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?

[Ginger's Mom, MSN, RN]

From the Medicare Home Care Manual - you are violating number 5- the agency is responsible for the scheduling, not you. Bringing this up about "your visits" just sheds light on the fact you had a good thing going and now you could be loosing it all.

§484.14(f) Standard: Personnel Under Hourly or Per Visit Contracts

______________________________________________________________________

G142

If personnel under hourly or per visit contracts are used by the HHA, there is a

written contract between those personnel and the agency that specifies the

following:

(1) Patients are accepted for care only by the primary HHA.

(2) The services to be furnished.

(3)The necessity to conform to all applicable agency policies, including personnel

qualifications.

(4) The responsibility for participating in developing plans of care.

(5) The manner in which services will be controlled, coordinated, and evaluated

by the primary HHA.

[LVNblue8]

From the Medicare Home Care Manual - you are violating number 5- the agency is responsible for the scheduling, not you. Bringing this up about "your visits" just sheds light on the fact you had a good thing going and now you could be loosing it all.

§484.14(f) Standard: Personnel Under Hourly or Per Visit Contracts

______________________________________________________________________

G142

If personnel under hourly or per visit contracts are used by the HHA, there is a

written contract between those personnel and the agency that specifies the

following:

(1) Patients are accepted for care only by the primary HHA.

(2) The services to be furnished.

(3)The necessity to conform to all applicable agency policies, including personnel

qualifications.

(4) The responsibility for participating in developing plans of care.

(5) The manner in which services will be controlled, coordinated, and evaluated

by the primary HHA.

The agency does do the scheduling! They scheduled me for these visits! But because of the grueling nature of twice daily visits every day of the week indefinitely, I looked for someone who could do semi regular coverage. That way I wouldn't be counting on the agency to find coverage for me every single week for one or two mornings or evenings whether on the weekend or weekday, since obviously I wasn't going to be able to do morning and evening seven days a week forever. But that's what I'm trying to say, the agency did schedule these visits. To me. And whether or not it was the same nurse going a few times a week, or a different nurse going every time, those visits were coverage because I was scheduled. This was just a way to streamline things for everybody. If I got sick, and she could not go, the agency did get those visits covered. And when the case manager does go, she just tells me when she's going, She makes the schedule. So when she does have SOCs or ROCs or supervisory visits ( I did forget to mention supervisory visits in my last post), she goes according to her schedule.

What if these were shifts instead of visits? Would that be easier to understand? If I was scheduled for dayshift on Sunday, Monday, Tuesday, Thursday, and Saturday, the agency scheduled me for those days every week. If for some reason I need Thursday off fairly frequently, I can't just say "please find a different nurse for this Thursday". They have already scheduled me for that day, and as you have all said a thousand times, I'm not in charge of scheduling. So instead, I find another nurse at the agency who is willing to cover that shift, they agree to cover or trade, and I let the agency know. And As long as a nurse who is contracted with the agency is covering, everyone is OK with it. But in the end, that is one nurse's scheduled shift, and another nurse is filling in either that day or intermittently. Unless the agency changes the nurse's schedule. In that case, it may no longer be the first nurse's shift. But if the agency is not changing anyone's schedule, then that shift is scheduled to the first nurse, and the first nurse is sometimes getting coverage. It would be bizarre for the nurse who started coveraging about half of the Thursdays to just show up every Thursday whether asked to cover or not, if the agency never told her to and the first nurse was still on the schedule.

Im not saying I own The agency or those patients or those visits. But I am saying that my agency has scheduled those visits to me, and has never changed that, and I went and got coverage for visits that I knew I would need fairly frequently, instead of asking the agency to get those visits covered week by week. And without ever being told to do those visits by the agency, my friend decided that instead of going only on the weekends or evening shifts that I asked for coverage and that she said she could cover, she just decided to go every evening and weekend, and then ask me if I could ‘cover her' if she was not going to be available or be out of town. So it was a bit of a takeover that was not authorized by the agency, and one last time, the agency did schedule me for those visits.

It doesn't matter at this point because I did already talk to someone at the office about it and I talked directly to my friend yesterday, and we worked it out because we adjusted both of our schedules in a way that works for us.

It's funny because I anticipated that she might get upset, but she actually took it just fine and it also worked for her. She's actually moving in four months anyway. She had not mentioned that yet, and was trying to figure out when to tell me because she wanted to give me enough time to get coverage but she didn't want to have less work up until moving. So she totally did know that it was coverage the whole time and really was just getting the most out of it, which I can't blame her for since I was afraid to be forward about it. The PCC found a couple of other nurses at the agency who will be sometimes willing to fill in once this nurse moves. Of course if I get sick or have an emergency, the agency gets these visits covered. But because these are ongoing daily visits (not for all the patients, but at the facility as a whole), it is nice to just have some standby nurses who don't mind doing coverage for this facility once or twice a week. It's just easier on the agency and on me. That's the whole idea.

But I know I certainly won't be coming here for advice anymore!

[NurseCard, ADN]

LOL, this whole thread has me confused. So forgive me. But this:

Quote:

And without ever being told to do those visits by the agency, my friend

decided that instead of going only on the weekends or evening shifts that

I asked for coverage and that she said she could cover, she just decided to

go every evening and weekend, and then ask me if I could ‘cover her' if

she was not going to be available or be out of town.

So it was a bit of a takeover that was not authorized by the agency, and

one last time, the agency did schedule me for those visits."

HOW in heaven's name could your friend "just go" to do visits that were

scheduled to you? That makes NO sense whatsoever. In my experience,

I could get in a S-TON of trouble for going to visit a patient that I was

not scheduled by the agency to see! The agency scheduled you

for those visits, you go! You can't perform your visits for whatever

reason, then the agency schedules someone else.

This whole thread has me confused as all get out. I know it

seems simple to you, but it has me totally confused.

[kbrn2002, ADN, RN]

What if these were shifts instead of visits? Would that be easier to understand? If I was scheduled for dayshift on Sunday, Monday, Tuesday, Thursday, and Saturday, the agency scheduled me for those days every week. If for some reason I need Thursday off fairly frequently, I can't just say "please find a different nurse for this Thursday". They have already scheduled me for that day, and as you have all said a thousand times, I'm not in charge of scheduling. So instead, I find another nurse at the agency who is willing to cover that shift, they agree to cover or trade, and I let the agency know. And As long as a nurse who is contracted with the agency is covering, everyone is OK with it. But in the end, that is one nurse's scheduled shift, and another nurse is filling in either that day or intermittently. Unless the agency changes the nurse's schedule. In that case, it may no longer be the first nurse's shift. But if the agency is not changing anyone's schedule, then that shift is scheduled to the first nurse, and the first nurse is sometimes getting coverage. It would be bizarre for the nurse who started coveraging about half of the Thursdays to just show up every Thursday whether asked to cover or not, if the agency never told her to and the first nurse was still on the schedule.

I'm glad you worked it out, but this analogy doesn't help your cause at all. What if they were shifts instead of visits? There's no employer anywhere that schedules a single nurse for 2 shifts every day, seven days a week. I'm surprised that a Home Health agency is allowed to schedule like that. If your schedule is as you say you are obligated to work twice a day, seven days a week with zero time off unless you replace yourself? Is this even legal?