WWYD: Caregiver not home at end of shift?

[HisTreasure, BSN, RN]

You are on a 12 hour shift. Primary caregiver has an emergency at 2 PM. Your shift is over at 7 PM and PCG is not back, no nursing coverage is expected until 11 PM. Another competent adult is in the home but is not the primary caregiver, and you have never seen this adult provide care for your patient. What would you do? What have you done in the past, if this has happened to you before?

[sugabrwn1971]

Call the agency and make them aware of the situation and wait for further instructions.

[HisTreasure, BSN, RN]

So, to be clear, you wouldn't just leave the child with the other adult in the home at the end of your shift?

[caliotter3]

In similar circumstances my agency has instructed me to leave the patient with the adult if they are willing to assume care, but not when the adult was not able to provide care due to their obvious intoxication.

[HisTreasure, BSN, RN]

Thank you.

Ok, so here's the story: I get a phone call from a parent who is irate that her child's nurse left on Friday before she got home. The child was left in the care of the uncle, who resides in the home. I don't know the nurse, but the mom was asking me if we get trained on patient abandonment in nursing school, what are agency's rules for situations such as this, and is this a reportable (to the BON) offense? The mom has already called the agency and spoke with on-call about her complaint, but I don't know that what the nurse did is truly patient abandonment? I mean, theoretically, the reimbursable shift was over and the child was left in competent (sober) hands. The other issue the mom is alleging is the uncle hasn't been trained on all the care of the child, and when she arrived home shortly after 9 the child was asleep in her room and the uncle was watching TV in another room and she takes this as a sign that the uncle doesn't know how medically fragile the child is. Everyone is telling her to report the nurse to the BON. She wanted my opinion.

[morte, LPN, LVN]

if the patient is a minor, I might call CPS. it is the mom's (in this case) responsibility to be there.

[mluvsgnc]

I think I would have just stayed, calling the agency to make them aware of the situation, and the mom to get an idea on how long she might be. If it was too much longer (subjective), I might ask for compensation for the time from the agency. I would also talk to the other adult in the home and find out more info ("has this happened before?" "have you taken care of the child before?" etc.). I might also look up the definition of "patient abandonment" under my state's nurse practice act to see exactly what I'm dealing with.

[OrganizedChaos, LVN]

I would definitely call the agency & find out what they wanted me to do. Like someone stated, the billing time is over & if I'm not gonna get paid for being there & be there late I would have a hard time staying - if the agency told me I could leave. If there is a capable, sober adult I would teach him how to take care of the child. But that's IF I got the ok from the agency. I don't know if it would be abandonment since the nurse was there during her scheduled time & anything after that is not.

[HappyWife77, BSN, RN]

The mom should have made plans to cover for herself if she wasn't going to be back....now she wants to throw the nurse under the bus.

That is ridiculous...I hope you stand behind your nurse.

Maybe you should bring up parental abandonment. ..see if she knows anything about that?

[Esme12, ASN, BSN, RN]

Thank you.

Ok, so here's the story: I get a phone call from a parent who is irate that her child's nurse left on Friday before she got home. The child was left in the care of the uncle, who resides in the home. I don't know the nurse, but the mom was asking me if we get trained on patient abandonment in nursing school, what are agency's rules for situations such as this, and is this a reportable (to the BON) offense? The mom has already called the agency and spoke with on-call about her complaint, but I don't know that what the nurse did is truly patient abandonment? I mean, theoretically, the reimbursable shift was over and the child was left in competent (sober) hands. The other issue the mom is alleging is the uncle hasn't been trained on all the care of the child, and when she arrived home shortly after 9 the child was asleep in her room and the uncle was watching TV in another room and she takes this as a sign that the uncle doesn't know how medically fragile the child is. Everyone is telling her to report the nurse to the BON. She wanted my opinion.

Without knowing details this is a difficult question. IS there a care plan that is to be followed which includes which care givers are allowed to care for the child in the home? Is this child using specific medical equipment that one must be trained on to know how to use to sufficiently and safely care for this patient? What arrangements have been made for alternative caregivers have been made with the family? what is the policy of the agency about leaving without the designated caregiver present.

Second....unless you are management with the agency you should NOT be discussing this with the mother of the patient... she needs to take her complaint to the agency, call the BON, or seek legal advice. It is NOT your place to advise or comment...you will get yourself in the middle and it is NOT where you want to be....if you work for the same agency it can place your position at work. If this nurse is liable and abandoned and you didn't report some states BON have it as mandated reporting and if you don't you are responsible as well.

Abandonment....

The premature termination of medical treatment is often the subject of a legal cause of action known as "abandonment." Abandonment is defined as the unilateral termination of a physician-patient or health professional-patient relationship by the health care provider without proper notice to the patient when there is still the necessity of continuing medical attention.

Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient's will or without the patient's knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

it is the nurses obligation that the care of the patient is turned over to a competent care giver. Not just the adult in the home because they live in the home.

Did the nurse call the agency and notify them of the situation?

[JustBeachyNurse, LPN]

I would defer to the agency. If the uncle isn't listed as a qualified caregiver that can sign the chart & assume care, my agency will have me stay with pay as unbillable hours. Agency would be contacting parent. If parent not home within a reasonable time, and parent declared uncle incapable of caring, parent would be given options such as verbal permission for uncle to assume care, self-pay for hours over billable at $xx/hr rate or informed that CPS may be called. By the outgoing nurse calling agency to advise of the situation, the documentation trail is started should mom later claim mismanagement of care or nurse abandoned patient.

Why is mom calling you? I would stay out of it and refer the mom to the clinical supervisor or branch director. Why risk it ending up well "I called nurse kiyasmom and she wouldn't have left so I am reporting you to the BoN for abandonment. And formally complaining about the agency. "

Why risk your professional relationship with the other nurse and your employer/agency?

If the outgoing nurse did not notify the agency that was her main error.

[HisTreasure, BSN, RN]

Meh... I called mom when I got off of work to see how things worked out with the agency staff today and she told me that this didn't actually happen to her, she read about it on a discussion board or something and wanted some of us nurses to weigh-in. Apparently she contacted some other nurses to see what they would say as well. I wish she would've presented it as hearsay rather than first-hand experience. Parents.