How to make a PDN job appealing?

Specialties Private Duty

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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?

16 hours ago, nursenmom3 said:

For the bolded, I guess what I'm asking is what happens if I transport the nurse one way, away from their car, and then can't transport them back? For example, nurse is working until 5, at 2 kid spikes a fever and we decide to go to get it checked out and the hospital ends up keeping him overnight for IV antibiotics. How does the nurse get back to their car, if I'm not providing the transportation?

The agency should have a policy on this. My agency provides an Uber for us. For example, if I have to send a pt to the ED, it is our company's policy that I go with to the hospital and stay until we know where the pt will be admitted to. Since I've never been in the situation, I'm not sure if I'm reimbursed for the Uber, or if they have an account. Probably reimbursed.

1 Votes

Thank you all! This is super helpful.

Can you tell me about how you handle food? Is simple food prep (e.g. heat up the left over salmon from last night, or cut this avocado into pieces for him, or serve him some oatmeal from the crockpot with a spoonful of almond butter stirred in) a reasonable expectation? Can I ask you to make simple choices, or help him make simple choices? For example, can I just say "if he's too tired for the pasta, offer him this particular yogurt?" or "offer him a choice of X and Y." Can I ask you to actually cook something, like scramble an egg, or microwave a sweet potato, or heat up a can of soup?

How would the 485 be worded to allow that kind of flexibility? Also, if I have preferences beyond what's actually medically needed can I just write that down somewhere or tell you verbally? I'm thinking of things like "I don't want him drinking soda" or "use the whole milk yogurt, not the nonfat that I got for the other kids".

54 minutes ago, nursenmom3 said:

Thank you all! This is super helpful.

Can you tell me about how you handle food? Is simple food prep (e.g. heat up the left over salmon from last night, or cut this avocado into pieces for him, or serve him some oatmeal from the crockpot with a spoonful of almond butter stirred in) a reasonable expectation? Can I ask you to make simple choices, or help him make simple choices? For example, can I just say "if he's too tired for the pasta, offer him this particular yogurt?" or "offer him a choice of X and Y." Can I ask you to actually cook something, like scramble an egg, or microwave a sweet potato, or heat up a can of soup?

How would the 485 be worded to allow that kind of flexibility? Also, if I have preferences beyond what's actually medically needed can I just write that down somewhere or tell you verbally? I'm thinking of things like "I don't want him drinking soda" or "use the whole milk yogurt, not the nonfat that I got for the other kids".

I can't speak for other nurses, but I'm personally not doing any cooking. Most of the examples you gave are fine. I think if you wanted something like scrambled eggs for him, however, it should be precooked. But that's just my opinion. I'm interested in others' opinions. I'll happily microwave anything and follow whatever instructions you have. I'm uncertain about the 485, but it's very common to have things written down in the home as you stated.

2 Votes
18 minutes ago, Orion81RN said:

I can't speak for other nurses, but I'm personally not doing any cooking. Most of the examples you gave are fine. I think if you wanted something like scrambled eggs for him, however, it should be precooked. But that's just my opinion. I'm interested in others' opinions. I'll happily microwave anything and follow whatever instructions you have. I'm uncertain about the 485, but it's very common to have things written down in the home as you stated.

Thanks!

If I asked you "Would you be willing to scramble an egg?" Would you hold it against me? I wouldn't hold it against someone who said "no", but I'm curious if I should avoid asking.

What do your 485's usually say for people who eat orally?

Specializes in Private Duty Pediatrics.

If my client eats regular food, then preparing that food is part of my job. It would have to be something simple, though. I don't cook more than I have to, even for myself. So preparing a simple lunch, or heating up left-overs is fine. I can scramble an egg.

I do believe in using the 4 food groups (take out, eat out, microwave, and pizza!)

Preparing dinner from scratch isn't going to happen, but I can fix a microwave dinner. I wouldn't hold it against you if you asked me to do more, but I would be honest; my skills might not be sufficient.

2 Votes
14 minutes ago, nursenmom3 said:

Thanks!

If I asked you "Would you be willing to scramble an egg?" Would you hold it against me? I wouldn't hold it against someone who said "no", but I'm curious if I should avoid asking.

What do your 485's usually say for people who eat orally?

Darn, it happened again. Lost my reply. I don't remember what the 485 said about food. The mom and dad automatically cooked. For me too ? I was super lucky.

I wouldn't hold it against you. If you asked me to scramble an egg, bc I'm not a confrontational person, I'd probably do it. But I don't think it should be asked. I babysit my niece every week for my sister who is a teacher, and it's no big deal for her to scramble eggs and refrigerate for breakfast. Even my own sister doesn't expect me to cook for her toddler. I'd be a bit put off by the request, but I'd never say so to your face. Just being honest.

3 minutes ago, Orion81RN said:

Darn, it happened again. Lost my reply. I don't remember what the 485 said about food. The mom and dad automatically cooked. For me too ? I was super lucky.

I wouldn't hold it against you. If you asked me to scramble an egg, bc I'm not a confrontational person, I'd probably do it. But I don't think it should be asked. I babysit my niece every week for my sister who is a teacher, and it's no big deal for her to scramble eggs and refrigerate for breakfast. Even my own sister doesn't expect me to cook for her toddler. I'd be a bit put off by the request, but I'd never say so to your face. Just being honest.

My honest opinion is that reheated scrambled eggs are not appetizing. My other kids probably wouldn't bat an eye at eating them, so maybe that's my own hang up. But, this kid has enough problems eating, due to nausea/decreased appetite from meds, arthritis in his jaw, and the fact that's he's already full from overnight feeds, that I'm pretty committed to making sure that whatever's on his plate is as tasty as possible. It sounds like we should save the eggs for days when we don't have nursing, to avoid awkward situations. There are plenty of foods that taste fine reheated!

If you were willing to eat my food, that would actually make my day. I think that sitting down and sharing food with people is a nice thing to do, and I think my kid eats more when it's a social experience, so it would make me happy to think that my kid was eating with you when I couldn't be there to eat with him. I wonder how best to bring that up, because I'm sure there are nurses who would love that, and nurses who wouldn't. I assume the best time would be after you know me well enough to know my standards of hygiene? I just read the thread about roaches on the patient!

Specializes in Private Duty Pediatrics.
1 hour ago, nursenmom3 said:

Thank you all! This is super helpful.

Can you tell me about how you handle food? Is simple food prep (e.g. heat up the left over salmon from last night, or cut this avocado into pieces for him, or serve him some oatmeal from the crockpot with a spoonful of almond butter stirred in) a reasonable expectation? Can I ask you to make simple choices, or help him make simple choices? For example, can I just say "if he's too tired for the pasta, offer him this particular yogurt?" or "offer him a choice of X and Y." Can I ask you to actually cook something, like scramble an egg, or microwave a sweet potato, or heat up a can of soup?

How would the 485 be worded to allow that kind of flexibility? Also, if I have preferences beyond what's actually medically needed can I just write that down somewhere or tell you verbally? I'm thinking of things like "I don't want him drinking soda" or "use the whole milk yogurt, not the nonfat that I got for the other kids".

I would be fine with any of this.

Instructions for preparing the meals were not in the 485 for the kids I had who could eat regular food. The diet - like general, or no added salt - would be there. Fluid restrictions would be spelled out. But I would just go with the flow as to what specifically to fix. Usually the mom would mention if she had anything special already prepared.

1 Votes
4 minutes ago, nursenmom3 said:

My honest opinion is that reheated scrambled eggs are not appetizing. My other kids probably wouldn't bat an eye at eating them, so maybe that's my own hang up. But, this kid has enough problems eating, due to nausea/decreased appetite from meds, arthritis in his jaw, and the fact that's he's already full from overnight feeds, that I'm pretty committed to making sure that whatever's on his plate is as tasty as possible. It sounds like we should save the eggs for days when we don't have nursing, to avoid awkward situations. There are plenty of foods that taste fine reheated!

I actually started thinking about it further while you were replying (and while I was giving my pt his g-tube feed lol) and I have a few more thoughts. In regards to your specific situation, I completely agree that it would be in his best interest to eat fresh food. Now THAT is nursing related.

What I started thinking about was that the more comfortable I am with the parent, if I feel they respect, value and appreciate what I do, the more I'm willing to happily do even if it's not necessarily nursing related. Example: my last pt, who's family I absolutely adore, was having a cookout one time, and I helped set up for it. Kid was napping, and I was happy to pitch in. Same for her "heart birthday" (transplant kid) I helped set up tables and chairs. So looking back, if the mom had asked me to scramble some eggs after having built that rapport, I would have thought nothing of it.

1 Votes
Specializes in Private Duty Pediatrics.

Normally, I would eat my own food with him while he ate his. I would need specific permission from my supervisor to eat your food. We do not expect the families to provide us with food. It could be considered a form of compensation, or a bribe (legally speaking).

My companies both make a big deal out of avoiding anything that could be seen as expecting the client to pay anything, when the insurance is covering the cost. It could fall under Medicaid fraud. A once in a while sharing of birthday cake would be allowed, but not an ongoing deal where the nurse gets her meals provided.

Even as I say that, I do see how preparing the food and eating it with him would be to his benefit.

10 minutes ago, Kitiger said:

Normally, I would eat my own food with him while he ate his. I would need specific permission from my supervisor to eat your food. We do not expect the families to provide us with food. It could be considered a form of compensation, or a bribe (legally speaking).

My companies both make a big deal out of avoiding anything that could be seen as expecting the client to pay anything, when the insurance is covering the cost. It could fall under Medicaid fraud. A once in a while sharing of birthday cake would be allowed, but not an ongoing deal where the nurse gets her meals provided.

Even as I say that, I do see how preparing the food and eating it with him would be to his benefit.

That's interesting about your policy on food being a gift. We have to do annual education/competencies, and fraud and gift giving is a huge component. However our policy specifically states food is ok.

With my last kid, I did eat with her for therapeutic reasons. If she saw you eat, shed be more likely to eat. She was often scared to eat bc she aspirates a little, so she coughs when she eats. Well, so do I actually bc of a hiatal hernia. So we made a joke out of it. We'd both be eating and coughing. I'd tell her it's ok, I'll cough with you. Or she'd cough then I'd cough, and I would say, "look what you made me do?! You made me start coughing!" She found it hilarious. All the while I was carefully assessing her of course and guiding her to which foods to eat, which to avoid, seeing what foods she tolerated best. Meal times were some of my most find memories of her. She's actually very close to the active stage of dying now ?. I miss that kid so much. And her amazing family too that welcomed me so graciously into their home.

1 Votes
15 minutes ago, Orion81RN said:

I actually started thinking about it further while you were replying (and while I was giving my pt his g-tube feed lol) and I have a few more thoughts. In regards to your specific situation, I completely agree that it would be in his best interest to eat fresh food. Now THAT is nursing related.

What I started thinking about was that the more comfortable I am with the parent, if I feel they respect, value and appreciate what I do, the more I'm willing to happily do even if it's not necessarily nursing related. Example: my last pt, who's family I absolutely adore, was having a cookout one time, and I helped set up for it. Kid was napping, and I was happy to pitch in. Same for her "heart birthday" (transplant kid) I helped set up tables and chairs. So looking back, if the mom had asked me to scramble some eggs after having built that rapport, I would have thought nothing of it.

The bolded is my goal. That's the relationship I'd like to build. Not because I want you to scramble eggs or set up chairs, but because that's who I want to be as an employer.

But I also want to build the kind of relationship where the nurse can honestly say "I'd rather not do that." I don't want to be tiptoeing around worrying that if I say "hey, what about this" someone won't feel like they can "no". Or that if the nurse has an idea she won't feel comfortable floating it by me. I feel like the lines in private duty are fuzzy, and that means that the nurse and parent need to have good communication to figure out what works.

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