Is it legal for a nurse to work 24 hours straight?

[MrsMwenja_RN]

Im so upset. I need some opinions and to vent...............

I work in home health and I have a client that has 24 hour nursing care. I was scheduled yesterday to work 7a-7p. At 4pm my patient was in the hospital with a fever. My on-call supervisor had instructed me to stay with the patient and if the patient was admitted I was to go home. He also said if the patient was released I was to call him so he could call the next nurse (who was on standby) to come in and take over. My patient was cleared to go home at 10pm (afebrile, all blood work normal). I called my supervisor and he said ok I will call the next nurse and call you back. He called back 20 minutes later and said she's not answering. You will have to stay until I can get a hold of her. Her shift is 7p-7a. He never got ahold of her and I told him he needed to try to get someone to come in and I asked him if they were going to seriously make me work 24 hours. He basiclly told me I couldnt leave (I wouldn't anyways because of legal issues). So I stayed with my patient until 7am the next day. My supervisor had told me I can't find someone to come in. I was soooo mad at him.....for putting not only my patients safety at risk but also my lisence.

Should I report this to my main office? Is this even legal for them to not only put their employees in such conditions but putting the clients at risk. And this was an infant client that was on 24 hour 02, had a trach and a feeding tube and was on dialysis 13 hours a day. The client required alot of attention and needs a nurse who is I just can't believe they think that is ok.

I hope this wasn't too confusing. Please give me your opinions and advice!!!

[BuckyBadgerRN, ASN, RN]

And I was under the impression also that I could not leave my patient with anyone except the next nurse. The parents were not able to take care of the baby.

You would have been leaving him with a nurse----at the hospital!!! Sounds like your supervisor is a real piece of work....

[systoly]

In my state, leaving or staying past the end of the scheduled shift is not a nursing issue, but an employment issue. My BON doesn't care to get involved in these issues. However, your shift ended at 7p and you're still with the pt at 10p which means you effectively accepted another shift (again, this is the way it works in my state). I believe what happened is you took care of everyone else and as a reward you got burned. That's not on you.

[Purple_Scrubs, BSN, RN]

This infuriates me for you, OP. So, what, if you were scheduled the next day, and no one showed up to relieve you, you would have to work 36 hours? Then what if no one showed up again? 48? When does it stop? The supervisor should have relieved you himself if no one could be found. I would be looking for another position ASAP with a company that does not put their employees in this position.

I think there should be laws that prevent nurses from abandoning patients, but there should also be some protection for the nurse. When you show up for a shift, you should not be signing your life away in the event a replacement does not show up for the next shift. Dramatic, yes, but we can see what can happen when there are bad management practices...the nurse is the one to have to take up the slack.

[Esme12, ASN, BSN, RN]

In the state of New Jersey most adult employees could technically be required to work 24 hours a day, 7 days a week, 365 days a year. Of course that is physically impossible; however, there is nothing in either Federal or NJ law (or the law of many other states) that puts a limit on how many hours in a row you can be required to work. Federal and NJ law requires breaks depending on consecutive hours worked. All either Federal or state law (in your state) cares about is that you are paid appropriately for whatever hours you work.

There are only a very few states that have a weekly hours limit. NO state has a daily limit. Seven states require rest breaks; twenty two states require meal breaks for some or all employees; seven states require one day off out of every seven. Some states are on more than one list; NJ is on none of them.

New Jersey has some newer legislation specific for healthcare workers.

http://lwd.dol.state.nj.us/labor/wagehour/lawregs/health_care_worker_law.html#1156a32

The requirement that an employee of a health care facility accept work in excess of an agreed to, predetermined and regularly scheduled daily work shift, not to exceed 40 hours per week, except in the case of an unforeseeable emergent circumstance when the overtime is required only as a last resort and is not used to fill vacancies resulting from chronic short staffing and the employer has exhausted reasonable efforts to obtain staffing, is declared to be contrary to public policy and any such requirement contained in any contract, agreement or understanding executed or renewed after the effective date of this act shall be void.

34:11-56a34. Health care facility employee work shift determined; exceptions voluntary

(a) Notwithstanding any provision of law to the contrary, no health care facility shall require an employee to accept work in excess of an agreed to, predetermined and regularly scheduled daily work shift, not to exceed 40 hours per week.

"Reasonable efforts" means that the employer shall: a. seek persons who volunteer to work extra time from all available qualified staff who are working at the time of the unforeseeable emergent circumstance; b. contact all qualified employees who have made themselves available to work extra time; c. seek the use of per diem staff; and d. seek personnel from a contracted temporary agency when such staff is permitted by law or regulation.

"Unforeseeable emergent circumstance" means an unpredictable or unavoidable occurrence at unscheduled intervals relating to health care delivery that requires immediate action.

http://lwd.dol.state.nj.us/labor/wagehour/lawregs/health_care_worker_law.html

But I would check with the BON as it is usually stated there how many hours are legal for nurses to work. Even the federal labor laws fail to address this issue but are trying to change the laws for "involuntary" or "mandated" OT. The Fair Labor Standards Act of 1938 (FLSA), which regulates overtime, currently imposes no limits on overtime hours, nor does it prohibit dismissal or any other sanction for declining overtime work. Rather, the FLSA merely requires that payroll employees (who are not "exempt" from the overtime requirements of the FLSA) be paid an overtime premium of at least one-half of regular rate of pay for each hour worked over 40 during a work week with no provision to the max amount of hours to be worked consecutively.

I looked at the BON site and couldn't find it addressed but I have to ger the kids of the bus so I have to go.....I hope this helps.

[caliotter3]

When I have accompanied my patient to the hospital, the next assigned nurse reported to the hospital and took report from me and assumed care of the patient. There was no reason for this not to have occurred in this particular case. There is something wrong with the reasoning of the staffing coordinator. You need a serious talk with your Director of Patient Care Services.

[GHGoonette, BSN, RN]

Wait, wait...there's another thing I'd like to know, OP; if the patient was at the hospital, under the care of hospital nurses, why were you required to stay there? And in such a case, why weren't the parents, or at least one of them, present with their child? Then at least you could have gone home at 4pm and got some rest before being asked to go back to care for the child after discharge.

[Meriwhen, ASN, BSN, MSN, RN]

Legal to work 24 hours in a row? Depends on your state's BON as well as the state's labor laws.

Ethical? Big grey area.

Personally, I wouldn't have done it because I know I would not have been capable of practicing safely. Just because it would be legal for me to work 24 hours doesn't mean I wouldn't be putting my license at risk by doing so.

[CapeCodMermaid, RN]

We got cited at one SNF for having CNAs work 60 hrs a week. They picked up double shifts frequently....never did more than 16 at any one time, but we got cited anyway. I was on duty as the building supervisor for close to 40 hours straight during a huge blizzard. Not fun.

[healthstar, BSN, RN]

Working 24hours straight, without any sleep = big room for errors ( your body needs to rest)

[dudette10, MSN, RN]

He also said if the patient was released I was to call him so he could call the next nurse (who was on standby) to come in and take over.

First mistake your supervisor made. He should have never put the next nurse on standby. He should have told her to go the hospital to relieve you at 7 p.m.

I'm wondering if he told her "standby" expecting your patient to be admitted. When your patient wasn't admitted, that's when the trouble began.

Some places have this problem if no policies are set for employer call-offs. When things happen where a called-off nurse is needed back at the facility or assignment, the nurses who were initially called-off can't be found because there is no on-call policy and/or compensation incentive to answer the phone.

[beckster_01, BSN, RN]

Wait, wait...there's another thing I'd like to know, OP; if the patient was at the hospital, under the care of hospital nurses, why were you required to stay there?

I don't work in an ED or in Peds, but I can only imagine what it would be like if I got an admission that was 1:1 nursing care at HOME, and the home care nurse left! That's not safe either...

[Esme12, ASN, BSN, RN]

I had to dash so to continue.....YOur supervisor should NOT have canceled the on comming nurse. She should have reported to the hospital. Although there are no laws per-se.....it is deemed unsafe by many standars of care and in a court of law you may be held liable.

I would have a face to face discussion with the DON to discuss company policy and to make it clear that this will not happen again. I am sure there is a legal loophole here somewhere that this cannot be done but I would make it clear that you wil not do this again unless a disaster has been called. I'm not even sure if the regulations are different for home care.........If they continue this kind of behavior...I'd look for another position. :)

I found the ANA's position with state laws...http://nursingworld.org/MainMenuCategories/ANAPoliticalPower/State/StateLegislativeAgenda/MandatoryOvertime.aspx