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?

1 hour ago, Crystal-Wings said:

It would be nice to have a patient like him.

I think he'd be a pretty cool patient, but I'm slightly biased.

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He sounds like a really cool kid and a great case. Thank you for your kind words about my patient.

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You've got to be kidding me! I typed out my response again to your earlier question regarding parents performing care. I typed it up in a text to send to myself to copy and paste here so I wouldn't lose it. It just disappeared. Smh

Long story short. I don't mind. As long as it's not because you don't trust me after a reasonable time period. The only other reason it might be annoying is if it's the majority of the shift and I'm just feeling like a companion, not using any of my nursing skills. I'd be awfully bored. Respect for my education and experience is very important to me. Although I do love to learn from parents. I respect the knowledge parents have on their kid's disease process and care. For the most part. I've definitely had times where a parent absolutely went against the doctors' and nurses' advice. And when there is a negative side effect to that, it is extremely frustrating.

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Oh, and it's important to me that the parent show trust in front of the child so that the child can trust me. Especially when you're gone. Of course it's a different when enough time has gone by and you still can't trust a particular nurse. Then of course get rid of them.

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@Orion81RNThank you for taking the time to type that out three times, because it's super helpful for me to understand the other perspective!

Obviously, it's hard to know what it will be like having nurses in the house until it happens, but to me it's not about trust as much as it is about parenting. This is a kid who is just relearning what it means to have parents, and one of the ways we reinforce the idea of what a mom or dad is, is by being the ones to take care of him whenever we can. If there's a concrete reason why we're delegating, like we're asleep, or at work, he understands that. In the hospital, he knows that there are things that we can't do due to hospital policy. But I'm not sure how he'd make sense of it if we were home, and available, and delegating.

In addition, there are still some parts of his care that he's uncomfortable with. A simple example is anything that involves his feet. He really doesn't want anyone messing with his feet, but if someone's going to mess with his feet he wants it to be Dad. The fact that I have years of school, and more years of training in how to care for people is irrelevant. Apparently Dad is better at things like attaching/detaching pulse ox sensors on toes, or putting on AFO's, or washing and drying feet than I am. And given how little control he has about so many things, we honor those kinds of preference as much as possible. So, for example, if you were home with him in the morning, and Dad was coming home at 9, we'd ask that he just kept his resting splints on until Dad came home and helped with the shower and getting clothes on. If there was an urgent reason why something with his feet couldn't wait, then we'd get through it. I'm the one who takes him to most of his therapy and doctor's appointments, and he'll let me put his AFO's and shoes on afterwards if need be, but if he can wait for Dad, we let him wait.

Sorry this is so long. I think I wrote it more for my benefit than yours, but it's helpful for me to start thinking about how communicate both to him and to potential nurses about this so that it doesn't seem like a trust issue. How to give the message that "It's fine to wait for Daddy to put your shoes on, but just so you know, Ms./Mr. Orion (?) is also very good at putting shoes on. If we're ever not here and you need shoes, he/she can help." or "I know you know how to do this. I respect your skills. I just prefer to be the one to do it when I have the opportunity."

The other thing is that it probably doesn't make a lot of sense, in our specific situation, to schedule nursing so that there are long blocks of time when we're home and awake and a nurse is there. However, I get that that also needs to be balanced with the nurse's need for consistent hours. My impression, for example, is that if a nurse was scheduled to work, because I thought I'd be working, but then it turned out I wasn't scheduled, I should either have the nurse come in, or if we've gotten to the point where I have a phone number maybe call and offer a choice.

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Specializes in LTC.

Those are all reasonable requests. Getting the tape on just right to get an accurate reading for the pulse ox can be tricky, and if he doesn't like his feet messed with, it makes sense to have dad do it since that is what he's most comfortable with.

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4 minutes ago, Crystal-Wings said:

Those are all reasonable requests. Getting the tape on just right to get an accurate reading for the pulse ox can be tricky, and if he doesn't like his feet messed with, it makes sense to have dad do it since that is what he's most comfortable with.

And hopefully the nurse will understand that it's not personal. He'd really rather Mom didn't do it either, even though I'm the one who taught Dad!

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Specializes in LTC.

I think they would.

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42 minutes ago, Crystal-Wings said:

I think they would.

Agreed. And if you just talk to the nurses like you're talking to us here, you all will be on the same page.

I mention trust for a reason. It is inevitable you won't like a way a nurse does something. And then you may not trust him/her. Be prepared to actually maybe have to do a lot of teaching. We are often learning from you, the parent. For example I had a kid who needed to be put in her TLSO and all sorts of braces to then be put in a stander. It's not like it's something we learned in nursing school. We learn on the job. Grandma was the pro. She taught me. It did take a few times, and it's actually kinda scary to just walk away and let the nurse do it when they haven't done it before. I quickly learned and became the pro too, but it was annoying when the 23 year old sister would come in my patient's room (a YEAR after I had been doing it) and start adjusting things...wrongly. I do understand that has everything to do with not having any control over her sister's disease process and needing to feel some sense of control so I was able to let that go.

Oh, and pick your battles. On the one hand I'd say you'd be surprised what parents can be picky about. But then I remember you're a nurse ? You know how a family member can lose it over a pillow not being placed just so. For example I had a pt, that no matter how hard I tried, I simply could not put the diaper on the girl exactly how the mom wanted it. She learned to let it go. Eventually lol. It was secured appropriately, not too tight. Little things like that.

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6 minutes ago, Orion81RN said:

Agreed. And if you just talk to the nurses like you're talking to us here, you all will be on the same page.

I me too trust for a reaaon. It is inevitable you won't like a way a nurse does something. A d then you may not trust him/her. Be prepared to actually maybe have to do a lot of teaching. We are often learning from you, the parent. For example I had a kid who needed to be put in her TLSO and all sorts of braces to then be out in a stander. It's not like it's something we learned in nursing school. Grandma was the pro. She taught me. It did take a few times, and it's actually kinda scary to just walk away and let the nurse do it when they haven't done it before. I quickly learned and became the pro too, but it was annoying when the 23 year old sister would come in my patient's room (a YEAR after I had been doing it) and start adjusting things...wrongly. I do understand that has everything to do with not having any control over her sister's disease process and needing to feel some sense of control so I was able to let that go.

Oh, and pick your battles. On the one hand I'd say you'd be surprised what parents can be picky about. But then I remember you're a nurse ? You know how a family member can lose it over a pillow not being placed just so. For example I had a pt, that no matter how hard I tried, I simply could not put the diaper on the girl exactly how the mom wanted it. She learned to let it go. Eventually lol. It was secured appropriately, not too tight. Little things like that.

Surprised? Not any more. Annoyed? More and more every year! LOL!

I'm sure that I'll have some annoying thing that will come out. During our most recent stay, I'm pretty sure the PICU staff thought I had lost it because 3 times a day I'd order him a tray of healthy food, and cut it up, and arrange it in front of him, and then I'd throw it out after he ate basically nothing. His anxiety in the hospital is pretty consistently too high for him to eat anything, but somehow I feel better knowing that I have done my job by offering him healthy proteins, whole grains, and vegetables! I also think that he feels comforted in some way by the fact that I'm acting like a mom (moms like to serve vegetables to their children!), but that might be because I'm looking for evidence to support my delusion.

My hope is that my nursing experience will allow me to recognize when I've gone too far, and that we'll have a good enough relationship that if I don't the nurse can just tell me!

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28 minutes ago, nursenmom3 said:

My hope is that my nursing experience will allow me to recognize when I've gone too far, and that we'll have a good enough relationship that if I don't the nurse can just tell me!

I think a lot of nurses leave cases without talking to the parent. So, I'd bring that up when you first meet them. Something along the lines of, "I'm new to the world of PDN. If you find something unreasonable, my hope is that you can feel comfortable talking to me and we can go from there." And on that topic, what runs rampant in PDN is nurses overstepping boundaries. I know I absolutely did, subtly and slowly over my 2 years with my heart transplant kid. So what I found acceptable to do wasn't necessarily what another nurse may find acceptable. Another nurse may have looked at me like I'm crazy for helping set up a party, for example. Then you have the nurse who is doing her very best to maintain professional boundaries. It gets the parents confused on what's expected. And suddenly drama can start.

Ex: at my old agency we were NOT to do laundry. In my current agency it is on the 485. So at the other company if one nurse did laundry thinking nothing of it, the parent might look down on the nurse who won't do it. Even though that nurse is in the right. Then nurses are pitted against each other. Drama eyeroll So I'd ask the nurses to be upfront with you and have a conversation if they have any issues.

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37 minutes ago, Orion81RN said:

I think a lot of nurses leave cases without talking to the parent. So, I'd bring that up when you first meet them. Something along the lines of, "I'm new to the world of PDN. If you find something unreasonable, my hope is that you can feel comfortable talking to me and we can go from there." And on that topic, what runs rampant in PDN is nurses overstepping boundaries. I know I absolutely did, subtly and slowly over my 2 years with my heart transplant kid. So what I found acceptable to do wasn't necessarily what another nurse may find acceptable. Another nurse may have looked at me like I'm crazy for helping set up a party, for example. Then you have the nurse who is doing her very best to maintain professional boundaries. It gets the parents confused on what's expected. And suddenly drama can start.

Ex: at my old agency we were NOT to do laundry. In my current agency it is on the 485. So at the other company if one nurse did laundry thinking nothing of it, the parent might look down on the nurse who won't do it. Even though that nurse is in the right. Then nurses are pitted against each other. Drama eyeroll So I'd ask the nurses to be upfront with you and have a conversation if they have any issues.

That's good advice.

It's becoming very clear to me that I probably need to spend a lot of time going over expectations for communication, but also for other things. For example, it would never have occurred to me that a nurse would be involved in laundry beyond putting things into a hamper after you use it, but now I feel like I might need to say something specific "Here is the laundry hamper for any dirty clothing or towels, he might need you to remind him to put things in there, please do not do any laundry!"

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