Hospitalizations and Pdn

Specialties Private Duty

Published

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.

Because CPR in and of itself is grossly inadequate. CPR is highly unlikely to restart the heart. That's why there's such a big focus on early defibrillation these days.

I'm saying,if that's the case,then why don't we have defibs in the home then?

I'm mostly referring to Peds btw,and according to AhA,most children's hearts stop because of respiratory arrest,while in adults its because of cardiac issues that respirations arrest.

That's what I've been told by past nursing supervisors also,which is why defibs aren't needed in the home.

To me it makes sense.

Mypatients have not used an ambulance. However we have made numerous trips to doctor appts and ER visits. I always stay until the patient is admitted.I get paid for that.Generally I am quite busy since the patient wouldnt be there if they werent sick.

I'm guessing the agency pays you with their own money,and not incurance money?

I guess if I didn't get paid,I would just stick around.

The human side of me would want to.

I regularly stay late at some cases(a 1/2 hr max) but I don't put the time down.

I put the time I'm supposed to leave.

Specializes in Pediatric.
In my orientation I was told to stay until the patient is loaded into the ambulance.[/quote']

This is what I've had told to me from two agencies.

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Specializes in Pediatric.

Usually we stopped getting paid at the formal time patient was admitted- at which time agency expected us to leave, HOWEVER I had one family who was very "needy" I say this in the nicest way, and they insisted I stay until the end of my shift AND get paid, and I did. The agency just had me not chart and they paid me directly.

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I'm sure I sound awful, but I don't work for free. I maintain a strictly professional relationship with the families so I won't spend time after my shift. Luckily, I work nights so I don't have to deal with MD visits and not being paid. One of the nurses on my current case is looking for another job because she can't afford to lose so many hours.

Usually we stopped getting paid at the formal time patient was admitted- at which time agency expected us to leave, HOWEVER I had one family who was very "needy" I say this in the nicest way, and they insisted I stay until the end of my shift AND get paid, and I did. The agency just had me not chart and they paid me directly.

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My pts don't get admitted until 2 to 3 hrs after they arrived in the ER.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I am not even sure how to respond..a defibrillator in the home? I am SURE that even in South Jersey woods you are close enough to 911 that it isn't necessary to have a defibrillator at home. IF the family wanted to purchase one they are called a AED Automatic External Defibrillator.

My experience, which I admit is limited, with home care was one agency that catered to critically ill children at home. We were ALL critical care RN's and the parents had a mini ICU in their homes. Even I had to call 911. I had drugs...but no defibrillator. I was required to go to ALL appointments, however, when it came to the ER, once I turned her care over to a critical care team my responsibility ended.

IF the call was non ACLS worthy and the patient could be cared by the local ED...I was PAID to go along and stay with the patient until I had relief by another critical care nurse. Many times IF the patient could be cared for the local ED we stayed as an agreement was reached with the facility, agency, and parent for the agency RN to stay due to the complexity of the patient but only if the home vent was used during the patient visit.

As an emergency department nurse....if there is a private duty nurse the care of the patient is the responsibility of the home care nurse for the equipment/vent/patient for routine care/suctioning/cleaning unless they ask for assistance. Why on earth would the PDN need assistance of the ED RN when this is their patient and they are the ones familiar with the equipment/patient...that is what YOU are being paid for...care for the patient in transition until the patient is admitted and placed on hospital equipment. Which can easily be 2-3 hours.

However, I have never had the PDN take supplies without asking as you have indicated in another thread.

I am not even sure how to respond..a defibrillator in the home? I am SURE that even in South Jersey woods you are close enough to 911 that it isn't necessary to have a defibrillator at home. IF the family wanted to purchase one they are called a AED Automatic External Defibrillator.

My experience, which I admit is limited, with home care was one agency that catered to critically ill children at home. We were ALL critical care RN's and the parents had a mini ICU in their homes. Even I had to call 911. I had drugs...but no defibrillator. I was required to go to ALL appointments, however, when it came to the ER, once I turned her care over to a critical care team my responsibility ended.

IF the call was non ACLS worthy and the patient could be cared by the local ED...I was PAID to go along and stay with the patient until I had relief by another critical care nurse. Many times IF the patient could be cared for the local ED we stayed as an agreement was reached with the facility, agency, and parent for the agency RN to stay due to the complexity of the patient but only if the home vent was used during the patient visit.

As an emergency department nurse....if there is a private duty nurse the care of the patient is the responsibility of the home care nurse for the equipment/vent/patient for routine care/suctioning/cleaning unless they ask for assistance. Why on earth would the PDN need assistance of the ED RN when this is their patient and they are the ones familiar with the equipment/patient...that is what YOU are being paid for...care for the patient in transition until the patient is admitted and placed on hospital equipment. Which can easily be 2-3 hours.

However, I have never had the PDN take supplies without asking as you have indicated in another thread.

As far as taking supplies,well I had to.

I had to get diapers and suction caths from somewhere.

As far as asking about the ER,what I was saying is that I don't understand when some agencies tell us to go home as soon as pt is in ambulance,while others tell me to stay.

As some have indicated,the agency might not get reimbursed because there are nurses in the hospital.

What I'm saying to if that's true,then why do I find myself doing some of the nursing care while pt is in the hospital?

Also,parents have told me that the staff nurses don't help them while they wait in the ER.

I would leave,but that would leave the parents to do everything,which they shouldn't because there are staff nurses there.

As an emergency department nurse....if there is a private duty nurse the care of the patient is the responsibility of the home care nurse for the equipment/vent/patient for routine care/suctioning/cleaning unless they ask for assistance. Why on earth would the PDN need assistance of the ED RN when this is their patient and they are the ones familiar with the equipment/patient...that is what YOU are being paid for...care for the patient in transition until the patient is admitted and placed on hospital equipment. Which can easily be 2-3 hours.

However, I have never had the PDN take supplies without asking as you have indicated in another thread.

That's the point.....we may or may not get paid depending on the agency.

I am also trying to establish when the PDN work ends and the hospital's begin.

According to you,its our job until pt gets admitted.

according to 1 of my agencies,its YOUR job.

So,if the pt has no Pdn,then whose job is it then?

As far as a defib, I was asking because when I transport a private duty trach/vent,the sate of Nj mandates an ambulance with EMT's and a critical care nurse be there on the ambulance.

What I'm trying to establish is why we need her when the pt already had a Pdn,and back up equipment.

Its totally overkill and a waste of money.

However,she said she is needed because I don't have meds nor a defib to start the pts heart if it stops.

I said in an earlier thread she still isn't needed because most kids go into cardiac arrest because of repsiratory issues.

That's according to AHA.

I responded to another poster who said a defib is better than compressions.

I also said if that was the case,maybe we should have access to defibs then(it was sarcasm)

Back up into the thread and read what I wrote.

Specializes in Current: ER Past: Cardiac Tele.
That's the point.....we may or may not get paid depending on the agency. I am also trying to establish when the PDN work ends and the hospital's begin. According to youits our job until pt gets admitted. according to 1 of my agencies,its YOUR job. So,if the pt has no Pdn,then whose job is it then?[/quote']

As an ER nurse, I consider the patient mine in the ER. Sometimes when a trach/vent pt has their own home vent machine come in we will give the parent the option to keep their vent on or to switch to ours depending on the situation. I don't expect the PDN nor the parents to do anything for me when they are there. Sometimes if they're finishing their shift they stay and help care for that patient. I don't expect them to, but if they're willing to help, I'm not gonna stop you. You do know the patient more. In most cases they notify their agency and are told to stay until the patient gets admitted. This is also Florida and I have seen different nurses say they are supposed to stay in the ER and others say they aren't. Sometimes we discharge from ER so I can see why the PDN will want to stay.

Also for the critical care transport team. I just meant maybe it's your states guidelines for "safe transport." just because it is a peds pt with respiratory issues doesn't mean they can't arrest whether resp/cardiac. Also maybe if they deteriorate during transport the critical care nurse/medic can initiate resp tx that you may not have a doctor's order for? I will admit the county I live in our ambulance and transport is a little different and the regular ambulance (only EMT and Paramedic team) would usually transport such a pt.

Specializes in Complex pedi to LTC/SA & now a manager.
As far as a defib I was asking because when I transport a private duty trach/vent,the sate of Nj mandates an ambulance with EMT's and a critical care nurse be there on the ambulance. What I'm trying to establish is why we need her when the pt already had a Pdn,and back up equipment. Its totally overkill and a waste of money. However,she said she is needed because I don't have meds nor a defib to start the pts heart if it stops. I said in an earlier thread she still isn't needed because most kids go into cardiac arrest because of repsiratory issues. That's according to AHA. I responded to another poster who said a defib is better than compressions. I also said if that was the case,maybe we should have access to defibs then(it was sarcasm) Back up into the thread and read what I wrote.[/quote']

NJ onlyrequires ALS/CCT team. (Which can be a EMT-P or MICN) IF a trach/vent patient is transported by ambulance as trach/vent is out if the scope of a basic EMT not because of ACLS meds or defib. There is NO MANDATE in NJ that a trach/vent child must ONLY be transported by ambulance (hence why school bus & PDN is sufficient) a parent, guardian or competent adult can transport a trach-vent child in a private vehicle.

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