SO one of my peds vent/trach clients has Covid. His mom and dad plus two older brothers have it.
I asked my nursing manager if I have to sit at the bedside for the whole 8 hours. She said I can go take breaks. I also asked her if I can sit 6 feet from the patient until he needs care. She said no,how are you going to provide care?
Is it unreasonable for me to sit with all PPE on about 3 feet from a Covid + client for 8 hours with breaks? Can I increase my risk of infection that way?
My nursing manager told me I can't sit in the kitchen or anything,I have to be by the bedside literally. I think she is NUTS.
I am protected from severe disease if I happen to become infected,that is true.
From what I've read on CDC website,vaccinated individuals can still get infected and pass the virus to unvaccinated individuals. I have unvaccinated,high risk family members at home. Plus I work with other high risk clients throughout the week.
All that being said, the patient still needs care. You are responsible for not bringing any bug-not just Covid-19- out of one home and into the wild so your donning/doffing and other precautions need to be spot on.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
You're fine if you wear your PPE, 3 feet or 6 feet. If you feel like you can monitor just as well 6 feet away and that's where you're most comfortable, then I trust that you know best.
Your problem began when you asked your manager for advice on your practice when you already had a clear idea of what you wanted to do.
Go to your manager when you really don't know the best way to do something. That way, you have another nurse who is sharing responsibility for the decision.
If you feel confident about your choice then don't consult your manager. It eliminates unnecessary disagreements and arguments.
Of course, if she walks in and tells you that you have to change your practice, then you may have to have an argument if you think you're right. Just don't unnecessarily create that situation.
All that being said, the patient still needs care. You are responsible for not bringing any bug-not just Covid-19- out of one home and into the wild so your donning/doffing and other precautions need to be spot on.
True. The other agency that was servicing the client pulled all of their nurses when he was first diagnosed. They told parents they can care for him and that they did not want their nurses exposed.
I also asked her if I can sit 6 feet from the patient until he needs care. She said no,how are you going to provide care?
Agree with @FolksBtrippin. I would never have asked her and would have waited for the issue to arise on its own if it were going to.
The only reason to sit w/in three feet of a patient, with or without covid, is if it is necessary for care that they must constantly be attended by someone who is within 3 feet at all times. Short of that, I would neither need nor want to be that close to them. And yes, IMO, all the more if they have covid. PPE or no PPE that's just dumb. The commonsense thing to do is to take all reasonable precautions, and sitting in the doorway within line of sight instead of in a covid patient's face is just common sense.
So. I'd sit in the door way. If anyone complains I'd tell the manager I decided to sit in the door way in direct line of sight. If s/he didn't find that acceptable I would invite them to find someone else to work the case.
His bedroom is very tiny,so you would need to sit in the kitchen,hence me asking the question.You can still see him from the kitchen,but his nurses sit in the room with him. I had no choice but to ask her. She actually did not even go in the house. She was covering for another nurse manager on vacation. She just dropped off supplies at the door and that was it. Maybe I should not have asked. In private duty,from my understanding of working as a PDN for 10+ years,is that these kids need 24 hour supervision and eyes on them at all times. That is the reason we do not get lunch breaks.
I did read on Allnurses that some PDN's do take lunch breaks. Hmmmm.
You can still see him from the kitchen,but his nurses sit in the room with him.
It doesn't matter if it's the kitchen or the back porch. The patient is either in direct line of sight and within very quick access or he isn't. Also, I wouldn't care where his nurses usually sit. He usually doesn't have covid.
Alterations that can be made with out an *actual* compromise to his care should be allowed. If someone sitting directly at his bedside is more about what has been done up to this point or what makes his family feel good, that's fine, but if that's the only reason it is being done, that's not an adequate reason for me in this circumstance.
BTW, if you don't get an actual break does that mean you are having a snack and keeping yourself hydrated while at the bedside? I'm no germophobe but that would not be happening especially in this scenario.
It doesn't matter if it's the kitchen or the back porch. The patient is either in direct line of sight and within very quick access or he isn't. Also, I wouldn't care where his nurses usually sit. He usually doesn't have covid.
Alterations that can be made with out an *actual* compromise to his care should be allowed. If someone sitting directly at his bedside is more about what has been done up to this point or what makes his family feel good, that's fine, but if that's the only reason it is being done, that's not an adequate reason for me in this circumstance.
BTW, if you don't get an actual break does that mean you are having a snack and keeping yourself hydrated while at the bedside? I'm no germophobe but that would not be happening especially in this scenario.
At present,I drink my coffee before I go into his home
Pre-Covid I would snack at the bedside. So if you wanted to eat or drink something,you did it at the bedside. If the patient needed suctioning while I was eating,I had to stop eating,suction the patient,go wash my hands,and finish eating.
In private duty, from my understanding of working as a PDN for 10+ years, is that these kids need 24 hour supervision and eyes on them at all times. That is the reason we do not get lunch breaks.
I did read on Allnurses that some PDN's do take lunch breaks. Hmmmm.
"Eyes on them at all times" isn't even reasonable. Do you give meds? You're not looking at the child while you're preparing the meds, or preparing his food, etc..
If I can hear him, and I visually check frequently, I will keep him safe.
I would not go outside for 10 minutes, leaving him inside, unless I could see & hear him the whole time and I could be at his side helping him within half a minute. (Maybe on the deck with him on the other side of the screen door.)
For lunch, I go to the kitchen - where I can still hear him - and drink a Glucerna, or a glass of water. It doesn't take long at all to drink 8 ounces of fluid, remask, and wash my hands.
It's not that an extended care nurse in the home does not get lunch breaks, it is that the nurse does not get lunch breaks outside of the home. Some agencies make one sign an acknowledgement of this fact upon hire stating that this is the reason they are being paid for that lunch break. The only question that ever comes up is where one is allowed to eat. I always ask the family if I am allowed food/drink inside the patient's area. They almost always say it is fine, and I always make certain I clean up if necessary. Crumbs and spills are also not good for infection control. If my patient had Covid, out of caution, I would not eat in their area at all.
It's not that an extended care nurse in the home does not get lunch breaks, it is that the nurse does not get lunch breaks outside of the home. Some agencies make one sign an acknowledgement of this fact upon hire stating that this is the reason they are being paid for that lunch break. The only question that ever comes up is where one is allowed to eat. I always ask the family if I am allowed food/drink inside the patient's area. They almost always say it is fine, and I always make certain I clean up if necessary. Crumbs and spills are also not good for infection control. If my patient had Covid, out of caution, I would not eat in their area at all.
This is correct. Lunch breaks are never uninterrupted though. So if you are eating,and a patient needs suctioning,you have to stop eating and go suction the patient.
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CharleeFoxtrot, BSN, RN
840 Posts
All that being said, the patient still needs care. You are responsible for not bringing any bug-not just Covid-19- out of one home and into the wild so your donning/doffing and other precautions need to be spot on.