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How many hours is too many

Private Duty   (2,614 Views | 12 Replies)

mb1949 has 2 years experience and specializes in med surg home care PEDS.

6,455 Profile Views; 402 Posts

I have a weird situation and would like some advice. I have a peds patient, pre school, vent dependent with other issues. Anyway I believe the case has 20h/day x 7 days. Nice family, however, the parents want to go away by themselves for a long week end. The idea is to leave the patient alone with the nurses, from Friday to Monday morning. I would work my 2 regular overnight shifts the week-end but am uncomfortable with the whole scenario!!! I have never seen the 485 or care plan for the patient, the chart in the house is pretty ben at up by the tme I came on the case. Should I call my agency and ask for a copy. I am afraid if something goes wrong and I call 911 I could be sanctioned for not following the care plan etc.

I had another case where the careplan specifically stated another care giver should be in the home with the nurse at all times. I know an RN can be left alone with a patient for a certain amount of time, but 4 days, I don't know.

Another relative will be home in a separate apt in same house but is definitely not a skilled caregiver.

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5 Followers; 37,438 Posts; 100,506 Profile Views

For pete's sake, update that field chart at once. Get the latest 485 and copies of any signed orders since the 485 was last signed. What in the world is the clinical supervisor looking at when she does her visits? You need to discuss this entire situation with her as well as the condition of the field chart. You can update the field chart yourself simply by going to the office and getting the required paperwork, but you should bring this to the supervisor's attention.

There is nothing wrong with the patient being alone with the nurses (if not prohibited by the 485) while the family goes away as long as all are informed and a definite plan is in place for emergencies.

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meanmaryjean has 40 years experience as a DNP, RN and specializes in NICU, ICU, PICU, Academia.

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I've had clients whose parents have gone out of town and nursing stayed 24/7. No biggie as long as the POC is updated. Surely to goodness these people have respite hours, right?

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mb1949 has 2 years experience and specializes in med surg home care PEDS.

402 Posts; 6,455 Profile Views

Thanks for your input. I will stop by agency office tomorrow and get copy of 485 andBoth pare

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5 Followers; 37,438 Posts; 100,506 Profile Views

Since the other nurses on the case have been neglecting the upkeep of the field chart, you should take the initiative to take care of this task yourself. The nursing supervisor may appoint you as the primary nurse for stepping up. Somebody should be keeping on top of this, it looks like you are the one that is willing to take the responsibility.

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smartnurse1982 has 7 years experience.

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I do not understand the OP and the question.

How was the OP doing overnights with the pt without the 485 in the first place?

The 485 contains the meds that are used(along with the MAR)

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5 Followers; 37,438 Posts; 100,506 Profile Views

On occasion you will find a case where the field chart is not around or is in disarray or the 485 is not up to date. My most recent agency did not bother with a MAR, much less an up to date 485. When I asked about it on my first case, I was told that the nurses just gave the meds as instructed by the parents. Good agencies will mail up to date 485s, as well as copies of signed orders, and blank forms, on a regular basis to the client's home. The nurse on duty places these items in the book or where the forms are kept.

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SDALPN specializes in Peds(PICU, NICU float), PDN, ICU.

997 Posts; 16,390 Profile Views

Sometimes families get hours authorized for emergencies or whatever and can get 24 hours if coverage while they are out if town. The main concern is that you should ALWAYS have a 485. Not all orders or instructions are on the MAR.

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brillohead has 5 years experience as a ADN, RN and specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

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For my cases, the hours are "per week" and the parents can decide when/how to use those hours.

Most of my cases have 12 hours / 7 days a week for a total of 84 hours a week. The parents could use all 84 hours in a row if they were going to be out of town, or they could get 16 hours some days and just 8 hours other days, however worked best for their schedules and/or nursing availability.

But there is no way in heck I would work in ANY situation without a careplan in place. I've seen some really disorganized field charts (and I'm the one who always ends up taking EVERYthing out and putting it back together again and notifying the office of what is missing), but never one without any type of careplan / physician orders.

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mb1949 has 2 years experience and specializes in med surg home care PEDS.

402 Posts; 6,455 Profile Views

The patient has no meds. Just vent dependent and g tube

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PerfectlyPlump is a ADN, RN and specializes in Peds, developmental disability.

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It surprises me that your agency is so loose about all this. As a licensed nurse, you need orders just to be in the home, according to my understanding! This is what protects the public and the nurses. Call it Plan of Care, or 485. You surely need MD orders for all the vent settings, to give tube feedings, when to report vitals out-of-range, etc.

And BTW, you can't take orders from the parents. I am so glad my agency stresses this fundamental.

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5 Followers; 37,438 Posts; 100,506 Profile Views

Some agencies allow a nurse to transcribe an order taken from a parent onto an MD order form to be sent forward to the MD for signature, provided the nurse is comfortable with the information provided. The endorsement line states that the parent received the order from the MD and is transmitting the order to the nurse. Other agencies do not allow this at all and require the usual chain of information when the nurse does not accompany the patient on an appointment to the MD, or is not in the home to take a phone order from the MD. At any rate, a copy of the signed order is required to be in the home along with the current 485, except for that one agency I worked for that did not care if their nurses knew what was on the Plan of Care. Just asking for trouble.

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