How to invoke safe harbor in home health

[bfit262]

Hello fellow nurses! I am hoping someone out there has some experience with home health. I am in my first year as a home health nurse and wondering if anyone else has any advice on how to handle demands that could put a nursing license in jeopardy. At the company I currently work for we are required to take on call 3 times a year. This involves being available 24 hours a day for 7 straight days and doing a full time patient load . If a pt calls with an emergent need we are supposed to go see them. This means that you work 8-5 and answer calls all night for 7 days in a row. I had my turn on call this week and by day six I was irritable and delirious from lack of sleep. I missed one call at 1 am that night because I could not stay awake any longer. I received a reprimand by email the next morning. I think this is horrible for the patient who did not get the call answered. Luckily the patient improved at home and did not require a visit. I feel this puts my license at risk. I have heard that being overly tired is worse than driving drunk. Has anyone else had this problem with home health nursing? Do all companies do on call this way? Can you invoke safe harbor to protect your license in this situation?

[kiszi, RN]

That sounds like a disaster. When I worked home health, call was two nights a month, and never back to back. Typically I would have 0 to 1 calls in a night, occasionally more. We had triage nurses take the initial call and then get a hold of the nurse if warranted. A lot of things were handled by the triage nurses, which cut down on unnecessary calls to the on-call staff.

I am not familiar with safe harbor rules, but if you are constantly working without adequate sleep for a week, the labor board would be very interested.

[Libby1987]

I don't know about safe harbor laws but our call is set up same way on a more frequent basis. The difference it seems is that we are a smaller agency (100 admissions/month) and visits are only necessary on catheter for retention patients. Calls for advice are minimized by an expectation that the case Mgr has provided adequate instruction and patients are encouraged to call earlier rather than later for questions/concerns.

Our nursing staff are not resistant to call as it's considered "easy money" due to the way they are not treated like a dedicated night nurse. Often a call isn't received for the entire week and visits are uncommon.

Also, I encouraged my patients to call me directly if they did it during waking hours, it takes a minute for me to answer a question on a patient I know than the nurse taking call having to get the whole back story in the middle of the night. They were also very well prepared to trouble shoot issues independently. The results were an occasional evening call and my patients didn't call the on call nurse which reduced her burden.

[JustBeachyNurse, LPN]

This may help:

Texas Board of Nursing - Nursing Practice FAQ

[TheCommuter, BSN, RN]

Moved to the Home Health Nursing forum...

Be cognizant that Safe Harbor laws only exist in Texas. Since the majority of the membership does not practice in Texas, they may not know about Safe Harbor.

[bfit262]

Thank you! I did not realize that

[caliotter3]

Whenever things are not up to par with a home health agency, it is usually easier just to move on down the road. If there are a limited number of available agencies to work with in your area, consider relocating or trying a different area of nursing. After I got the reprimand that you mention, I would have been gone, if not pushed out the door earlier by the work conditions you describe. No reason to have to put up with that.