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Forced 24 hr shift

Private Duty   (998 Views 17 Comments)
by Orion81RN Orion81RN (Member)

Orion81RN has 7 years experience .

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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. 🙄 

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390 Posts; 10,231 Profile Views

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.

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Alex Egan has 9 years experience as a LPN, EMT-B and specializes in Home Health (PDN), Camp Nursing.

6 Articles; 852 Posts; 22,986 Profile Views

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) 

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Orion81RN has 7 years experience.

723 Posts; 7,804 Profile Views

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

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Orion81RN has 7 years experience.

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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. 

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36,698 Posts; 96,702 Profile Views

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.

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390 Posts; 10,231 Profile Views

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

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Orion81RN has 7 years experience.

723 Posts; 7,804 Profile Views

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

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268 Posts; 3,739 Profile Views

That sounds miserable, and incredibly unsafe. 

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Elektra6 has 14 years experience as a ASN, BSN, RN and specializes in Home Health, LTC, subacute.

535 Posts; 11,074 Profile Views

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

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Orion81RN has 7 years experience.

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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. 

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BiscuitRN has 4 years experience as a BSN, RN.

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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.

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