Getting Going in Pvt Dty Nursing! - page 2

Here are a few ideas I am mulling about getting in Private Duty LPN Nursing, and would like feedback if anyone has had luck with this approach. I am not interested in going through agencies at this point. -Magnetic... Read More

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    Quote from GardenerGirl
    I just lost my entire email, because I clicked, "post reply" instead of "post quick reply." Here's an abreviated version of what I just wrote:

    How does an RN make a living at private duty, if she/he wants to work outside of an agency? How does the client bill insurance for such a service? How could the RN help the client determine what their insurance would cover for such private duty RN services?

    Obviously, people need their nursing services covered by their insurance companies. How would an independent RN find out what would be covered, so she/he could take on a case? Who would pay the nurse? How would the client be reimbursed from their insurance co? What can the nurse expect for payment? (RN)

    I have some experience in home care and case management/hospice; I wonder if I could make it on my own....?

    As far as insurance, that should be set up during the discharge process from the hospital as far as I know. The parents of children who qualify are sent home fully trained in all aspects of their care, etc. Often they will start with an agency because there might be 24-hour care needed initially. As the children get older the parents may switch to being their own agency basically so that the nurses get the full payment (higher rate of pay per hour obviously without the agency taking their hourly cut) and the nurse turnover greatly improves. In Illinois, the private insurance is around 36.00 an hour, and the Medicaid/KidCare rate is 29.55 an hour. Every week nurses complete a time sheet, of course, and that is submitted to the insurer. The nurses receive their check by mail, and file a quarterly estimated income tax with a 1099 form. Being a contractor rather than employee means you can deduct mileage in addition to the deductions you are taking now (such as professional associations, stethoscopes, etc.) One more consideration - your malpractice insurance, about 90.00 a year (which many nurses carry even WHEN employed). I have always had it, never had to use it.
    Nurses have EVERY RIGHT to be more pro-active and TAKE NURSING BACK by seeking these through newspapers, online ads, word-of-mouth, etc. and AVOID the salary-cut they get when going through an agency.
    If anyone else has more to add, please do. Thanks!
    Neveranurseagain likes this.

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  2. 0
    Quote from ArwenEvenstar
    Yes, when working through an agency, you are at the mercy of the middleman. I agree. Boy does my agency annoy me sometimes. I recently asked for a raise, and was given a "circular" speech to placate me. So, I am with ya!

    However, an agency can also be a great advocate for the nurse! The first private duty case I worked, to sumarize a long and complex situation....the family had unrealistic expectations about the tasks the nurse was suppose to perform, and was unrealistic about staffing. I was extremely thankful that I had an agency as my liaison! My supervisor backed me up numerous times when the family was having unrealistic demands. Although this case was perhaps extreme, I have found that degrees of dysfunctional coping and complex psycho-social family dynamics are pretty common in all these cases. I keep a firm professional boundary between myself and the families as a result. (Could tell you some real horror stories about the problems that can result when nurses on these cases do not keep a professional boundary.) Having an agency makes keeping this boundary easier! I put all communication through the agency. For example, I let the agency know when I need time off, and it is their job to replace me or notify the family if no staffing is available.

    That said, all power to anyone wanting to do private duty independently! It can work out well. I think that pros and cons can be listed for doing it either independently or through an agency. Each particular nurse may have different circumstances that may make one or the other option better for her.
    Thanks for your response, Arwen. I have to say, though, that I haven't had any more difficulty with "boundaries" working as a contractor as opposed to an agency. In fact, we (the nursing team) found agencies at times a DETRIMENT in our effort to create understanding with the family. I've learned that teams of NURSES are much more effective together than NON-nursing personnel acting as a go-between. But that's my experience. Thanks.
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    Thank you for your input. Do the agencies have stipulations in which they can prevent you from hiring on w/ a client if that client decided to stop using their agency? I used to do travel nursing, and they had rules like that, to protect themselves. I am only asking because it sounds like, from what you said before, that many people start out w/ the agencies and then go private hire later.

    So, their health insurance will cover for an independent nurse? If they aren't just coming home from a facility and have more chronic issues, how does the insurance company approve the nurse? How does this work?

    I will need a thorough understanding of all the in's and out's if I'm going to be advertising for a job. I don't want to look like I'm fumbling my way through it. Not a good way to win people's confidance and trust.

    What would a good "situations wanted" ad look like for this type of job?

    Thanks again, to all.

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    Have never been on my own.... But it seems that many other have and do well... Good luck.... Some one will help you out...!!!!!!!!

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