WWYD: Caregiver not home at end of shift?

[HisTreasure]

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?

[caliotter3]

Is it illegal to have the parents sign before the shift is up?

I have a vent/trach client who was in the room downstairs and her mom's room was upstairs.

She would sign our timesheets at the beginning of the shift,and the nurses would just leave when the shift ended(mom told us she would get up 15 min later,but we would not know as we never waited around)

I always wondered if something happened in those 15 minutes who would be on the hook?

I had one case where the father signed the sheet at 11 pm when we came in. I always was very, very careful with my charting on that one because he came right out and said that he had too much to do in the morning with getting his son ready for school and wanted nothing to do with our paperwork. On another case, the mom said she couldn't stand dealing with our paperwork and signed a stack (and I mean a stack) of blank forms once a month, around bill paying time. In her case, this made a lot of sense, because she was almost never in the home at certain shift changes. I am certain that it is technically illegal, but then, I've had agency personnel tell me that they don't give a hoot who signs the paper (literally). And what about those situations where the nurses are committing fraud and the clients are complicit? A 55-gallon drum full of worms there!

[CloudySue]

It is in the parents' best interest to read the notes at the end of the shift, BEFORE signing off, every day. This is the best protection the caregivers have to ensure quality care for their child. Seldom do caregivers give my notes more than a glance, in my experience. You protect yourself if you finish with a very detailed end note- "0700: Nurse report off to "X". Left client in c/o "X" in stable condition, Pox on, alarms audible. O2 continues running at 2 LPM delivered by nasal canula, diaper dry, whatever, whatever, etc.' You need to paint a picture of how you leave that client, and that signature is legal proof that the parent accepted this client back at that time in the condition stated, that the notes are true and correct. If this is not the case, well, they're going to have a hard time proving otherwise to anyone.

[caliotter3]

I explain the importance of reading the notes to my clients. If they want to take responsibility for signing them early for their own convenience they can't say I didn't advise them otherwise (I document this). Conversely, we have been warned at one agency, that a client refused to verify a shift after the fact for a nurse who left the home without a signature. Too many clients will tell you, "Well Suzie has me sign a week at a time". My response is that there are many situations where I may never see the client again, so I rest better knowing my paycheck document signatures are current.

[systoly]

Oh, lord, that would be annoying. Would it be legit to just take the papers into their room and have them sign while they are still in bed? Or I guess I could just start making a bunch of noise about 15 minutes before the end of my shift so they will be nice and awake... I am kidding, of course. It's late and my smartass is showing!

I'm not going in anyone's bedroom but the pt.'s

getting signatures before end of shift is a major violation with my agency,

but the oncoming can sign for the off going if no one else is available

the very last thing i do is write down my time out, so if there is no on coming

what caliotter3 said, let the agency deal or pay OT

[smartnurse1982]

This one agency,it was a pain in the ass to call the times worked into a system.

We had to use the landline phones,and you could not use your cell.

this was in 2004,and my pts did not have a landline.

I think it is just easier to sign.

[RN3339]

Agencies usually require there to be a trained alternate caregiver other than the primary give (or two alternates) because emergencies can and will arise. That being said the first thing I would of done is notified my office or the on call to intervene in getting mom or an approved caregiver to the home. To take it a step further, even under the worse case scenario if there was no approved caregiver that could come to the home and mom couldn't get back I would not leave no matter how inconvenient or aggravated with the situation I was. If something happened to that patient I would be held responsible legally. As for pay the agency would have to pay for the time and either bill the parent directly or eat it as part of the cost of doing business, but in this situation pay is secondary to the risk of losing my license. I will say that unless it were a true dire emergency I probably would not go back to the case after.