How to make a PDN job appealing?

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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?

5 hours ago, nursenmom3 said:

Do nurses choose jobs based on who is in the house?

I read the archives, and two things that stood out were someone who didn’t want to alone in the house with an adult male, and concerns about other kids.

My husband works nights so if we ever got daytime nursing there would be times when he was there, and we also use a Grandfather as a caregiver for my other kids. One of my kid’s home teachers through the school system is also male.

Our other kids are 9 and 12, and would also be in and out. When my kid with the medical needs isn’t in the house, then we let the 12 year old stay alone sometimes, or the two of them together. Is that even an option?

I think I know the post you are speaking of regarding being alone in the home with males. I want to say I doubt most female nurses would have a problem with this to the extent of not taking a case. That post was a particular situation where the original poster and one other poster understandably had issues with it due to a past assault. I, and many of my coworkers, have done it with no issues.

As far as other kids, the issue is when the parent of the patient expects or asks the nurse to babysit/keep an eye on another child in the home. I don't know the age laws off the top of my head, but as long as a child is old enough to be in the home unsupervised, a d as long as the parents, the child, the nurse, the agency, all understand that the nurse is not responsible in any way shape or form for the other child in the house, it should be no problem. (As long as it's legal for the child to be alone, bc for all intents and purposes, the child is in fact under no supervision since the nurse is not responsible for said child.)

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3 hours ago, Orion81RN said:

I think I know the post you are speaking of regarding being alone in the home with males. I want to say I doubt most female nurses would have a problem with this to the extent of not taking a case. That post was a particular situation where the original poster and one other poster understandably had issues with it due to a past assault. I, and many of my coworkers, have done it with no issues.

As far as other kids, the issue is when the parent of the patient expects or asks the nurse to babysit/keep an eye on another child in the home. I don't know the age laws off the top of my head, but as long as a child is old enough to be in the home unsupervised, a d as long as the parents, the child, the nurse, the agency, all understand that the nurse is not responsible in any way shape or form for the other child in the house, it should be no problem. (As long as it's legal for the child to be alone, bc for all intents and purposes, the child is in fact under no supervision since the nurse is not responsible for said child.)

I looked up age related laws for staying home alone, and it doesn't appear that our state has one. However, I think that having a 12 year old stay home alone, or with a 9 year old sibling, is a pretty mainstream choice, so hopefully the nurse won't mind.

I would not expect a nurse to supervise my other kids, but I would expect my other kids to listen if he/she asked them to do something within their capabilities, such as fetching something, or tidying something, the same way they would for another adult in the home.

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Sorry, but I keep reading the archives and coming up with new questions!

I just read a post where someone was complaining about parents providing medical care while the nurse is there. The complaint seemed to be a mixture of "it's boring and I feel useless" to "if I don't chart that I did anything, then the hours might get cut".

Does this apply when a parent is providing care intermittently? Does that bother nurses, or put hours at risk? Let's say, for example, that the nurse comes on and I leave for work, but a few hours later my husband, who works nights, comes home and wants to spend a few hours with our son before Dad goes to bed, and care gets handed back to the nurse. Is that something that bothers people, or do you think "great, I've got a couple hour break to read or whatever"? My son has a pretty strong preference for parental care, if a parent is available, and given that he hasn't been in our home that long that's actually a really wonderful thing we want to reinforce.

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When the parent provides care the nurse simply identifies that fact in the narrative portion of the note if a narrative comment is made. Sometimes nurses will state something about an intervention being done but not specify who did it. Have never heard of a problem with the parents doing the work then the payor taking away hours. I worked a case at night where the two parents took turns splitting the shift and did everything. I was only there as a second pair of hands if necessary. They had their reasoning for doing it this way and there was no problem that I knew of. Where the problem arises, is if the client does not use nurses or the agency does not provide nurses, i.e. lots of "missed" hours. Don't use your hours, then Medicaid (the usual payor) will take those hours away from you and they don't care what reason you have for not using your hours.

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15 hours ago, nursenmom3 said:

Sorry, but I keep reading the archives and coming up with new questions!

I just read a post where someone was complaining about parents providing medical care while the nurse is there. The complaint seemed to be a mixture of "it's boring and I feel useless" to "if I don't chart that I did anything, then the hours might get cut".

Does this apply when a parent is providing care intermittently? Does that bother nurses, or put hours at risk? Let's say, for example, that the nurse comes on and I leave for work, but a few hours later my husband, who works nights, comes home and wants to spend a few hours with our son before Dad goes to bed, and care gets handed back to the nurse. Is that something that bothers people, or do you think "great, I've got a couple hour break to read or whatever"? My son has a pretty strong preference for parental care, if a parent is available, and given that he hasn't been in our home that long that's actually a really wonderful thing we want to reinforce.

Darnit. This happens all the time on this site. I typed out a very detailed response, and it disappeared. Lol. Anyway, I'll respond in a bit. My patient is needing me now ?. Spent my entire lunch on that reply too. But I have pretty strong feelings on this topic, so I'll be back! PS. Don't feel bad for posting lots of questions. This must be quite overwhelming, and I'm sure I speak for us all when I say we're happy to answer your questions.

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4 hours ago, Orion81RN said:

Darnit. This happens all the time on this site. I typed out a very detailed response, and it disappeared. Lol. Anyway, I'll respond in a bit. My patient is needing me now ?. Spent my entire lunch on that reply too. But I have pretty strong feelings on this topic, so I'll be back! PS. Don't feel bad for posting lots of questions. This must be quite overwhelming, and I'm sure I speak for us all when I say we're happy to answer your questions.

Awww thanks! You are very kind. It is overwhelming, but I'm still aware that I'm going overboard. My husband and son and I are out of town because my son was admitted to an out of state hospital where we took him for a second opinion. So, I suddenly have lots of time to worry while he's asleep or hanging out with Dad, and I have no work or other kids to attend to, and worrying about things like whether or not the PDN will get along with Grandpa is easier than worrying about test results! In the same vein, last night I spent a few hours researching high school options in my area for kids who are both gifted and physically disabled. My kid is 9. He does not actually need me to select a high school at this point.

I look forward to hearing your strong feelings. I really appreciate all the insight.

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Specializes in LTC.

Don't stab your nurses in the back. If you have a problem with something they are doing or not doing, TELL them directly first instead of being passive aggressive and complaining to the agency first. We aren't mind readers, and there is nothing that grinds my gears more than dealing with parents who are nice to my face and telling me what a "great job" I'm doing while talking to the agency behind my back and complaining. If you don't like how the nurse does something, just straight up tell them first. If the problem continues and there are still concerns after talking to the nurse, then call the agency.

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1 hour ago, Crystal-Wings said:

Don't stab your nurses in the back. If you have a problem with something they are doing or not doing, TELL them directly first instead of being passive aggressive and complaining to the agency first. We aren't mind readers, and there is nothing that grinds my gears more than dealing with parents who are nice to my face and telling me what a "great job" I'm doing while talking to the agency behind my back and complaining. If you don't like how the nurse does something, just straight up tell them first. If the problem continues and there are still concerns after talking to the nurse, then call the agency.

Thank you!

I feel like one thing that's coming across on this thread, is that once we find someone, they might be thrilled to find us, because many of your patients' parents sound awful!

I will say that we did fire one nurse without talking to her first, but we had been crystal clear about the expectations that were broken. We also didn't find out what happened until our son told us later, so there was no way to talk to her in the moment.

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Specializes in LTC.
1 hour ago, nursenmom3 said:

Thank you!

I feel like one thing that's coming across on this thread, is that once we find someone, they might be thrilled to find us, because many of your patients' parents sound awful!

I will say that we did fire one nurse without talking to her first, but we had been crystal clear about the expectations that were broken. We also didn't find out what happened until our son told us later, so there was no way to talk to her in the moment.

LOL if you only knew how some of the families I've worked for have treated me...worse than a servant or the help. Sometimes I swear some of them had me confused for a babysitter and not a nurse! Not letting me attend any of the doctor's appointments or updating me about any changes to meds or letting me give any of the meds, even though that's uh, part of my job?! Blamming ME for not reminding you to keep track of your kid's supplies because you're too busy watching tv all day.

Changing my schedual at the last minute and making me leave early just because dad wanted to go to a friend's house and watch a tv show so I didn't get my full pay. Telling me I was allowed to do such and such, and then going behind my back and complaining to the agency about it.

Just a lot of condescending and rude behavior. I could go on and on...

Did he/she know what the expectations were ahead of time? I.E.did you sit down and talk to them about what they were before they started working with you?

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18 minutes ago, Crystal-Wings said:

LOL if you only knew how some of the families I've worked for have treated me...worse than a servant or the help. Sometimes I swear some of them had me confused for a babysitter and not a nurse! Not letting me attend any of the doctor's appointments or updating me about any changes to meds or letting me give any of the meds, even though that's uh, part of my job?! Blamming ME for not reminding you to keep track of your kid's supplies because you're too busy watching tv all day.

Changing my schedual at the last minute and making me leave early just because dad wanted to go to a friend's house and watch a tv show so I didn't get my full pay. Telling me I was allowed to do such and such, and then going behind my back and complaining to the agency about it.

Just a lot of condescending and rude behavior. I could go on and on...

Did he/she know what the expectations were ahead of time? I.E.did you sit down and talk to them about what they were before they started working with you?

The first bolded part is why I need this thread. It would never occur to me to bring a nurse to the doctor. We need a nurse so we can go to work, and sleep. If there's a doctor's appointment, then at least one parent is neither working or sleeping, so it wouldn't occur to me to use hours for that. Now, I know it's something I need to clarify with a nurse.

Now, on the other hand, I'm a nurse. I know what orders that are right look like, and I'm not leaving the office until I have them. Similarly, I know how to hand off a patient. So, there's no way the nurse will be in the dark.

As to the second bolded part. Yes. My expectations were made clear multiple times before the incident, both verbally and in writing.

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@Crystal-WingsSorry to come back to the same post, but I'm still thinking about this question of coming to a doctor's appointment.

All of my kids' local specialists are at a Children's hospital about an hour from my home, where my kid also goes for multiple therapies, and infusion treatments. We are generally there for the better part of a day twice a week, and might have one or more therapy appointments, a doctors appointment or two, lab work, and an infusion.

So, if you were the nurse, and you wanted to be there, how would that work? Would you expect to meet us at home, and ride with us, and stay all day? Or meet us there for the appointment, in which case you'd be traveling 2 hours (assuming you live near me), for an hour of work?

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Specializes in Private Duty Pediatrics.

If the doctor appointment is not on a day that I'm scheduled to work, and the parents are fine with taking him themselves, then I don't expect to go. I do expect the parents to keep me up to date on changes and new orders.

I have often gone with the moms to all-day appointments out of town on days that I'm scheduled to work. This is because those particular clients needed two caregivers during transit; one to drive, and one to attend to his needs. The mom would tell me ahead of time, so I knew what to expect that day.

I'm pretty self-contained at work. I bring Glucerna drinks and fruit to work - food that doesn't need to be kept in the fridge. And while it's nice to have a microwave, for instance, I can make a cup of coffee using hot tap water. I carry my own coffee mix with me. So, if I get to work and find out that we're going out on an all-dayer, that's fine.

I had one mom who would have me come to the doctor's office with them, but I had to sit in the waiting room while she took her son in to see the doctor. She would go out of her way to prevent me from interacting with the doctor. That means I had to sign out during that time. (How can I be responsible for a child that I cannot see or hear?)

Now-a-days, that would mean that I would have to call my office to have them change the time in and out. This is because we now have to clock in & out electronically, and the GPS on my phone has to show that I am at the client's house.

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