your own limitations should this situation arise: “I am sorry you have to find another staff member, but I need to leave after xxx number of hours otherwise I don’t feel I can safely manage my patient. I want to help as much as I can, but I know our patient’s safety is the top priority and that’s all I can offer” ... thing is if you continue on this case and they have not found a replacement you would need to call 911 to report off or be at risk for patient abandonment ... it would be messy but not as much so as you falling asleep and your patient being injured or dying

Kitiger, RN

Specializes in Private Duty Pediatrics.

If my agency required me to work 24 hours straight, I would find another agency. I would resign even if this was only a potential requirement.

I will not put myself in that position.

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