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?

Just now, nursenmom3 said:

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.

Yes, the lines are definitely fuzzy. It's a whole different ball game than a facility setting. I think you should tell the nurses exactly that. Exactly the way you just worded it. That would be perfect and should lead to great communication and a mutual understanding.

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I'd work for someone like you, but i don't do nightshifts and vents make me nervous. ?

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13 minutes ago, Crystal-Wings said:

I'd work for someone like you, but i don't do nightshifts and vents make me nervous. ?

I assume that if we ever get a steady nursing plan, that we'll end up with separate night and day people. It seems to me that the two shifts would appeal to very different personalities. So, I'd be happy if I found someone great who only wanted days, or someone great who only wanted nights.

I would also never say this to the Agency, but to be honest my kid would be a really good situation for someone who is capable but nervous about a vent, and wants to get comfortable. He uses a vent when he's asleep, or very sick (but if he was that sick, I'd be home, or with him in the hospital). So, if something goes really wrong with the vent, you have the option of waking him up. Which makes things a whole lot less scary than someone who will literally die if the vent stops working. Plus he talks, and he's rational. He's not like a toddler who will fall asleep, or pull out his trach, or wrap the g-tube extension around his neck, the second you take your eyes off him. Don't get me wrong. He's fragile, and it's scary, but in the world of technology dependent kids, there are plenty of scarier situations.

Edited because of the rules of English grammar.

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38 minutes ago, Orion81RN said:

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.

I am so sorry. I hope you know what an incredible difference you must have made in both her parents' lives and hers.

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1 minute ago, Crystal-Wings said:

I'd work for someone like you, but i don't do nightshifts and vents make me nervous. ?

Funny but not really funny story. So my current patient is an adult male with ALS. He is on a vent. He's very much with it. Well, his alarms never alarm. The only time you will hear an alarm is when it's a circuit disconnect while suctioning. Apparently one day his vent was alarming and the nurse on duty had NO idea why (in fact in her documentation, she wrote down an alarm that doesn't even exist, so who knows why it was alarming.) From what I gathered he appeared fine other than a look on his face of "what alarm is that?" So what did this nurse do? She BAGGED him and had the wife call 911. She didn't suction him. AND to top it off, the icing on the cake, there was a portable vent right next to him. But no. She used the ambu and called 911 on a DNR pt who by all assessment purposes appeared fine. He. Was. Livid. He was so mad at her later for doing that to him. Oh, and she's in FNP school.

I have kind of a funny story of one of my very first days with him, my first vent patient. Out of nowhere there was a long loud alarm sound. I'm looking at my patient. He looks completely fine. I'm looking at the vent. I see nothing. I was baffled. I kept a very calm face, but was freaked. I went to take his pulse ox when I hear from his assist device "bell." He typed out with his eyes that it was his call bell ?. He "laughed" with me. HUGE smile on his face. His arm was resting on it.

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1 hour ago, Orion81RN said:

Yes, the lines are definitely fuzzy. It's a whole different ball game than a facility setting. I think you should tell the nurses exactly that. Exactly the way you just worded it. That would be perfect and should lead to great communication and a mutual understanding.

I think that more than food, the place where I need to have conversations up front is about downtime.

If someone's working with my kid, even during the day, there's going to be a lot of downtime. He's a kid who needs a fair amount of medical treatment, but most of it's pretty scheduled, and there are periods in between when he needs someone trained close by and ready to jump in, but there isn't a lot of actual jumping in.

So, I guessing that it makes sense up front to talk about that time. On one hand, he's got lots of anxiety that's totally understandable given his history. So, he's going to benefit from someone taking the time to get to know him, and forming a relationship. But, on the other hand, I think that constant 1:1 attention from adults isn't a great thing for kids. If he weren't sick, he'd be at school sharing the teacher with 25 other kids, or I'd be sending him out in the backyard so I can get some peace and quiet. And on top of that, there are lots of other people in and out of the house for him to interact with. He's got siblings, and Dad will be in and out Grandpa's here when the other kids get home from school, and the school system sends a tutor 5 hours a week, plus he's got home O.T. and P.T..

So, does it make sense to say up front "I hope you'll spend time with him outside of nursing care to form a relationship, and that you'll find things to do together that you both enjoy, but I leave it up to you and him to figure that out. But I don't expect constant attention. If you need a break, whether it's time to chart, or time to surf AN or read a book, it's fine to tell him he needs to figure out something to do on his own. He's perfectly capable of reading a book, or doing his homework, or building with legos for an hour, and in my opinion it's good for him to be asked. I do expect that he's either in the room with you, or monitored remotely in some way (e.g. pulse ox, or he's with an adult who could call out if something went wrong).

That's reasonable, right? And probably good for me to just say up front?

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2 minutes ago, nursenmom3 said:

I think that more than food, the place where I need to have conversations up front is about downtime.

If someone's working with my kid, even during the day, there's going to be a lot of downtime. He's a kid who needs a fair amount of medical treatment, but most of it's pretty scheduled, and there are periods in between when he needs someone trained close by and ready to jump in, but there isn't a lot of actual jumping in.

So, I guessing that it makes sense up front to talk about that time. On one hand, he's got lots of anxiety that's totally understandable given his history. So, he's going to benefit from someone taking the time to get to know him, and forming a relationship. But, on the other hand, I think that constant 1:1 attention from adults isn't a great thing for kids. If he weren't sick, he'd be at school sharing the teacher with 25 other kids, or I'd be sending him out in the backyard so I can get some peace and quiet. And on top of that, there are lots of other people in and out of the house for him to interact with. He's got siblings, and Dad will be in and out Grandpa's here when the other kids get home from school, and the school system sends a tutor 5 hours a week, plus he's got home O.T. and P.T..

So, does it make sense to say up front "I hope you'll spend time with him outside of nursing care to form a relationship, and that you'll find things to do together that you both enjoy, but I leave it up to you and him to figure that out. But I don't expect constant attention. If you need a break, whether it's time to chart, or time to surf AN or read a book, it's fine to tell him he needs to figure out something to do on his own. He's perfectly capable of reading a book, or doing his homework, or building with legos for an hour, and in my opinion it's good for him to be asked. I do expect that he's either in the room with you, or monitored remotely in some way (e.g. pulse ox, or he's with an adult who could call out if something went wrong).

That's reasonable, right? And probably good for me to just say up front?

That's pretty reasonable. What things does he like to do?

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48 minutes ago, Crystal-Wings said:

That's pretty reasonable. What things does he like to do?

He's super smart and intellectual, which I realize is a weird word for a 9 year old, but most of the things he enjoys are things that involve thinking? So, strategy games, or reading and talking about books, or music, or building with those legos that make robots . . . He also really really loves math and chess, and he's really good at both,.

In my experience, if someone spends time with him, they'll hit on something, but it's different from person to person. For example, I have a friend from work who has done a little occasional babysitting for us (a huge advantage of being a nurse is that when your colleagues hear that you fired the night nurse they might offer to babysit your trach/vent kid and you can actually say yes). She's a soloist with her church choir, and I had mentioned that he likes music, so the last time she was at our house, they ended up fooling around on the piano with her teaching him songs. Or, my niece is over a fair amount and they spend a lot of time talking about books they've both read. Or my grandfather-in-law (that's Grandpa who babysits) loves to cook, and they'll spend hours together pouring over recipes and tinkering with them to make them better.

But it's not like I'm going to tell the nurse "He likes singing songs about Jesus" or "You need to read the Hobbit and talk to him about it" or "Please bake a cake with him". Because what he really likes is being with people, and learning about what they're interested in. So, if you were passionate about something, and shared it with him, I'm almost positive he would like it. On the other hand, what he hates is being talked down to or babied.

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20 minutes ago, nursenmom3 said:

He's super smart and intellectual, which I realize is a weird word for a 9 year old, but most of the things he enjoys are things that involve thinking? So, strategy games, or reading and talking about books, or music, or building with those legos that make robots . . . He also really really loves math and chess, and he's really good at both,.

In my experience, if someone spends time with him, they'll hit on something, but it's different from person to person. For example, I have a friend from work who has done a little occasional babysitting for us (a huge advantage of being a nurse is that when your colleagues hear that you fired the night nurse they might offer to babysit your trach/vent kid and you can actually say yes). She's a soloist with her church choir, and I had mentioned that he likes music, so the last time she was at our house, they ended up fooling around on the piano with her teaching him songs. Or, my niece is over a fair amount and they spend a lot of time talking about books they've both read. Or my grandfather-in-law (that's Grandpa who babysits) loves to cook, and they'll spend hours together pouring over recipes and tinkering with them to make them better.

But it's not like I'm going to tell the nurse "He likes singing songs about Jesus" or "You need to read the Hobbit and talk to him about it" or "Please bake a cake with him". Because what he really likes is being with people, and learning about what they're interested in. So, if you were passionate about something, and shared it with him, I'm almost positive he would like it. On the other hand, what he hates is being talked down to or babied.

Does he like classic rock? Queen is a wonderful band (ok, well I'm a bit biased but I think they made some of the best music ever LOL). I wish I was good at math.

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1 hour ago, Orion81RN said:

Funny but not really funny story. So my current patient is an adult male with ALS. He is on a vent. He's very much with it. Well, his alarms never alarm. The only time you will hear an alarm is when it's a circuit disconnect while suctioning. Apparently one day his vent was alarming and the nurse on duty had NO idea why (in fact in her documentation, she wrote down an alarm that doesn't even exist, so who knows why it was alarming.) From what I gathered he appeared fine other than a look on his face of "what alarm is that?" So what did this nurse do? She BAGGED him and had the wife call 911. She didn't suction him. AND to top it off, the icing on the cake, there was a portable vent right next to him. But no. She used the ambu and called 911 on a DNR pt who by all assessment purposes appeared fine. He. Was. Livid. He was so mad at her later for doing that to him. Oh, and she's in FNP school.

I have kind of a funny story of one of my very first days with him, my first vent patient. Out of nowhere there was a long loud alarm sound. I'm looking at my patient. He looks completely fine. I'm looking at the vent. I see nothing. I was baffled. I kept a very calm face, but was freaked. I went to take his pulse ox when I hear from his assist device "bell." He typed out with his eyes that it was his call bell ?. He "laughed" with me. HUGE smile on his face. His arm was resting on it.

I would crap a brick if that happened to me! LOL

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Just now, Crystal-Wings said:

Does he like classic rock? Queen is a wonderful band (ok, well I'm a bit biased but I think they made some of the best music ever LOL). ?

That's exactly how this would work, like the perfect thing would be for you to come to our house and say "I love Queen, let me watch Bohemian Rhapsody with you and teach you how to lip sync". And either he'll end up loving Queen, or he'll enjoy trying to convince you that the Beatles are better, but either way you'll both enjoy the experience, because it's something that let him him connect to you.

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8 minutes ago, nursenmom3 said:

That's exactly how this would work, like the perfect thing would be for you to come to our house and say "I love Queen, let me watch Bohemian Rhapsody with you and teach you how to lip sync". And either he'll end up loving Queen, or he'll enjoy trying to convince you that the Beatles are better, but either way you'll both enjoy the experience, because it's something that let him him connect to you.

It would be nice to have a patient like him.

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