Two patients one client-revisited

Specialties Private Duty

Published

I get paid X dollars per hour by an agency. The home that I go to there are two clients. I care for both clients. They both required the same care basically. Originally I was told that they were both approved for 4 hrs each. So, I didn't really argue about more pay.

One patient now gets more hours approved. I am told to chart the X+ hours and that means double assessments for this one. The other one is still only X. The second patient is often home ALL DAY LONG (usually out for things during most of the day), but often I have both all day long. Parents not home and even when they are they busy fighting the good fight for the patients.

When I was told to chart X+, I filled ALL my paper work out with the new hours, including my time sheet. I was paid. Week following, pay dropped to original rate. I am being told that RN's with twins (they are not twins at all) get a flat rate. I am pretty sure it ain't my small rate.

Before I email about this and raise the roof, what IS fair? AGAIN, these are NOT twins.

I'm not sure why it is necessary to pay more money for more than 1 patient. When I worked in the hospital, there were times my load was light and times it was insanely complex and heavy. The pay never changed based on my assignment.

Most nurses would be thrilled to have just 2 patients!!

That's why we don't work in a hospital. Too many patients for too little pay. Private duty is one on one.

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We also don't get paid sick, holiday, or vacation days. And, when out patients get well or age out or parents get sick of the agency, we are out of work. No raises unless you change agencies, usually either. No 401K plans. Big differences in compensation. Apples and oranges.

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Conclusion: as I suspected child A only gets 1/2 the hours and child B gets the other half. Got a bump in my pay anyway, which was comforting.

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Specializes in Complex pedi to LTC/SA & now a manager.

Who watches the other child while you work with child B?

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Most times me. Sometimes mom. Assessments and treatments are done once per shift. So, the care is more ADL's. Not ideal, but not horrible. As they get bigger I will have to rethink it, as they are full transfers with no assist. The insurance company is not good about approving the DME they need. This is the only client I have with this agency right now and I'd like to hit the one year mark with them. It works for me, the family, and the agency for now.

What are you thinking? Something I am not thinking about - not the money, but something else?

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Specializes in Complex pedi to LTC/SA & now a manager.
Most times me. Sometimes mom. Assessments and treatments are done once per shift. So, the care is more ADL's. Not ideal, but not horrible. As they get bigger I will have to rethink it, as they are full transfers with no assist. The insurance company is not good about approving the DME they need. This is the only client I have with this agency right now and I'd like to hit the one year mark with them. It works for me, the family, and the agency for now.

What are you thinking? Something I am not thinking about - not the money, but something else?

Liability.

If you care for A from 12p-4p and B from 4p -8p and mom is not home. Crisis or emergency from A or worse you are "helping" by transferring A and get hurt. You will lose workers comp as technically not working with A but sibling B. If A has an emergency and you care for A while on the clock for B, then B has a problem and parent not home you are in trouble as technically you abandoned your patient B to take care of A (technically not your patient at the time).

I have a patient with a borderline medical sibling. (Not complex enough to qualify for PDN but high risk respiratory none the less). If patients brother has a respiratory crisis I will talk the caregiver through emergency procedures and even call 911 but must not lose sight of the fact who is my patient.

We all want to help but need to protect purselves and current patient/ client

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Food for thought, but that was going to always be an issue because they are never going to get two nurses for this case. For the time being, I always keep them in the same room with me if we are alone. Sometimes one wants to be in a different room and my answer is "no" unless they both want to go. I also have refused to take them both on walks by myself. Other nurses do it, but I refuse.

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Specializes in Complex pedi to LTC/SA & now a manager.

The big concern is parent/guardian/caregiver not in home and leaving you with your patient and sibling. You should not be responsible for both. The issue is so many have crossed this line for so long to make someone happy, this is now expected and any new nurse will be assumed to perform services (baby sitting essentially a complex kiddo while on the case for their complex sibling) not normally expected and without reimbursement.

It's a catch 22.

You can bet if there is an where the nurse must make a choice as to who to care for in an emergency and something goes wrong, the agency and family will both throw the nurse under the bus.

If you have the chance to move on to another case or agency, take the opportunity. Also make sure your professional malpractice/liability insurance is up to date.

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