RN doing HH for neighbors -CYA?

[biltz]

I'm a Med-Surg RN in between jobs and I have a question about liability with providing care to neighbors.  I live in a very large retirement community in California.  My neighbor asked me to assist her after knee surgery.  Her daughter and she wanted me for my nursing skills and to monitor her post-surgery and then to progress to simple ambulation, ADL's, and light housekeeping.  I told them I was concerned with "representing myself as a nurse" as I didn't carry individual nursing insurance and didn't want to jeopardize my nursing license if something went wrong.  I insisted that I didn't want to be paid and would just volunteer doing it as a good neighbor.  In the end she insisted on paying me a nominal fee.  Ironically, right before discharge she suffered extreme orthostatic hypotension and ended up staying in the hospital an extra couple of days and went home with an agency home health nurse.  I came a few days later and just helped with ambulation and light ADL''s and housekeeping. 

She's mentioned to several friends and neighbors how much she appreciated my services and now they are asking her to ask me if I will work for them.  A friend who's husband has dementia would like me to come and sit with hIm so she can have some relief.   She mentioned though that she liked that I was an "RN and came with that background".  I would love to help her but I'd also like to get a little compensation for my time.  I might also like to do this for a few other referrals. 

It's been a long time since I took my healthcare law class.  Am I setting myself up for a huge liability case or losing my license?  I don't want have to carry insurance, set up a business, contracts etc...  I also don't want to do this long term, just until I go back to full time work.  I also don't want to get in to discharge orders, doctor communications, medication administration, etc..  I just want to go and offer simple "nurse's assistant" services.

1.  Would I need to carry insurance to cover my a$$?

2.  As an RN with a current license am I liable to perform to the highest scope of my license even if we agree on a limited scope of work?

3.  Would a contract limit liability in terms of scope of work?

4.  Would any of this jeopardize my license or do I have to be working with an agency?

5.  Anything I'm forgetting?

[Hannahbanana, BSN, MSN]

Not an atty, not giving legal advice. You would be wise to contact a TAANA member or atty for your state BON for details.

1. Yes. Also, what if you have a slip/fall injury on their front steps? Are they insured for your costs? If you are entering the house as part of your agreed nursing care, does that still apply? What if something happens and they are no longer your friends and choose to sue you for that something? Insurance will be a godsend. Ask about what coverage you might be able to obtain.

2. Yes. You must be super-careful not to exceed your nursing scope of practice and have a prescriber's plan of care in writing. This includes PT, if there is a plan of care you are going to be carrying out in the home, and NP/MD for medications. See also above, what happens if the friendship is damaged and then what ...

3. A contract is a good idea to cover what you're expected to do. It will only limit liability as to what's in it, but see also #2.

4. You don't have to work c an agency unless your state requires it. Ask.

5. You can always give first aid to the level of your scope of practice in an emergency if you don't have a financial interest in the case- that's the point of Good Samaritan laws. But an ongoing care relationship wouldn't fall under that.

IMHO it's better to thank these nice people for their confidence in you,  direct them to a licensed, insured, and bonded VNA, and limit your role to one as a helpful non-nurse neighbor-- toss in a load of laundry, make a light lunch, sweep the kitchen floor, water the plants, sit and chat, pick up the mail and some groceries. Then no conflicts or other pitfalls.

[Sour Lemon]

That wounds like muddled territory and not worth the potential headache(s). It's better to keep your business and your pleasure separate.

[dream'n, BSN, RN]

I'd do this (uncompensated of course) for close family only.  No way would I get myself involved in such muddy waters.  There are too many issues that could pop up so I would give the idea a hard no.