private duty nursing?? - page 2

I have been a hospital staff nurse (RN) for 14 years and I am VERY burned out. I need to get into a new area of nursing and i am considering several options. (such as home health, utilization... Read More

  1. Visit  PAmom profile page
    0
    I did just 3 days for PSA and I hated it. You are basically a babysitter with higher rate of paying. it is very hard a) emotionally - kids are really sick with little hope to ever get better and parents are exhausted, b) physically - you do have to carry kids around because unlike adults, even if they are sick, they do want to play, c) intellectually - you are not learning anything, you do not have contact with anybody except parents who are often not even home...It is very routine care...I would suggest gettring into either clinical trials or hosptal administration.
  2. Visit  caliotter3 profile page
    0
    I worked private duty on one case and could have stayed for years, unfortunately I became dreadfully ill and had to leave the case. The primary nurse/case manager has been with this client for over 15 years now and has no plans on leaving until something forces the issue. She worked private duty previously in very well to do homes and likes this venue very much. There are pros and cons. One thing I liked was that the client's family treated us like employees, had their CPA cut our checks, and took care of all the taxes, etc. We were pretty much covered. They paid all the necessary stuff that any household worker needs to have paid to be legal. The good parts of home health care without the hassles of dealing with the agency that is sometimes a hindrance rather than a help. I do not agree that this works out for every situation though. You have to be very careful who you go to work for, and what your parameters are. It is easy to be taken advantage of.
  3. Visit  ArwenEvenstar profile page
    2
    Hi! I noticed that my original post from 2005 got revived and was posted on just recently in 2007. I have been doing private duty for almost 3 years now and I feel like I have found a real nitch. I've worked two different cases now and thought I'd make some comments.

    Private duty is not for everyone. Yes, you are essentially a high-tech babysitter. Some may find it boring. But that is exactly why I like it! I love the non-chaotic, casual, boring, low-stress (comparatively speaking - there are some stressors which I'll comment on below) atmosphere. On my present case, there is only about 10 to 15 minutes of work for every hour. (Yet, my patient is getting excellent care! That is simply all there is to do.) The rest of the time I just sit there and do whatever I want. I read books and write letters (a hobby that I enjoy). I LOVE the fact that I am getting paid to read and write for pleasure!!

    I'd say the main con or stressor of private duty is the possibility of dysfunctional coping on the part of the family. Families can react in very different ways to having a severely disabled loved one. The two families I have now worked for are polar opposites!! The main reason I left the first case I was on and moved to a different case, was that I could no longer tolerate the family. They were very needy, demanding, with unrealistic expectations. They were unappreciative. I initially replaced a nurse who had not maintained a proper professional boundary, and this had made things worse. I loved my patient dearly, but had reached the end with the family.

    The new family on my new case is the complete opposite. They are helpful, appreciative, and very realistic about the care of someone disabled. It is a refreshing change! In fact, after being treated rather poorly by the last family, I feel overwhelmed by their respect and courtesy!

    My closing advice, it is VERY important to maintain a proper professional boundary in these cases!!!!! If you don't, you will easily get pulled in and stop seeing things objectively, and you won't even realize it! A firm professional boundary is imperative. If you think you'll have problems with this, do not do private duty. I had to deal with a lot of "issues" on my first case that were partially created by nurses who lacked a professional boundary.
    Ellie S. and dance4life like this.
  4. Visit  Brita01 profile page
    0
    Quote from ArwenEvenstar
    Hi! I noticed that my original post from 2005 got revived and was posted on just recently in 2007. I have been doing private duty for almost 3 years now and I feel like I have found a real nitch. I've worked two different cases now and thought I'd make some comments.

    Private duty is not for everyone. Yes, you are essentially a high-tech babysitter. Some may find it boring. But that is exactly why I like it! I love the non-chaotic, casual, boring, low-stress (comparatively speaking - there are some stressors which I'll comment on below) atmosphere. On my present case, there is only about 10 to 15 minutes of work for every hour. (Yet, my patient is getting excellent care! That is simply all there is to do.) The rest of the time I just sit there and do whatever I want. I read books and write letters (a hobby that I enjoy). I LOVE the fact that I am getting paid to read and write for pleasure!!

    I'd say the main con or stressor of private duty is the possibility of dysfunctional coping on the part of the family. Families can react in very different ways to having a severely disabled loved one. The two families I have now worked for are polar opposites!! The main reason I left the first case I was on and moved to a different case, was that I could no longer tolerate the family. They were very needy, demanding, with unrealistic expectations. They were unappreciative. I initially replaced a nurse who had not maintained a proper professional boundary, and this had made things worse. I loved my patient dearly, but had reached the end with the family.

    The new family on my new case is the complete opposite. They are helpful, appreciative, and very realistic about the care of someone disabled. It is a refreshing change! In fact, after being treated rather poorly by the last family, I feel overwhelmed by their respect and courtesy!

    My closing advice, it is VERY important to maintain a proper professional boundary in these cases!!!!! If you don't, you will easily get pulled in and stop seeing things objectively, and you won't even realize it! A firm professional boundary is imperative. If you think you'll have problems with this, do not do private duty. I had to deal with a lot of "issues" on my first case that were partially created by nurses who lacked a professional boundary.

    I enjoyed reading this and hearing that three years later you have found your niche. I myself absolutely LOVED private duty. I took care of a lovely girl for 3 years and would have stayed with her until my retirement age if I could have, but she passed on. The family were some of the finest and most loving people I've ever met. After that, other families that I dealt with had some of the same issues that you spoke of and I moved on to another area of nursing. But I will always look back at my private duty nursing job as one of the best and least stressful nursing jobs that I've ever had.
  5. Visit  kwagner_51 profile page
    0
    I have been in private duty nursing for almost a year now. I ABSOLUTELY love it!! I am losing one pt due to family [ hers] issues. The POA is bi-polar and refuses to medicate self. She watches us with a camera in the room and tells us how to do our job. [Literally, instructed me on how to give a fleet's enema. You know, left lateral position etc :angryfire :angryfire ]

    I care for two young males. One is 19 and has trisomy 9 the other is 14 and has trisomy 8. I have very little spare time for reading etc. The 19 y/o will sleep and he likes basketball. When I work nocs I put him to bed. The 14 y/o likes pro wrestling. His fave is "Undertaker". I am supposed to do all the moves that his rivals do. Of course I don't do anything dangerous. We have so much fun. Last Sunday we walked outside and I introduced him to trees. Unknown to me, he is afraid of trees. we will work to overcome that fear. I actually got him to touch the trees and to stand under them so he could see how tall they are.

    As far as losing skills, I think that I have gained skills. The 19 y/o has a new HHN that has two machines. One is the regular HHN machine. The other one hooks into the first machine and delivers 10 lbs of pressure to force the medication into his lungs. It attaches straight to his trache. He also has something called a percussion vest that he wears while he is getting the neb tx. It precusses his lungs to help prevent pneumonia.

    I don't think I will be leaving any time soon!! :heartbeat :heartbeat
  6. Visit  DMBFAN4EVR profile page
    0
    Hi All! I have a couple of questions for anybody able to answer. How have you gone about getting these patients and how do you determine what to charge for an hourly rate. PDN is something that I am seriously interested in doing but am not quite sure how to go about it.
  7. Visit  Lorie P. profile page
    2
    to answer and update this thread. i work through maxim health care and was contacted by one of there nursing recuiters.

    i had spent the last 4.5 years as a staff lpn on a very busy med/surge floor with a pt load of 5-9 very ill pt's. i worked night shift, couldn't get on a day shift position and was getting so burned out.

    long story short, i was able to accept the position offered to me and my very first pt was a 19 y male that i took care of 4 evenings a week from 3-9. i coudn't not have asked for a better first pt to start my pdn career with.

    now, i have 8 week old that has a rare genetic disease, a trach and g-tube. i work less than 25 miles from home, monday-friday 8-4 or 8-6, depends on the day.

    she is an only child to a very pleasant young couple who are so happy to have a nurse that comes and takes care of their little one.

    so far, i haven't had any problems and i really seen any happening, which could change, one never knows.


    i am able to come to this family from both a nurse's view and a from the veiw of a mother that went through much of the exact same emotional issues.

    my only child was born 16 premature and i can so relate to the emotions this couple is going through.


    this job is not that demanding, stress levels are so low and i get to make a difference in my pt's life.

    i don't think i will ever go back to hospital/bed side nursing.

    i hope this helps, also, sorry this is so long and kinda jumps around.


    i also posted my resume on monster and other site along with word of mouth.

    good luck to you !!!
    dance4life and DMBFAN4EVR like this.
  8. Visit  oldiegoldie profile page
    0
    As a private contractor couldn't you slightly undercut the agencies and still make a huge profit? If taking care of an elderly person, can I bill medicare and the family? Where can I find a complete list of medicare laws regarding something like this?

    Thanks.
  9. Visit  ArwenEvenstar profile page
    0
    Quote from oldiegoldie
    As a private contractor couldn't you slightly undercut the agencies and still make a huge profit? If taking care of an elderly person, can I bill medicare and the family? Where can I find a complete list of medicare laws regarding something like this?

    Thanks.
    Private duty RN (or LPN) level cases tend to be pediatric medicaid cases. I know that in some states a RN can be approved as an independent medicaid provider for these cases, but I don't know the details of it. I think that RN (or LPN) level elderly cases (and thus medicare) are going to be rare. Most elderly cases would be more likely to be nurse's aid/home care assistant level cases. Although there are exceptions...for instance I know about an elderly ventilator dependent client in my area that requires RN/LPN level care. But I think those cases are not too frequent. Well..I have not really answered your question. Sorry! Maybe someone else can.
  10. Visit  HisTreasure profile page
    1
    Around here you will see more adults with PDNs than peds. The reason is most agencies have in-house hospital reps to start the private cases before the families have a chance to explore the private (without agency) options. Here you will make $22.XX for low tech adults and $25.93 for high tech. Medically fragile peds get the same base reimbursement rates plus a 30% add on. Therefore, it's easier to get adult cases because there is significantly less money to be made and because as a rule the agencies aren't out actively recruiting adult patients as they are pediatric. I see Craigslist ads for adults but very rarely for peds, and when a peds case is posted it's normally filled very quickly and will experience minimal turnover.
    Jenn55e likes this.
  11. Visit  Nurse_Re profile page
    0
    Hey Bob, thank you for sharing your experience with becoming a private duty provider. I myself have just been approved by medicaid, I currently have one patient, and will begin my own billiong this week. So I am desperate for your help. I have no clue what type of procedure codes to use, I know the diagnosis coding, but are so confused as to whether there is one specific code for LPN private provider, or if it's billed as per procedure as in a medical office. Also please share more regarding how you became a comrporation, and fees associated with all you have accomplished. Thank you. Reann
  12. Visit  WI_home_RN profile page
    1
    Quote from ArwenEvenstar
    Hi! I noticed that my original post from 2005 got revived and was posted on just recently in 2007. I have been doing private duty for almost 3 years now and I feel like I have found a real nitch. I've worked two different cases now and thought I'd make some comments.

    Private duty is not for everyone. Yes, you are essentially a high-tech babysitter. Some may find it boring. But that is exactly why I like it! I love the non-chaotic, casual, boring, low-stress (comparatively speaking - there are some stressors which I'll comment on below) atmosphere. I had to deal with a lot of "issues" on my first case that were partially created by nurses who lacked a professional boundary.
    Reading this thread with high interest...thanks for posting your story and following up with it I have been in PDN for over a year now and really enjoying my two cases.

    Can you elaborate a little more on the nurses who lacked professional boundaries? Just recently I encountered an RN who crossed that line and the family let her go. It was a really ugly scene. Just wondered what your exact experience was.
    DianeDon likes this.
  13. Visit  karensflowers profile page
    0
    [color=#1a1a1a]what i find to be outrageous is that the agencies who hire home care workers are getting rich as their employees are getting poorer. on average, the agencies pay their workers less than 1/3 of what the agencies are getting reimbursed by medicaid (for the employee who does all the actual work).

    [color=#1a1a1a]home care workers generally get zero paid holidays, zero mileage, zero medical insurance, etc.

    [color=#1a1a1a]at most agencies, medical insurance is denied unless the worker commits to working 4 weekend days monthly....even if that employee is already scheduled to already work 40 hours during the week each week. the agencies get away with that by saying, '...we will always schedule someone else for one of your 'scheduled' days during the week when you work weekends (never happens)...". that phrase doesn't even make sense!!!! why? because they [color=#1a1a1a]make out your schedules 4-6 weeks in advance and it would be at that point that the agency should be deleting two of your days during the week if they are going to schedule you for a weekend. this is fine for those who relish overtime....but for others, a big fat no!

    i find this to be extortion and an immoral way for agencies to provide their employees with medical insurance. oh, by the way.....the agencies do not pay the employee a higher wage differential for weekend work (when you are scheduled for weekdays) , so it is no wonder the agencies must use the leverage of denying medical insurance to the employee if they do not work 2 weekends a month.....no one wants to work weekends if they do not get a higher wage for sacrificing family time.

    agencies are receiving $68 hrly from medicaid for services for a rn and paying that same rn anywhere from $18-$22 hourly depending on their rn experience. medicaid is paying agencies $57 hourly and paying the lpn anywhere from $14-$18 hourly. these nurses have college degrees and most have student loans to repay.

    i would assume that agency caregivers (who are not nurses) mentioned in the star's letter-to-the-editor are being abused even more.

    by the way, the agency office employees, managers, and agency owners get paid holidays and vacation/sick days while their field nurses and aides get none. they do give them a week pto annually, but that is always used up when their patients get ill and must be hospitalized for days and the employee needs a full paycheck that week, which happens several times annually...so the workers do not generally get to take vacations with their families unless they want to go a week without any pay.

    solution: have medicaid pay home care workers directly and they will save 66% of the bill for the disabled, terminal, and senior citizens. while the state will have to hire a few more office personnel to do this, i doubt it would be the 66% the agencies are pocketing.

    Quote from arwenevenstar
    i have been a hospital staff nurse (rn) for 14 years and i am very burned out. i need to get into a new area of nursing and i am considering several options. (such as home health, utilization review/case management, mobile field examiner for a life insurance company, etc.)

    regarding home health...i am not sure i like the idea of driving all over creation! so i have been thinking about private duty home nursing. atleast you are just driving to one house and stay there an entire shift doing one-on-one care.

    a local home care company (pedriatic services of america) has recently been advertsing in my area for private duty nursing positions. i called and got some
    basic information. they do mostly 8 hour shifts.

    anyone out there with private duty nursing experience? pros?? cons?? advice?? how does the stress level compare to hospital staff nursing? atleast you are just dealing with one patient...not 6 to 10. right?

    i am interested in night shift...which is 12 mn to 8 am for pediatric services of america. i am a natural night owl and have worked night shift for years. so this would be a way for me to get away from the hospital but still work at night. can't do regular home health visits at night (or other non-hospital jobs for that matter)!!

    thanks in advance. please do share your private duty nursing experiences and thoughts with me. it will be much appreciated.


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