Getting Going in Pvt Dty Nursing!

ArwenEvenstar · Jul 1, 2008

I myself would be scared, or perhaps a better word would be nervous, to do private duty completely on my own like that. Maybe if I got a medicaid number and was medicaid approved to do medicaid peds cases, that might be okay. But to just look for cases at random in the community, I don't have the guts. I would be way to worried about liability, having to negotiate pay/contracts with individual people, unsafe situations, etc. Through an agency there is screening, malpractice coverage (etc) and they do all of the behind the scenes arranging. You can also keep more of a "distance" between you and the client because the agency does all the scheduling and such. I like how the agency is a middle man.

BUT I AM NOT trying to discourage you. Anyone who has the guts to venture out on there own is to be admired! I wish you the best. Your ideas sound like good ones to get your name and services known in the community. I'd love to hear updates of how this goes for you.

alaskabound · Jul 27, 2008

the first thing I would do is find out how you are liable. you worked hard for your liscense and its important to do the work first before the fun stuff of PR!

lc177985 · Aug 27, 2008

I too would be nervous. Having worked in private duty for the last 1 1/2 years I have noticed that private duty is very creative. Patients don't have the money or resources to get the proper equipment and you are often making do with something less than optimal. Being able to document my issues and then referring the client to the agency I work through has been a lifesaver. They carry the liability and make the decisions as to what is appropriate or not. The agency I work for is private duty and I am able to choose my own patients and work a schedule that is agreeable to us both. My suggestion would be to find a smaller agency in your area. They are usually willing to work with you and give you the experience that you want.

dpw · Nov 25, 2008

I would think that your liability would be the same working in either situation.All nurses should cover their own malpractice insurance even if the agency has a policy. I was told by the owner of the company I work for that this should be the case because if it came right down to it; he would throw the nurse to the wolves, meaning place as much distance between the two to save his own business. Not only that, even hospitals have been know to turn on a nurse to get back what they lost in a suit.If you stayed with in your scope of practice you should be ok. I think I would write my own policey and procedures manual or purchase one. That way you have a formal document to cover you. In any case, contact a lawyer in your area.

caliotter3 · Nov 25, 2008

I agree with everything previously stated. I just do not care to go through the extra work and precaution taking required for this type of venture at this time. I prefer to let the agency do all the dirty work. I like having the backup of the agency even if it is limited. Too much can go wrong to have to be worrying about all the time. Less worry when the agency takes care of things and puts up with the problems encountered. But if you do go through all of this, that is good. I think your ideas in your post are very good. You do have to make certain that you are taken care of liability wise and that you handle your tax deduction stuff correctly. Good luck in your endeavors.

NurSpeak · Jan 18, 2009

I'm surprised to find such pro-agency rhetoric here. I hope OldMare has done what she had planned and is happily caring for a private duty client as we speak. As far as "equipment," the client has their own! It would be unsanitary and inappropriate to supply the equipment. Remaining at the mercy of middlemen who take a few dollars from EVERY HOUR of our pay is one way nurses have remained in a vulnerable position. OldMare, how's it going? Thanks!

ArwenEvenstar · Jan 19, 2009

I'm surprised to find such pro-agency rhetoric here. I hope OldMare has done what she had planned and is happily caring for a private duty client as we speak. As far as "equipment," the client has their own! It would be unsanitary and inappropriate to supply the equipment. Remaining at the mercy of middlemen who take a few dollars from EVERY HOUR of our pay is one way nurses have remained in a vulnerable position. OldMare, how's it going? Thanks!

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.

dixiedo · Jan 23, 2009

I registered with the Minnesota Dept. of Health and got my private duty license, I can bill on line the insurance company, medicare, VA and the state all at one place. It is a good idea to have your own insurance which is reasonable. The biggest factor is finding a client or two. The agencies have this sewed up, but the law changed in recent years to allow individuals to practice on their own. I am glad for this as the state pays $39.50 per hour for a vent case. It is worth the trouble to find your patient to make a decent living. All the nurses I spoke with who have left agencies are glad they did, and the families and patients feel like they have more control on who comes. Don't give up.

GardenerGirl · Jan 24, 2009

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....?

Cheryl

NurSpeak · Jan 24, 2009

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....?
Cheryl

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!

NurSpeak · Jan 24, 2009

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.