How to make a PDN job appealing?

caliotter3 · Jun 28, 2019

Wishes of the parents rate higher with the agency than wishes of the individual nurse (unless s/he is one of the golden ones). I always tell clients that if they are especially satisfied with the work of a certain nurse to make that known to the agency, as well as any other matters that concern them. I let them know that the agency listens to them before they listen to the nurse. This is a truism that I have found reported by other field nurses I have met on the job.

Coffeeandcasemanagement · Jun 28, 2019

Hi! There isn't anything that could make it appealing to me, as when I did PDN, I had a succession of particularly horrific experiences. However, most of those experiences revolved around the abuse heaped on me by parents.

I guess I could say is: being realistic and managing expectations. It is not realistic to expect the nurse to be busy with the child for the entire shift. There will and should be downtime, where the nurse is free to read, use their phone, or watch TV. Of course, this largely depends on the complexity of the case.

Also, remember that although the nurse is in someone's home, it is also their workplace. I had parents who wouldn't provide toilet paper, access to a fridge or microwave, access to a seat and desk... the list goes on. That is just inhumane.

Also, remember that most PDN employees are not receiving PDO, don't have much, if any sick time, and are not being paid well by their agencies.

nursenmom3 · Jun 28, 2019

2 hours ago, caliotter3 said:
Wishes of the parents rate higher with the agency than wishes of the individual nurse (unless s/he is one of the golden ones). I always tell clients that if they are especially satisfied with the work of a certain nurse to make that known to the agency, as well as any other matters that concern them. I let them know that the agency listens to them before they listen to the nurse. This is a truism that I have found reported by other field nurses I have met on the job.

Thank you! Giving feedback is a great idea. Are there things I could do in the house that would make you feel welcome? I know that pay and leave are issues, but they aren't issues within my control. I also know enough to provide toilet paper, fridge access, and an abuse free environment. But I'd love ideas beyond that.

caliotter3 · Jun 28, 2019

Find that sweet spot in the middle between standing directly behind the nurse to micromanage their every move and never ever being seen after the first meeting. Nurses are required to provide input to the parent about their child and to document that they have provided teaching regarding care. Please don’t provide impediments if a nurse is serious about this. Likewise inform the nurse. If you took the child to an appointment, let the nurse know what transpired so the nurse can update the care plan. That care plan (the paperwork) is part of the nurse’s job.

nursenmom3 · Jun 28, 2019

1 hour ago, caliotter3 said:
Find that sweet spot in the middle between standing directly behind the nurse to micromanage their every move and never ever being seen after the first meeting. Nurses are required to provide input to the parent about their child and to document that they have provided teaching regarding care. Please don’t provide impediments if a nurse is serious about this. Likewise inform the nurse. If you took the child to an appointment, let the nurse know what transpired so the nurse can update the care plan. That care plan (the paperwork) is part of the nurse’s job.

Thanks!

I hear you on walking that middle ground. If DH and I stray too far in one direction it's definitely on the helicopter side, although we generally only want nursing care when we're planning to sleep, or we won't be there (e.g. he's at school or we're at work). I think the fact that I'm a nurse is a mixed blessing. On one hand, it means that I get the paperwork piece, and if I'm asking the nurse to do something a specific way I can guarantee that the paperwork matches. On the other hand, I think that some nurses find working for another nurse intimidating.

I also have a kid who likes to micromanage his own care, which some people see as a strength, and some people see as bossy. Frankly, if someone doesn't appreciate his self advocacy they probably aren't a fit for us.

Kitiger, RN · Jun 29, 2019

5 hours ago, nursenmom3 said:
I also have a kid who likes to micromanage his own care, which some people see as a strength, and some people see as bossy. Frankly, if someone doesn't appreciate his self advocacy they probably aren't a fit for us.

I can easily work with kids who micromanage . . . if they do it right. If they are insulting and mean, I probably won't stay on the case. If they like to teach the nurse, that's fine. If they need at least some areas where they can feel in control, that works for me.

If they refuse to cooperate with the care that their parents & I have agreed is necessary, and their parents are OK with that, I probably won't stay on the case.

Kitiger, RN · Jun 29, 2019

Something that gets old is when I've been there a while and the parent still stands there telling me what to do.

I expect parents to watch me closely at first. After all, this is their child that they need to protect. The first time I do a specific treatment, I don't mind if the parent wants to watch me. But as the days go by, I would expect the parents to back off somewhat. Of course, it's always OK for them to pop into the room anytime.

When it's something that I need to think through - like attaching a different type of sling to a lift, or putting an unfamiliar splint on the child - let me figure it out. You can watch. Certainly you can correct me if I do it wrong, but give me a chance to do it. I will learn your way more quickly if you don't push the answers at me. You want me to truly understand how to do it next time, right?

As Caliotter3 said, communication is huge. The more you can share about your goals for your child's care and his growth & development, the better. I want to work with you. Keep me in the loop about doctor visits and any new prescriptions or changes in the care plan. Also, tell me about any changes with PT or OT.

For my part, I will give you report on how he is doing medically, any problems and what I did to mitigate them. I'll be sure to report on any successes or compliments that he received. After the first few weeks, I may make suggestions from time to time, perhaps an easier way to do something. Perhaps not; you may have him is such a great routine that I can't add to it. ?

nursenmom3 · Jun 29, 2019

41 minutes ago, Kitiger said:
I can easily work with kids who micromanage . . . if they do it right. If they are insulting and mean, I probably won't stay on the case. If they like to teach the nurse, that's fine. If they need at least some areas where they can feel in control, that works for me.
If they refuse to cooperate with the care that their parents & I have agreed is necessary, and their parents are OK with that, I probably won't stay on the case.

He's pretty consistently polite and rational about it, and if the nurse shows him equal respect then he'll listen to their side. At this point, though, he's been asleep through almost all the limited hours of PDN we've had, other than one pretty bad incident, so most of my observations are based on his interactions with professionals at the hospital and outpatient settings. I would say about 80% respect his desire to have some control and enjoy him, but the other 20% wouldn't be a fit for us.

nursenmom3 · Jun 29, 2019

14 minutes ago, Kitiger said:
Something that gets old is when I've been there a while and the parent still stands there telling me what to do.
I expect parents to watch me closely at first. After all, this is their child that they need to protect. The first time I do a specific treatment, I don't mind if the parent wants to watch me. But as the days go by, I would expect the parents to back off somewhat. Of course, it's always OK for them to pop into the room anytime.
When it's something that I need to think through - like attaching a different type of sling to a lift, or putting an unfamiliar splint on the child - let me figure it out. You can watch. Certainly you can correct me if I do it wrong, but give me a chance to do it. I will learn your way more quickly if you don't push the answers at me. You want me to truly understand how to do it next time, right?
As Caliotter3 said, communication is huge. The more you can share about your goals for your child's care and his growth & development, the better. I want to work with you. Keep me in the loop about doctor visits and any new prescriptions or changes in the care plan. Also, tell me about any changes with PT or OT.
For my part, I will give you report on how he is doing medically, any problems and what I did to mitigate them. I'll be sure to report on any successes or compliments that he received. After the first few weeks, I may make suggestions from time to time, perhaps an easier way to do something. Perhaps not; you may have him is such a great routine that I can't add to it. ?

If I'm there and available to pop in, then he wouldn't have nursing care, because my preference is to care for him myself.

Now, if I do increase my hours at work, then we'd need a nurse during daytime hours, in which case there would be a grandparent there, because I have other kids, and my son's preference is to be in the middle of the action. So, whoever is there would need to be comfortable with supporting/monitoring him in that context. I can't tell you if it would be easier or harder to hire for that position, because at this point we've only tried to find overnight people.

nursenmom3 · Jun 29, 2019

Can I ask how people get referrals from agencies? One thing I'm not clear about is whether when the agency tells me they have no one to send, that means that they literally have no one looking for hours, or they decided to prioritize other cases, or they offered my case to someone who didn't like the particulars.

I went through the archives, and I feel as though, from some of what I read here, we've got to be one of the better families to work with. Our house is clean, and the nurse is welcome to use the kitchen or hang out in the living room with our WiFi; we're happy to share our coffee and our toilet paper; our kid might be asleep (boring) or talking your ear off, but he's generally well behaved; and he more stable than many kids. So, I keep hoping that once we get a candidate who wants regular hours, they'll be happy to stay.

caliotter3 · Jun 29, 2019

In your first paragraph any of those scenarios could be the case. Unfortunately, sometimes the agency rep will fib to the client, nurse, or both, about circumstances. They think they are avoiding friction but they undermine the relationship when the client or nurses catch the untruth. Making up excuses is not necessary. Just state a fact. “We can’t cover Thur night at this time. We will continue to look.” Works for the clients or the nurses. One thing you can do on your own behalf: run your own employment ad (say on Craigslist or another empl website) and make your last statement say: “Nurse will work through patient’s agency”, or words to that effect. You can probably give nuanced info in your ad that might be a little different (acceptable) than what agencies put in their generic help wanted ads.