Private duty nursing??

Bookerton · Feb 13, 2005

Hey Arwen,

My name is Bob and I am an LPN private provider based on Long Island, NY, who gives care to a terminally ill young man. To give you a quick overview, I rec'd this case working weekends and odd hours through a registry when I first joined them. My other hours were filled by taking care of end-stage renal pts through another agency. Two years later I learned about becoming a Medicaid/Medicare Private Provider and was informed by the family that they would prefer to have me provide care to their son a private provider. By this time I was the only nurse on this case, my other people had passed, I had the available hours and they were pleased with my care. A "Win-Win" situation....well except for the registry. They weren't pleased but they knew it was the family's wishes. My pt. was expected to be gone by this time. Ten years later I can say this, "One of the best things I ever did was becoming a Private Provider!"

PRO's: 1) More Money; 2) Autonomy; 3) Ease of Care.

CON's: 1) Many Hours/Lack of Additional Coverage (for me); 2) Ease of Care; 3) Tax Issues(initially); 4) Slow Payment.

Net Result: A) I make significantly more as my counterpart would, say, in a local nursing home; B) My only real boss is my client and he is easily pleased as a result of our many hours together each week over the years; C) I am self-employed so I had set up a business structure which best suits my lifestyle*.

The ugly part of it....my situation at least...is that my skill set has diminished. That's the CON perspective of "Ease of Care." With respect to my client those skills couldn't be any sharper but throw me in a med-surg situation, I'd flounder. Just the idea of dealing with so many other para-medicals seems foreign. As a Private Provider your role in your client's wellness takes on a whole new significance.

Anyhow, I hope you found this helpful. By the way, insurance companies pay more than Medicaid/Medicare. Bob

*C ended up being a nice perk. It got to the point where half of my income was taxes (single, no write-offs) so I sat down with my CPA buddy, griped, and in one month I was incorporated. My company makes this, pays out that, the cashflow is still the same but my tax liability is lessened. Anything remotely related to my nursing business is a write-off....this computer and other home office items, the car and its expenses, my health coverage (any plan I choose), my retirement (a $10k contribution for 2005 SIMPLE IRA), a professional lunch, so on and so forth. By being incorporated I am not strictly limited to uniforms, stethoscopes, and other directly work-related items.

ArwenEvenstar · Feb 13, 2005

Thanks for the info Bob! I appreciate your thoughts and perspective. It sounds like the "doors opened for you" and you were able to ease into and adjust to your situation.

I was actually just surfing the web and found some info about independent private duty nursing. Doing it independently had never even occurred to me.

Since I am brand new to this area of nursing, I think I'll start out through an agency or registry to gain some private duty experience. (If this is the direction I decide to go...)

When I make a decison, I'll let you know. It may be awhile. At this point, I am just networking and exploring my options... All I know is that I need to get AWAY from hospital staff nursing!!! (I am so burned out I am toasty!!)

renerian, BSN, RN · Feb 13, 2005

Some companies define private duty differently more based on the side of the company they put shift work in. So private may mean private pay or private duty shift work as in medicaid shift work. Depending on what you want to do or what part of town you want to work in defines some things for you. Good questions to ask if you interview somewhere.

The pay is a big con. Most companies where I live only pay 19 to 21 for an hourly RN. LPN Is less. Some companies may be higher or lower depending on where you live.

renerian

steelcityrn, RN · Feb 13, 2005

I have done private duty nursing for years. Once your established with a case that gels with you, your going to love it. OMG, you can't compare the work load at all. No more phones ringing off the hook, no more being paged, no more families fighting with the staff that you have to take care of. I can't tell you how much more relaxing it is. I am doing homecare daylight now, the p. duty case i was on for over 3 years only has the 11p to 7am open. I did work firday night though, and the biggest decision I had to make was what movie to watch. I know the care of the patient inside and out, this is a adult on a vent with a g tube. Good luck to you. If I had to say of any drawbacks it would be that you need to work in a different environment at times to keep up with the vast amount of nursing your exposed to now, or read alot of nursing books, magazines to keep yourself current.

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.

ArwenEvenstar · Feb 17, 2005

thanks renerian for your thoughts! I was actually wondering how big of a pay cut I would be taking. And just today I spoke with an agency about a private duty peds case, and they told me the pay was 19-20/hr. So it is about the same as where you live in Ohio.

My sanity is worth money too. I can't even tell you how burned out I was/am with hospital staff nursing...

DDRN4me · Feb 17, 2005

Arwen, I have done pedi private duty since the mid 1980's. (Can you tell i love it??) there are some pros and cons as previously mentioned. Biggest pros for me: Flexibility when my girls were young; and when i was in school;

The autonomy of working independently but still having a case manager to call if i really needed;

the priveldge of meeting some wonderful families and very special kids;

the continuity of care i could provide without feeling like i was only giving part of what i wanted to

a decent income..need more $$ work more hours!!

Cons: some families that think you are the babysitter and/or housekeeper

finding the hours to work that fit with the cases you want

paperwork (esp. if client is >18= Oasis:uhoh21:

I always kept more than one patient on my caseload in case one was hospitalized or on vacation, t hat way i didnt lose work, also kept up with skills.I found that my assessment skills really improved because you are the one person responsible for this client..they really depend on your professional care. Good Luck!! Mary

ArwenEvenstar · Feb 19, 2005

Thanks Mary for your response. I had not quite decided what I wanted to do...All I knew is that I did not want to be a hospital staff nurse anymore! But private duty nursing is really appealing to me. And I am making that my first choice for new employment. So atleast I have narrowed it down...That helps when you are on a job hunt.

I have decided not to go with Pediatric Services of America (that i mentioned in another post) as I have heard some questionable things about them.

I have a job interview this Monday with Healthforce for a particular case. The lady talked with me at length on the phone, and it almost sounds like the case is mine as long as the interview goes fine. It is a little girl with a trach, ventilator, PEG tube. The hours would be good for me. And it is near my home also. I feel good about this, and hope all goes well with my interview. And of course, I have some questions too. I have no ventilator expereince and would need proper orientation to that...

Thanks for sharing the pros and cons with me. All the posts have been helpful and informative. THANK YOU everyone.

Arwen, I have done pedi private duty since the mid 1980's. (Can you tell i love it??) there are some pros and cons as previously mentioned. Biggest pros for me: Flexibility when my girls were young; and when i was in school;
The autonomy of working independently but still having a case manager to call if i really needed;
the priveldge of meeting some wonderful families and very special kids;
the continuity of care i could provide without feeling like i was only giving part of what i wanted to
a decent income..need more $$ work more hours!!
Cons: some families that think you are the babysitter and/or housekeeper
finding the hours to work that fit with the cases you want
paperwork (esp. if client is >18= Oasis:uhoh21:
I always kept more than one patient on my caseload in case one was hospitalized or on vacation, t hat way i didnt lose work, also kept up with skills.I found that my assessment skills really improved because you are the one person responsible for this client..they really depend on your professional care. Good Luck!! Mary

DDRN4me · Feb 20, 2005

Good luck! let us know how it goes! Mary

Thanks Mary for your response. I had not quite decided what I wanted to do...All I knew is that I did not want to be a hospital staff nurse anymore! But private duty nursing is really appealing to me. And I am making that my first choice for new employment. So atleast I have narrowed it down...That helps when you are on a job hunt.
I have decided not to go with Pediatric Services of America (that i mentioned in another post) as I have heard some questionable things about them.
I have a job interview this Monday with Healthforce for a particular case. The lady talked with me at length on the phone, and it almost sounds like the case is mine as long as the interview goes fine. It is a little girl with a trach, ventilator, PEG tube. The hours would be good for me. And it is near my home also. I feel good about this, and hope all goes well with my interview. And of course, I have some questions too. I have no ventilator expereince and would need proper orientation to that...
Thanks for sharing the pros and cons with me. All the posts have been helpful and informative. THANK YOU everyone.

renerian, BSN, RN · Feb 26, 2005

How did your interview go?

renerian

ArwenEvenstar · Feb 26, 2005

My interview went well...I start next monday (march 7) with my first Private duty nursing case. The same nurse has been on this case for the last several years but she is retiring, so that is why this position opened. It is in a private home with a little girl with multiple medical problems. I have not been to the home yet, but the agency told me they live in a beautiful home in a nice area. They told me they are a very easy-going family, and I won't have to worry about the family being "difficult".

During the school year, I will be with her from 2pm till 8pm Monday to Friday. In the summer (no school) I'll be with her from 7:30 am till 5 pm, also Monday to Friday. LONG hours in the summer!!! But since it is temporary I can handle it! The 2pm to 8pm is PERFECT FOR ME! I hate mornings, am a natural night owl, and have worked either evenings or night shift for years now.

I feel very positive and excited about this... In fact, the whole situation seems almost too good to be true! I feel like a "gift" has been dropped in my lap. I was VERY BURNED OUT (stressed out to the max!) of hospital nursing, and am so looking forward to this change of pace.

Meanwhile, the last few nights I worked at the hospital I have told various nurses of the new position I am taking...some have wished me well and are happy for me, but others have been sordof critical...saying I'll be bored and unchallenged. Such as,

"You'll only have one patient?? That sounds boring."

"I wouldn't know what to do without 6 or 8 patients. I like to be busy. I wouldn't want a job like that...I wouldn't feel challenged."

These comments, to be honest, really surprised me. It wasn't what I was expecting.... DO ANY OF YOU OTHERS WHO DO PRIVATE DUTY NURSING ENCOUNTER REMARKS LIKE THIS?? Do they act like you are a "lesser" nurse because you only care for one??

As stated above, I feel really excited and positive about this and the change of pace. After 14 years of hospital staff nursing (running around with my head cut off, overloaded with work, never being able to leave feeling like my patients truly got PROPER care, etc) - I am ready for a job that is a different pace. I am excited that I will have the time to actually give a patient PROPER care!!!!!!!! I am excited about getting to know ONE patient and their family, instead of caring for hundreds of patients over the course of time. And if there are moments of boredom...after 14 years of INSANITY at the hospital, I welcome it!

Well, this is a LONG post!! So sorry! Laura (Arwen Evenstar)

Good luck! let us know how it goes! Mary

renerian, BSN, RN · Feb 26, 2005

Yes I have heard people say negative comments on private duty and home care in general. I have had patient's several time says, I left home care as I could not cut it in the hospital LOL. Big different between not being able to cut it and running from scarey legal issues or exhaustion... :rotfl:

I am glad you posted how your interview went. So many times people ask for advice and never post on the outcome so you don't know what happened.

I am glad your pleased with your new direction in nursing. That is all the counts.

renerian