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How to make a PDN job appealing?

I guess you could consider this a spin off on my post about private duty nursing for my 9 year old at school, but I'm wondering if people have thoughts on what makes a private duty assignment more or less desirable.

Are there things a parent could do that would make you either want to run away from an assignment, or work there as many days as you could?

Also, if you have an assignment you particularly enjoy, are you able to request it through the agency? Particularly if the parent is also requesting you?

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.

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.

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.

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.

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

Specializes in Private Duty Pediatrics.

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

Specializes in Private Duty Pediatrics.

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. 🙂

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.

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.

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.

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.

1 minute ago, caliotter3 said:

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.

If I do that, advertise for someone and then refer them to my agency, does the agency have to give priority to my case? Could I end up in a situation where the agency decides that someone else is a higher priority, and sends the nurse I found there?

To be clear, I'm not talking about a situation where the nurse I find decides they don't want our case. I'm not interested in forcing someone.

I have never heard of the agency "stealing" your found nurse for another case. That would be detrimental to their interests. But that is not to say that the nurse themselves would not start working for you and say, ten months later, decide they wanted to move on. It also isn't to say that the agency could start the nurse out on your case, and down the road, "convince" the nurse to leave your case for another agency need. All kinds of the usual human interactions when wheeling and dealing can occur. Unless you pick up on things you would probably never know if something like this were to occur. When untruths are being bandied about, I think though, that it almost always makes itself known to the nurses and clients, and vice versa with the agency reps too. People pick up on shenanigans, so to speak.

Not sure where you are located, but here in California, recruitment is the most difficult part of the job. LVNs are required to have a year of experience before working for an agency and reimbursement rates were just increased for the first time in 19 years so wages were dismal in comparison to other job opportunities.

Great advice from caliotter to advertise on an employment website such as Craigslist or some families choose Care.com (though this is much harder to find LVNs on). Agree from what you describe here that you have a lot of the “preferable” work assignment qualities. The challenge may simply be finding a nurse who is willing to travel to your location and/or work the hours you are working for

Certainly not every agency is reputable and some do “business” by robbing from Paul to pay Peter (moving a nurse to a higher priority case), ours does not, but I’ve heard otherwise from patients and nurses

I am curious- are you employed by your agency and working any unstaffed hours?

Thank you. Unfortunately for us, although it probably makes sense ethically, our state doesn’t allow nurses to serve as PDN’s for their own children or anyone living in their house. I do have a few close nurse friends who have signed up with the agency so they can provide occasional care, but they have full time jobs, so they are not regulars.

I agree that the issue is that there simply aren’t enough nurses willing to work for Medicaid wages. I also think that while we parents experience it as a hardship not to have nursing, my kid is in no danger because we are in a position to do right by him. I wonder if the agency takes that into account when they allocate limited staffing. I know that I would probably do the same.

On the other hand, when I read about families who are abusive or don’t let people have TP or light or whatever, I wonder why those nurses aren’t flocking to our house.

7 minutes ago, nursenmom3 said:

Thank you. Unfortunately for us, although it probably makes sense ethically, our state doesn’t allow nurses to serve as PDN’s for their own children or anyone living in their house. I do have a few close nurse friends who have signed up with the agency so they can provide occasional care, but they have full time jobs, so they are not regulars.

I agree that the issue is that there simply aren’t enough nurses willing to work for Medicaid wages. I also think that while we parents experience it as a hardship not to have nursing, my kid is in no danger because we are in a position to do right by him. I wonder if the agency takes that into account when they allocate limited staffing. I know that I would probably do the same.

On the other hand, when I read about families who are abusive or don’t let people have TP or light or whatever, I wonder why those nurses aren’t flocking to our house.

Well I hate to read that, having a trained nurse employed to provide skilled nursing services for a child who qualifies for them is the exact reason these programs are in place, a parent is certainly the best equipped individual to do this especially once they’ve obtained licensure. It is so wonderful to create a home environment where a parent who makes the choice to stay home and meet their child’s medical needs can support themselves financially doing so. I hope this will change in your State (and if I knew your State well enough would share how to advocate as such)

On to your more immediate statements, I can say if you were without nursing in my agency, it would be because I just couldn’t get someone in the door whose hours matched your desired shifts (or anyone in the door at all). I know my “challenging” families (but abusive or unsafe work environments would not continue if they were reported to me either) - when I have a “desirable” home, family, and patient ... I just have to get someone in the door - so if you are successful in meeting a nurse from an advertisement - I would keep contact and if you felt they were removed to meet agency’s needs you might know where you stand.

Nurses and families do communicate and many of the stories of agencies doing unethical things (moving nurses to another case against their wishes to a higher priority case for example) were reported by the nurse to the parent directly in confidence.

I hope you find your “match” soon

Thank you!

You mention not being able to find someone who wants the hours. Do you think that some hours would be easier to fill than others? I have a lot of flexibility at work, so if different days, or different hours would make a difference, we could probably figure it out.

27 minutes ago, nursenmom3 said:

Thank you!

You mention not being able to find someone who wants the hours. Do you think that some hours would be easier to fill than others? I have a lot of flexibility at work, so if different days, or different hours would make a difference, we could probably figure it out.

I would ask your agency the question on hours, for us, there are certainly ebbs and flows to nurse availability, with the most difficult to staff almost always being weekend and NOC hours (which it sounds like you’ve already struggled with).

If you are flexible, I would give your agency the opportunity to find any available shifts based on nurses hiring on. Just let the agency know you are trying to find reliable care but have some flexibility in how you use the shifts, so the next time a nurse comes in looking for full time work regardless of the hours they’re available - you’d like to meet them? Can you work opposite your husband for a time until you feel comfortable with a nurse being reliable and available?

1 minute ago, kaliRN said:

I would ask your agency the question on hours, for us, there are certainly ebbs and flows to nurse availability, with the most difficult to staff almost always being weekend and NOC hours (which it sounds like you’ve already struggled with).

If you are flexible, I would give your agency the opportunity to find any available shifts based on nurses hiring on. Just let the agency know you are trying to find reliable care but have some flexibility in how you use the shifts, so the next time a nurse comes in looking for full time work regardless of the hours they’re available - you’d like to meet them? Can you work opposite your husband for a time until you feel comfortable with a nurse being reliable and available?

We do work opposite hours. Right now, my husband works 5 nights, and I work 12 hour shifts on the two days after the nights he doesn't work, and sometimes a third day if a friend or family member who is trained on the vent etc . . . can cover the night before. I can't cover my son overnight, and safely work the next day, so I only work days when I can sleep the night before.

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