Free Time for Doctors Visits?

[blissmissrn]

Hello to All, I really enjoy allnurses and wish I would have discovered it sooner. This is my first thread. All replies will be appreciated.

How do you handle it when a pediatric client has frequent doctor visits, some of which are out of town? The agency I work for leaves it up to the discretion of the nurse to accompany the parent or not. It is not a have too part of the job because the nurse is not paid for her time during the visit to any doctor,therapist, or clinician. The parent has the expectation that the nurse goes to numerous visits. It could be anywhere from 4 to 10 per month. Ranging from 1/2 hour to 2 hours. I was rudely told by the mother that I was getting paid until the doctor came in so I needed to hold the child and entertain them in the exam room while waiting for the clinician because she was going to read a magazine. She stated she wanted what she was entitled to. Some times we wait an hour for the doctor to come in so this is not an easy task. I did not go on all the visits as I explained that I am working for a living and have to limit the amt. of free time I give. And, most people don't give any free time on a paid job. This caused some difficulties and the parent eventually informed the agency that she wanted a nurse that would accompany her on all visits. Also, I had misgivings about being in their car in event of an accident and what a legal mess that would be. Who knows if these clients even have a drivers license or car insurance. Do we have the right to ask to see proof? Do any of you nurse give free time? BlissMissRN

[caliotter3]

No pay means no on duty means no backup from agency for problems or malpractice coverage. If your agency refuses to pay you to accompany the client on doctor visits, then the safe and practical thing to do is to go off the clock and go home. You don't need the liability any more than you need to be taken advantage of.

[blissmissrn]

Sorry, need to clarify. The nurse is paid the hourly rate for all time except for time client is being seen by the doctor,therapist,clinician. it was explained to me that Title 19 will not pay for both at the same time. For example, if the doctor visit was 1/2 hr in duration. I would be paid for 7 1/2 hrs. I could work an extra half hour if I wanted to make up the difference. BlissMissRN

[caliotter3]

I would not spend any unpaid time with the client.

[txredheadnurse, BSN, RN]

I second the other posters stance about not providing care or being in attendance if you are not on the clock. You are not covered if anything happens to you or the client while you are not on the clock. By that I mean you are not covered if you should be injured, if there should be some adverse event during the appointment and trust me, the provider (your employer) would be happy to throw you under the bus if something did happen.

If this person was on my caseload I would make sure the mother knows Medicaid does not provide for skilled nursing while any other provider is engaged in care and suggest that she consider clumping as many of these medical appointments as possible in the same day or days and make arrangements for unskilled help to accompany her if she desires that. That way it would minimize and compress the time frames the nurse would not be paid.

If the mother feels she must have a nurse in attendance then I do believe Medicaid would require her to compensate the nurse out of her pocket. It is not a skilled service to entertain a client so that the parent can read a magazine. Double billing for overlapping medical services is not covered and can result in the provider having to refund their compensation for that time frame if billing is submitted for skilled nursing during the appointment.