Great opportunity, might lose a friend???

[LVNblue8]

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?

[LVNblue8]

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]

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.

[LVNblue8]

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.

[LVNblue8]

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?

[Been there,done that, ASN, RN]

"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.

[Ginger's Mom, MSN, RN]

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.

[LVNblue8]

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.

[LVNblue8]

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.[/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.

[Libby1987]

You're speaking of your role as if you're an RN case manager but your user name is LVN.

Are these intermittent billed visits and who's the payer? Or this some sort of private arrangement?

[LVNblue8]

You're speaking of your role as if you're an RN case manager but your user name is LVN.

Are these intermittent billed visits and who's the payer? Or this some sort of private arrangement?

No, I'm not speaking as if my role is the case manager. I'm speaking as if my role is the visiting LVN according to the way my agency operates.

The case managers here do the SOC and ROCs but are otherwise in the office and then the assigned LVN does all of the visits in between and reports to the case manager. I give weekly updates on these patients to the case manager, I go in for case conference, I pick up supplies for these patients, I report to the MD and get new orders if necessary. The other nurse does not do those things for THESE patients. She simply goes to do the hands-on care, and if anything else comes up she reports to me, and I handle it with the case manager. She DOES do all of those tasks for patients that are assigned to her. That's why I'm insisting, as far as the agency is concerned, these are my visits unless I get them covered, and she has just happened to be the primary coverage. But she absolutely understands the situation, because she does have a bigger responsibility for patients that are actually assigned to her, and those patients stay with her unless the agency changes that.

These are intermittent billed visits, some Medicare and some private insurance.

[Libby1987]

We don't have patients like that on service, ours are primarily high acuity and/or advanced illness. Wound patients with WOCN oversight and a small amount of indwelling catheters.

Our RN case managers make more than the SOC and Recert visit. They perform the assessments on the high risk patients and eval/adjust the POC on all patients throughout their episode of care. What you have been describing does not exist in our company nor any of the large hospital based home health agencies in my area.

[Ginger's Mom, MSN, RN]

We don't have patients like that on service, ours are primarily high acuity and/or advanced illness. Wound patients with WOCN oversight and a small amount of indwelling catheters.

Our RN case managers make more than the SOC and Recert visit. They perform the assessments on the high risk patients and eval/adjust the POC on all patients throughout their episode of care. What you have been describing does not exist in our company nor any of the large hospital based home health agencies in my area.

Your agency is doing it right it is the regulation. The agency if Medicare Certified is responsible for staffing not an individual. I understand how you can become familiar with an assignment but it does promote a sense of entitlement. For example the "friend" took the less desirable weekends and nights, and now when the original nurse wants more time rather than asking the agency for more visits she is asking the helper to give up her assignment.