Is doing a little private duty on the side "okay"?

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I've been taking care of a gentleman at my facility for the past six months or so. This is a terminal patient. Recently the patient and family decided to take him home and initiate hospice care. The patient has a few things the family needed teaching on, namely a G-tube and a Foley cath. We've been teaching in the facility. The pt's adult children are fairly competent with the G-tube and handling the Foley (hospice will of course be changing it out as needed, etc.,)but the wife still needs a lot of reinforcement. The children all live 2-3 hrs. away so the wife will be the primary caretaker and have responsibility for passing meds through the tube, changing the feeds, etc.

One of the pts. daughters took me aside the other day and asked if I would be willing to come in for a couple hrs. for a week or so to reinforce teaching with the wife and also to show the private duty aides they hired how to use the G-tube.

I didn't commit to anything at the time and today they asked about it again.

This is a very nice family and I enjoy working with them, and also the extra money would come in handy right now, but I keep thinking if I accept and work finds out I could get into trouble somehow. I can't seem to find a policy prohibiting this but really this facility has so many policies about so many things scattered across so many resources I don't know if I could locate it if it does exist. What if people at work find out somehow?

Also, I'm wondering if there are liability issues? I've always worked for a facility or agency (did home health for a couple years) and never worked on my own.

So, I guess my quesiton is would accepting this assignment be an "okay" thing for me to do from an ethical, legal and work standpoint? Are there complications or issues I haven't thought of? Has this ever happened to anyone else (been approached by a family for private duty? It's never happened to me before and I was really taken aback, obviously).

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The only problem I can see is that the pt is still a pt at your facility. If the family had approached you after discharge I'd say go for it. Having a second job is not prohibited, but there might be a conflict of interest because the pt is still in.

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Pt. was discharged today, actually. They want me to start next week.

Thank you for replying! I don't know why I'm so freaked out about this...I guess it's the whole private duty thing and I was a bit freaked to be approached at work.

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Specializes in Acute Care Psych, DNP Student.

Do you have malpractice or E&O insurance? If so - is private duty work covered?

I would think it would be easier to drift out of your scope if you are out there on your own, also.

How are they going to pay you? On a 1099-MISC? Or under the table? Things to think about.

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Our first semester ethics review seminar for nurses basically said it is inappropriate and unethical for an employee to give a patient/family their home number and have meaningful contact outside of the hospital. This would probably fall under that category because he was your patient at your place of work. THey showed a video and a similar situation was shown and it was a big no-no. Talk to HR and see what they think.

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Our first semester ethics review seminar for nurses basically said it is inappropriate and unethical for an employee to give a patient/family their home number and have meaningful contact outside of the hospital. This would probably fall under that category because he was your patient at your place of work. THey showed a video and a similar situation was shown and it was a big no-no. Talk to HR and see what they think.

I wouldn't think this would fall into the category you're describing; the pt's family member is looking to hire a nurse for a specific task. He isn't talking about having her come and visit for emotional reasons, or other personal ones. It's a job offer, one that is to begin AFTER the patient is appropriately discharged from the hospital, and not one that impacts on her ability to perform her normal job functions while in the hospital. In other words, no conflict of interest. This family is looking to hire a nurse, liked how this nurse handled the information presented, and so decides she is the most suitable candidate. This isn't an ethical breach because the pt would otherwise have continued care at the hospital, thereby depriving the hospital of income. He isn't choosing to go to another facility where she works, doing the same. She did NOT solicit employment (as would be the case if she handed them her phonenumber BEFORE they asked, and said "call me anytime with questions". That would be what your video/lecture is discussing. It's a different situation.

To the OP: If your current job allows you to take on outside positions (and I don't know of a nursing position that doesn't, but it's worth looking through the employee handbook all the same), it's your choice. But I absolutely would get myself some great , because you'd be ripe for the picking if it came down to it.

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Our first semester ethics review seminar for nurses basically said it is inappropriate and unethical for an employee to give a patient/family their home number and have meaningful contact outside of the hospital. This would probably fall under that category because he was your patient at your place of work. THey showed a video and a similar situation was shown and it was a big no-no. Talk to HR and see what they think.

She didn't give her home phone # or contact them outside the hospital.

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I think you need to speak with a couple of employment attorneys to find out the true, legal answers to your questions.

I'd also agree that you need and be sure it covers you in this situation.

I know that there are some LVN's who advertise here locally that they do private duty. I guess an RN can, too, although I never before thought that much about it. If you needed MD orders, you would call the patient's MD, I guess. Hmm, the more I think about it, there are probably really no valid LEGAL reasons to not accept, as long as you get the pay and insurance issues worked out. And I personally see no ethical reason, either.

You might need to draw up a contract with the family so these issues are spelled out properly. And be prepared to file tax information as required by law.

Not sure what to say about informing your employer that this family has approached you but I can assure that, eventually, it WILL come out and be public knowledge. Maybe you should notify the DON and/or HR that this offer has arisen and see what they have to say. I'd talk to the lawyers first so you don't allow the hospital bamboozle you.

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Hey...I'm definitely not a nurse here, but I know that the local policy at the hospital around here (when I asked about it) is that a nurse can do home health care on the side, but never for patients that they had any direct care with at the hospital.

Supposedly the reason behind it is if something should go wrong, there would be a very clear cut avenue of who was responsible.

If Suzie Q took care of John Doe at ABC memorial, and then took care of him at home and something went wrong...did she make the mistake at his home or at the hospital? It's harder to say if it's the same caregiver.

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Hey...I'm definitely not a nurse here, but I know that the local policy at the hospital around here (when I asked about it) is that a nurse can do home health care on the side, but never for patients that they had any direct care with at the hospital.

Supposedly the reason behind it is if something should go wrong, there would be a very clear cut avenue of who was responsible.

If Suzie Q took care of John Doe at ABC memorial, and then took care of him at home and something went wrong...did she make the mistake at his home or at the hospital? It's harder to say if it's the same caregiver.

Excellent point. Guess that's why there are attorneys that specialize in medical issues!

One more thing to keep in mind as I branch out into the world of nursing.

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Specializes in Ortho, Med surg and L&D.
I've been taking care of a gentleman at my facility for the past six months or so. This is a terminal patient. Recently the patient and family decided to take him home and initiate hospice care.

One of the pts. daughters took me aside the other day and asked if I would be willing to come in for a couple hrs. for a week or so to reinforce teaching with the wife and also to show the private duty aides they hired how to use the G-tube.

So, I guess my quesiton is would accepting this assignment be an "okay" thing for me to do from an ethical, legal and work standpoint? ...

Hi,

I had been asked this many times in the past, (many people have). At one hospital it was clearly addressed that if a patient or family wanted us to do private duty that it must be officially followed through with an agency and that we could not "self-hire" ourselves.

There is a lot more to taking an assignment than just going with a family that asks, especially if it is a family that you met while working for your employer in this role.

I would suggest you ask the family to, or you yourself, consult with social services or nursing services at your facility.

The place where I worked it was a major violation to to do, because it is taking money from a client/patient and a role confusion.

Gen

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Specializes in Ortho, Med surg and L&D.
I wouldn't think this would fall into the category you're describing; ...

Hi,

I see it as being the *reason* for the category. Family's intention and the nurses intentions are great, but, it is murkey. No one is there to protect the nurse, if things go badly, it is her license...

Gen

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