Hospitalizations and Pdn

[smartnurse1982]

When you pts have an emergency and need to go to the hospital,does your agency make you go with the parents and child? Most agencies tell us to go,but follow the ambulance in our own car. Some say don't go anywhere;you have to go home because its the caregiver responsiblility.

Agency M tells us to stay until the kid gets admitted or discharged,because leaving would constitute "abandonment". The kids aren't the hospital's responsibility until either admission or discharge.

Another agency says as soon as the kids are in the hospital or ambulance,its the hospital's responsibility and the parents responsibility. You must leave as there is no reimbursement by the insurance companies.

What are your agencies rules?

I'm curious, because I have stayed in the hospital with some of the kids until admission or d/c and none of the nurses who worked for the hospital didn't do any actual hands on care, but they did take vitals.

I had to do all the suctioning of the trachs and changing the diapers.

Almost all of the parents have said when they wait in the ER(about 4 hrs around here) if the Pdn wasn't there that they would have to do everything themselves.

[nursel56]

Usually our nurses drive to the hospital and stay with the patient until what would've been the end of the shift and so far as I know, the agency always pays the hours. I know of at least one case where caregivers would show up for work in the hospital room and were still paid by In Home Supportive Services.

I don't think it can be considered abandonment if you leave at the end of your shift as there are consent forms signed for treatment in the ED apart from whether or not the child is admitted.

It is a great question though because I know that if a staff nurse sees a pd nurse there, he or she tends to make infrequent visits even though legally they are under their care at that time.

I'd be curious to know how quickly your EDs want to switch to hospital vents. One of my adult patients had major anxiety issues to the point of panic over that.

[eeffoc_emmig]

In my orientation, I was told to stay until the patient is loaded into the ambulance.

[smartnurse1982]

Usually our nurses drive to the hospital and stay with the patient until what would've been the end of the shift and so far as I know, the agency always pays the hours. I know of at least one case where caregivers would show up for work in the hospital room and were still paid by In Home Supportive Services.

I don't think it can be considered abandonment if you leave at the end of your shift as there are consent forms signed for treatment in the ED apart from whether or not the child is admitted.

It is a great question though because I know that if a staff nurse sees a pd nurse there, he or she tends to make infrequent visits even though legally they are under their care at that time.

I'd be curious to know how quickly your EDs want to switch to hospital vents. One of my adult patients had major anxiety issues to the point of panic over that.

They don't switch vents until 2 hrs later.

Many don't have the common in home vent ,the Ltv series,available.

[ventmommy]

Our hospital only used the ICU vents if there was a respiratory problem and adjustments on the home vent didn't alleviate the problem.

We went to the hospital a couple of times by ambulance and a couple of times POV. In every case, the nurse came with and didn't leave until my little one was admitted. I did most of the bedside care but it was nice to have the nurse there in the ER especially on the times when my husband was deployed.

[SDALPN]

Medicare/medicaid doesn't pay for nursing while a patient is in a Dr office or hospital because it's considered double billing. So the agencies here all tell the nurses that they can't go with the pt. The agencies here tell us they won't pay us while the pt is at the Dr office, but we still have to go. I won't work if they won't pay me. I don't see how it would be abandonment if the care has been transferred to a competent, skilled provider. Especially if at that time, the billing switches over to the next provider. Plus if the parent is with the child and report has been given to the parent it's not abandonment. Report is legally what transfers care to the next person, just as if we don't accept report we haven't accepted the patient/assignment.

[eeffoc_emmig]

Medicare/medicaid doesn't pay for nursing while a patient is in a Dr office or hospital because it's considered double billing. So the agencies here all tell the nurses that they can't go with the pt. The agencies here tell us they won't pay us while the pt is at the Dr office but we still have to go. I won't work if they won't pay me. I don't see how it would be abandonment if the care has been transferred to a competent, skilled provider. Especially if at that time, the billing switches over to the next provider. Plus if the parent is with the child and report has been given to the parent it's not abandonment. Report is legally what transfers care to the next person, just as if we don't accept report we haven't accepted the patient/assignment.[/quote']

Our day shift nurses spend a lot of unpaid time in MD offices or at hospitals when a patient has tests. I would be furious to be forced to go and not get paid.

Our 485s state that the parents are competent caregivers. ..that keeps us from getting accused of abandonment. Just remember to get the parent to sign the flowsheet do they can't lie about it.

[ventmommy]

There is zero possibility that I could have taken my son to a medical appointment (or to the ER) without having a nurse with us since he couldn't be in the car by himself. I know that our nurses were paid for time at appointments and in the hospital because I specifically asked about it after a post on here (although his primary insurance was not Medicaid). Nurses were not allowed, per agency rules, to transport a child in their own vehicles or to drive my vehicle. They were only allowed to be the passengers in my vehicle, public transportation or the school bus.

[nursel56]

My experiences track with yours ventmommy and eeffoc. The plan of care specifically permits accompanying the client on outings (including visits to their doctor) and prohibits the nurse from transporting in their own vehicle. It helps to have an extra set of ears at these appointments, and expedites processing of new orders.

For the sake of parents or pcgs I'm glad this works out. The transport and admission process is stressful for everyone.

[eeffoc_emmig]

There is zero possibility that I could have taken my son to a medical appointment (or to the ER) without having a nurse with us since he couldn't be in the car by himself. I know that our nurses were paid for time at appointments and in the hospital because I specifically asked about it after a post on here (although his primary insurance was not Medicaid). Nurses were not allowed per agency rules, to transport a child in their own vehicles or to drive my vehicle. They were only allowed to be the passengers in my vehicle, public transportation or the school bus.[/quote']

My agency just started not paying for that time about 8 months ago.

[SDALPN]

My experiences track with yours ventmommy and eeffoc. The plan of care specifically permits accompanying the client on outings (including visits to their doctor) and prohibits the nurse from transporting in their own vehicle. It helps to have an extra set of ears at these appointments, and expedites processing of new orders.

For the sake of parents or pcgs I'm glad this works out. The transport and admission process is stressful for everyone.

We can still go anywhere the pt goes. We just won't be paid if they are at another providers.

[nursel56]

We can still go anywhere the pt goes. We just won't be paid if they are at another providers.

Sigh. . .I guess we have to get used to this. I can see the hospital or emergency dept being classified as "another provider" since they do have resources in place, but the average employee at a doctor's office (who may be a MA) is not going to have a clue what to "provide" if anything goes wrong, which alarm means what, etc., especially with fragile vent patients.

Most nurses I know will probably take the pay hit as leaving and returning is often not feasible with driving distances factored in.