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Great opportunity, might lose a friend???

Sorry for the super long post, but I tried to cover everything that would probably get asked in the comments. I'm sure I've missed something though LOL .

I've been a home health nurse for six years now. I am paid per visit, so I don't work assigned shifts, I just get assigned patients and I work out my schedule with them. A couple of years ago I was assigned some patients at an assisted living facility, Some of them needed daily visits because they cannot self administer insulin or other medications, some wound care, basic stuff. I've built up a good rapport with the administrator, the doctors who see patients at this facility, and the staff. So the home health agency designated this as my facility where all of the patients would be assigned to me. Visits were needed seven days a week, And one patient needed b.i.d. visits, so there was no way I could work seven days a week morning and evening. I couldn't find any other nurses at my home health agency who could help out since most of them live on the other side of town. I brought in a friend of mine who I went to nursing school with who could use some extra money and lives very close to the facility. At the time she was working per diem at a hospital. I mostly asked her to cover the majority of weekends and some evenings, since she doesn't have kids it worked out well for both of us.

Fast forward to now: gradually over time She started to see the weekend and evening visits as hers And would count on the income instead of being a fill-in for me. If she went on vacation or went out of town she considered that I was covering her visits, and would want me to switch visits with her on other days so that she could keep her income steady, even though I was available to do those visits and did not need them covered. I did not expect her to be available every time I needed coverage, but she was JUST supposed to be coverage for this facility. When new patients would get assigned to our home health from the facility she would ask who was supposed to see that patient, As if we were both covering the facility, rather than her filling in for times that I could not come. You get the point.

She does also see other patients for this home health, and if she does occasionally ask me to cover for her, she knows that they are still her patients and that I'm only covering while she's out of town, so I know that she understands how it works.

Now it has gotten to the point where the facility is so busy, that instead of driving all over town and putting hundreds of miles on my car per day and spending lots of time on the road, I could actually make a full-time income just by going to this facility twice daily. It would be a fantastic opportunity for me to finish school, and work on a side business that I'm starting. Opportunities like this don't come along very often. And I worked hard to build up the good reputation we have at this facility. I am the one who is there for the daytime visits with the administrator and the main med tech, they hardly know the other nurse, one of them actually doesn't even know her name after two years. She's Does her job fine, she's just not as visible to them partially because of the times that she's there and partially because she is really quiet and just hasn't been focused on building the relationship up.

So my dilemma is that I want to take back the reins on this facility, but it may be too late to do that without ruining the friendship, and I am concerned that if she gets mad about it she may not want to do coverage for this facility at all, which I still would need. I don't even know if she still working at the hospital part time. She definitely considers that the evenings and weekends are her visits, the idea that I've brought her in to the company in the first place to Provide back-up is long gone in her mind. And I don't want to put her in a position where she has a huge loss of income. But, the home health agency can assign her more patients. And I am a working mom, she does not have kids and she does still live at home with her parents so she is not going to be homeless without the income. And then, if she does get really mad and does not want to work with me at all anymore, not only do I lose a friend, but then I also have the dilemma of possibly having to work seven days a week twice a day without ever being able to take a day off if I can't find coverage. And we have a camping trip coming up in April.

So, What would you do in this case?

I think you need to discuss this with the Clinical Supervisor/Case Manager or the Director of Patient Care Services and have them resolve the issues. Ideally, you could speak to your colleague and get everything worked out, but that is not realistic and not likely. The supervisors get paid to deal with situations like this. Let them come up with the answers and if you lose a friend, well, she wasn't much of a friend to begin with. BTW, when I work only fill-in on a case, I know my place. I don't try to take a regular nurses' hours away from her/him. Common sense. Not so, with everyone. One time I was approached by the client who told me a newly added nurse to my extended care case, asked her to ask me to give up two of my shifts to her! I looked at the client and said something like, "Are you being serious? Did she say that with a straight face?" This is the type of bind your "friend" is putting you in. She needs to be put back in her place. Best done by the DPCS or Clinical Supervisor. Don't feel guilty. This is what happens when you try to help out a "friend".

You are wrong in this OP. She works for the company not you. She has a right to look out for herself, not play second fiddle to you so you can play mommy. She may not be a mom but she has a life and her time is as valuable as your . She is helping you achieve a better life with your kids and you are still upset! I sense jealous on your part. You should take back the facility and see how much you like working night and weekend. You should be more grateful to her and not try to putting knife in her back. Good luck working all nights and weekend I am sure your kids would love that

Wow, it's all about you OP, isn't it?

Your friend took a position with your employer, not you, and has covered most weekends so you can keep this sweet gig but you treat her like she's your *****.

I'm with Alt-Murse, you have it wrong.

Did you guys read the whole post? Do you do agency work in home health?

Yes, she now works for the agency, not me, and she also has her own patients with the agency. But for all of the patients at this specific Assisted Living, those patients are assigned to me. When you have Home Health patients at this kind of agency where the nurses are contractors, you get them covered when you need time off but the patients stay assigned to you. Nurses do not have to accept covering for you.

She does not have to cover my patients if she doesn't want to, but she also can't claim that certain visits days and times are now hers for my patients. I let her know that I was looking for this type of coverage and she said that worked for her so I brought her into the company. I assumed if she liked Home Health she'd continue working with the agency with her own patient load, no problem. And if she wanted to eventually stop covering that facility for me as needed I'd be fine with that too. I'm not saying I expect her to be available at my beck and call.

What I'm saying is that she has begun to flip it so that she acts like the evening and weekend visits at that facility are hers and wants me to give her more visits to make up when she can't do those. And has tried to get some of the patients at that facility assigned to her after I got the referral. Anyone who works per diem at Home Health knows the politics.

I'm not saying she's less important because she doesn't have kids and lives with her parents. What I'm saying is that I know that she doesn't have a lot of overhead so even if it's a slight adjustment and she has to get her own patient load up, it won't be a short term crisis. And I do have a family to look out for and I am the one who put in the work to build up this facility, so I shouldn't just let this go and sacrifice the income just because I'm afraid to confront her about it.

And I would not be working long evenings and weekends. That's the whole point, that I've built up the patient load here and now have it so that I could spend 2 hours in the AM and 1 hour in the evening at the facility and do my charts at home, instead of doing only the weekday AM visits here and then the rest of the day driving around the city to individual patients, and make the same money.

She covered visits but she did not do rounds with the MD, inservices with the staff, and all the other unpaid time I put in to build it up.

If she opened a new facility for this agency she would get the same benefit. The agency would assign all new patients from that facility to her, she could find a back up nurse for days and times that she can't make it.

But honestly, any nurse who works Per Diem for home health already understands all of this. So that's really who I'm looking for advice from.

CaliOtter3-

Yes I initially thought about going to my supervisor but I wasn't sure if that was my chicken instinct, hehe. But you are absolutely right, that's their job. I also talked to my mom about it and she said the same thing. My friend knows what she is doing as well, and has taken advantage of the fact that I haven't pushed back when she starting claiming all weekends and evenings even when I didn't need coverage. Most likely she'll just take on more of her own patients, and it won't be as sweet of a deal for her, but she can put in the same work I did if she wants this same situation for herself. Also, it was harder to find coverage when I started the place because visits were scant, but now that each visit will be 2-4 patients, it should be worth the drive even for the nurses who live across town, so getting coverage may be easier.

Thanks!

You are wrong in this OP. She works for the company not you. She has a right to look out for herself, not play second fiddle to you so you can play mommy. She may not be a mom but she has a life and her time is as valuable as your . She is helping you achieve a better life with your kids and you are still upset! I sense jealous on your part. You should take back the facility and see how much you like working night and weekend. You should be more grateful to her and not try to putting knife in her back. Good luck working all nights and weekend I am sure your kids would love that

I already end up working evening and weekend sometimes, usually at complicated hospice visits. I realized that she's getting the fruits of my labor doing the quick and easy 3-patients-in-one-stop at the facility that I got the referrals for, while I end up driving back and forth across town to see other home health and hospice patients.

She's not playing second fiddle so I can 'play mommy', although that says a lot about your views of kids and parenting. She's getting first fiddle from my years of work, while I juggle 'playing mommy' and taking on a hefty patient load of more complicated case that are all over the city and sometimes a 30 minute drive from one to the next.

She essentially put a knife in my back by trying to get my referrals assigned to her and expecting me to let her have my visits that i don't need coverage for because she has decided that she's entilted to a certain number of visits from MY patients. I do sometimes cover for her other patients when she goes out of town and I would NEVER think I could just keep seeing her patient when she got back just because its convenient or I need the money. I get new assignments from the agency when I need them.

Wow, it's all about you OP, isn't it?

Your friend took a position with your employer, not you, and has covered most weekends so you can keep this sweet gig but you treat her like she's your *****.

I'm with Alt-Murse, you have it wrong.

It's not a sweet gig, because I do a few visits and then spend additional unpaid time at the facility doing inservices, rounds with the MDs, and in wellness meetings. That has earned our HH a lot of ongoing patients and new referrals. She has decided that since I was having her cover 2-3 weekends a month and 1-3 evenings a week, that eventually the evenings and weekends were hers because that was easier than her other jobs. So now she has about 2/3 of the total visits at that facility instead of being my backup. She can get other assignments from the home health, and she does have some of her own patients, but she'd have to put in the same work i did to get the sweet gig SHE now has. And now I'm making up for it doing the kind of 100+ miles a day driving from visit to visit that I was doing as a new nurse. The point of putting that time in at that facility was to eventually get to this point. But now she's reaping it. She never had to cover any evening or weekend that she didn't want to or couldn't, but as far as this PARTICULAR facility goes she was only cover.

I don't know how to make that more clear.

Your explanations get more dramatic and contradictory as you go. Now it's a knife in your back? If that's the case, why are you concerned one iota of losing this friend?

I have a bit of experience in intermittent skilled home health, in all capacities of it.

Your explanations get more dramatic and contradictory as you go. Now it's a knife in your back? If that's the case, why are you concerned one iota of losing this friend?

I have a bit of experience in intermittent skilled home health, in all capacities of it.

Yeah I read through some of your comment history and I can see that you are looking more for an argument than to give any advice. I was using the "knife in my back "quote from the other commenter to say that if anyone is doing that it's not me, it's her. Because she is trying to steal patients that I got referral for, when everyone at the company knows that when you get the referral you get the patient unless you don't want it for some reason. Those were not my words, those were from the commenter that I was answering.

There is nothing contradictory in my statements. I just keep trying to explain the same thing over and over again in different ways, because obviously the context of the situation was not understood.

Nurses who get paid per visit rather than on salary or hourly, and who get rewarded for building up relationships with facilities by Getting those patient assignments will understand this situation better. I am not looking for judgemental comments from people who are not in that situation and are making assumptions. I was looking for advice from nurses who know this specific type of situation and have advice on how to handle it.

Edited by LVNblue8
Typos

Simplistically, it is 'first come, first get' unless for some reason the mgmt wants to 'take care' of her employment needs over your employment needs, which can sometimes happen. Since they are the bosses, its their call. Point out everything you said in the post above and see what they do about it. As long as you are logical and not emotional in your presentation, you should have no reason to fear what transpires. I understood what you were originally asking. I don't think you are out of line to bring up your concerns to mgmt, but you must be prepared to accept their resolution even if it does not go the way you would like.

Let's put it this way:

Say you have a full time job with regular shifts at the hospital. They are understaffed and when you need time off there is no one available, and you haven't been able to take a day off in 6 months. So you do your own recruiting and find a friend who is interested in signing on with the hospital to be a PRN shift nurse. And that friend now works for the company but is only PRN. If they want to hire her full time for her own position, that's fine with you, but they don't. You ask her to cover shifts here and there, she covers them if she can, doesn't cover if she can't. She also may get called in to cover for other nurses.

But then one month you end up taking a lot of leave, maybe have a vacation, then you get sick, some family leave, etc. While you were gone, the friend you brought in to the company ends up being the one to cover all of those shifts. She gets used to the schedule and the regular paychecks and starts to feel like it is her job.

When you come back she starts asking you if you can cover her on this or that day, even though those are going to be your shifts now that you are back. You were not fired or notified that you were losing your schedule, you were just out for an extended period. And she expects you to give up some of those shifts to her, as if it is now her job.

I think you can see in that situation it would be totally crazy for a PRN nurse to expect that she now has the job of the other nurse, just because she did cover for an extended period of time, even if she was mostly covering weekends and evenings and even if it was helpful to the primary nurse. It's still that first nurse's job.

Except, in my situation, we don't have a scheduler that can tell that other nurse that she is not scheduled for those days, because they just give me the patients and have me schedule myself, and I directly scheduled the coverage with the PRN nurse.

So basically what I'm asking is, since this person is my friend and I do care about her, she has crossed a professional boundary and I have been giving up visits to her that I don't need covered out of timidity basically. I am ready to take back some of those visits and feel the rewards of the work I've put in at that facility. What's the most diplomatic way to go about it?

Simplistically, it is 'first come, first get' unless for some reason the mgmt wants to 'take care' of her employment needs over your employment needs, which can sometimes happen. Since they are the bosses, its their call. Point out everything you said in the post above and see what they do about it. As long as you are logical and not emotional in your presentation, you should have no reason to fear what transpires. I understood what you were originally asking. I don't think you are out of line to bring up your concerns to mgmt, but you must be prepared to accept their resolution even if it does not go the way you would like.

I did talk to the PCC today and they are going to offer her a lot of new cases in the next couple weeks, then I will give her a period of time before I go back to my old schedule to allow her to gradually adjust to her own patient load. I'll still offer her opportunities to cover if she wants them, but I'll get other nurses on board for my already planned trips this year in case she doesn't want to cover anymore. Basically it's up to her to respond in a reasonable way. So I guess I figured it out. Honestly when I answered the other commenters I realized within those answers that she most likely knows she's been riding a lucky wave here and probably expected it to end eventually but was just getting the most out of it in the meantime.

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis.

Without reading any responses yet my first inclination is to say this friend works for the agency, not for you. Unless you are the case manager for the agency who gets offered what assignments isn't up to you. You're not her boss and really shouldn't have any say in what patients another employee is offered regardless of how she got the job. That said, if your employer allows flexible assignments you might be able to work out something that works for both of you.

Without reading any responses yet my first inclination is to say this friend works for the agency, not for you. Unless you are the case manager for the agency who gets offered what assignments isn't up to you. You're not her boss and really shouldn't have any say in what patients another employee is offered regardless of how she got the job. That said, if your employer allows flexible assignments you might be able to work out something that works for both of you.

Omg this is kafkaesque!!!

Yes, she works for the agency and I have ZERO control over HER assignments. If she asks me to cover one of her patients, I would ONLY be coverage, even if it was long term.

I'm not asking about HER assignments.

The case I described is regarding MY assignments which I asked her if doing coverage for these patients on some evenings and weekends was something she was interested in, and she was. She's not the only nurse I asked, she's the one who was the most interested.

I am not trying to have control over her relationship with the company or any of her independent assignments.

I'm saying that she got really comfortable doing coverage visits for me to the point that she sees those patients as ours and expects the weekend and evening visits to be hers even if I don't need coverage.

As I've tried to explain over and over: as far as the agency is concerned, we each have our own patients and we can get them covered as needed but they stay with us unless we ask to have them reassigned. The agency is not stopping me from setting that boundary with the other nurse. The agency assigns all visits at this specific facility to me, and I am allowed to schedule myself according to patient needs and my availability. If I'm getting visits covered, I just notify them which nurse is covering which visits so they know who to contact for anything urgent. That's how all patient assignments work here.

Everyone who keeps saying that she works for the agency and not me: Yes, she can do anything she wants with the agency, but when she is being asked to cover for already established patients for ANY other nurse at the facility, she is covering AT THAT NURSE'S discretion, as they need coverage.

If you showed up to work and a friend who had covered you for a few Fridays in a row showed up the next Friday when you didn't need it and expected that that was now her shift that you had to give up to her indefinitely, would you just say "we'll, she works for the agency, not me, I have to let her do this."? Neither myself NOR the agency has given her permission, she is imposing this on her own.

I was ONLY asking how to go about asserting myself in this power struggle she has created as diplomatically as possible with this friend who I care about but have grown frustrated with in this issue.

This forum is obviously not the place for thoughtful advice.

Without reading any responses yet my first inclination is to say this friend works for the agency, not for you. Unless you are the case manager for the agency who gets offered what assignments isn't up to you. You're not her boss and really shouldn't have any say in what patients another employee is offered regardless of how she got the job. That said, if your employer allows flexible assignments you might be able to work out something that works for both of you.

I just feel like it needs to be said one last time: the agency has never asked her to do these visits that I'm referring to. The agency views them as my visits. I'm not butting in on her relationship with the agency or her assigned patients.

These are visits that are my assignments, I am expected to either go myself or get coverage. Agency doesn't care how I do it as long as visits aren't missed.

Friend doesn't have to cover any visits that she doesn't want to. She was accepting almost all coverage that I was looking for, mostly weekends, some evenings and occasional mornings. Gradually she started to feel like certain visit blocks of these patients assigned to me were now her scheduled visits (in her eyes only, not according to agency, not according to me- the nurse assigned to these patients).

I'm trying to get back to an understanding that I only need coverage when requested, instead of her automatically going every evening and weekend. She never really had the right to get comfortable with those visits or that income, but she did. I want her to get her own assignments with the company if she wants to keep that work load instead of piggybacking my assignments in a way that no one authorized.

Is that clear? Or am I speaking a language from another planet?

"I couldn't find any other nurses at my home health agency who could help out,asked her to cover the majority of weekends and some evenings."

Now you want the former scheduling back. Sounds like there are plenty of patients to go around.

I feel you owe her some loyalty, only you know if it's worth losing the friendship.

Unless you own the agency you do not own the patients. The other nurse has the same rights you do. Good agencies would encourage different nurses to rotate in, why you may ask? Patients benefit from different nurses assessing a patient who need twice a day nursing deserve different providers assessing the patient.

I agreed with this at first, which was why I did not push back when she was starting to expect work even when I didn't need the coverage.

But, at the end of the day, it's not that she was doing me a favor. No one at my agency wanted those visits because they were across town. I approached the nurses that I knew either from school or prior jobs who lived near the area where these visits are, where it would make more sense for them. I wasn't begging for help, I was like "Does anyone want to do some intermittent home health visits in (this part of town), usually evenings and weekends" to multiple nurses. She wanted to do it.

The offer was to Sometimes cover these evenings and weekends when she could. No pressure to cover if she couldn't. It wouldn't be a matter of me wanting the former scheduling back if she hadn't pushed her way into taking over those evenings and weekends completely. It was never supposed to be that way. Any other work she wants with the agency, that's between her and the agency.

Unless you own the agency you do not own the patients. The other nurse has the same rights you do. Good agencies would encourage different nurses to rotate in' date=' why you may ask? Patients benefit from different nurses assessing a patient who need twice a day nursing deserve different providers assessing the patient.[/quote']

Sure, a good agency might rotate nurses. I agree. But this agency does not do that. This agency has never asked her to visit the specific patients that I am referring to in this thread. That would be a completely different story. If that was the case, my whole premise would be ridiculous. But at this agency, for better or for worse, they assign you a patient, and it is your responsibility to see that patient, whether they are one visit per week, or two visits per day. I don't actually think that this is a great system, but this is how the agency works. The agency will sometimes reassign or split cases for various reasons such as language needs, etc. In those cases, whatever the agency says goes. I am not in anyway asserting that I have more power than the agency. I have never argued with the agency if for any reason they reassigned a patient to a different nurse. I don't know how many times I can say that in this thread.

This is not a case of the agency sending out a different nurse. This is a case of me asking a nurse to cover for me sometimes, and that nurse deciding that instead of covering for me sometimes, she was just going to always go at those times, And because of the way this agency operates, there really isn't a mediator to step in unless I request it directly. And I realized that I put all of this work into building up a large number of patients at this facility, and that she just shows up basically when she wants to (all evenings and weekends EXCEPT when she goes on vacation or had something to do, and then expects me to give her morning visits when she is available to make up for any time she was gone. So she has the convenience of not being tethered to the visits and being able to come and go as she pleases by passively recognizing that the visits are my responsibility, but then making sure to get the amount of work that she wants in a given week). So I want to get things back under control. And that's all I wanted, was advice on how to approach that.

I thought this was more common, as nearly every agency I've ever worked at operates this way. But I'm thinking based on responses that this must be a very regional thing.

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