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).
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.
This is exactly as I have heard as well. Sure we can do private duty...just not for patients that we care for at the hospital. The family is soliciting her and want to compensate her...what will she do when the patient comes back for care in the hospital? Now she is on their personal payroll while also being an RN in the facility?
This is exactly as I have heard as well. Sure we can do private duty...just not for patients that we care for at the hospital. The family is soliciting her and want to compensate her...what will she do when the patient comes back for care in the hospital? Now she is on their personal payroll while also being an RN in the facility?
Gen
Another good point. Ok, I can see more of the gray areas now. Still, this must come up ALL the time; as a for instance, what if I worked private duty for someone on the side, and they are admitted to my unit as a patient--AFTER I have established the 1:1 on the side? They weren't my hospital patient in the past, but are now. The simple answer is the one that is probably most often used: don't take that assignment. Ask to have it switched, which of course IS done all the time for conflict reasons of a personal nature as well as professional.
I think a referral to a home health agency, or even a referral to hospice they are going home with would be more appropriate. No conflict of intrest between you and the hospital. I also might remind you that most states charge a fee for initial income tax filing as self employed. You may not even make enough to make that worth your while. I think id just explain your facility can give them a good referral or alert hospice that more teaching is needed and save yourself some heartache with the rest. A thank you for their conficence in you is enough.
I don't get the big deal here. I have done alot of high tech peds homecare. When the child is fresh out of ther NICU, their have been dozens of times where the NICU nurses did shifts at the little ones home. Because of how awesome the NICU nurses are around here, (i'm sure everywhere), the families have a bond with them. They call or stop by to visit also. More than once, the moms have called them to just touch base. This has also occured when I have cared for older teens and young adults, when they have been in the hospital a long time. I don't see the harm in what she is being asked to do. In fact I think the family will feel safer if someone they know and trust is there to help out and oversee things before they take on this task. Just my opinion.
Some of these responses seem to imply that any private duty nursing is questionable employment, yet many nurses do work private duty, especially for patients who need on-going care, can provide guaranteed hours and want to ensure continuity. It would sure be helpful if such issues were addressed in school. For all the of talk of the "many opportunities" in nursing and of nurses being "professional", nursing schools don't do much to prepare nurses for anything other than working for a health facility.
I don't think taking the job on the side would be a good idea; furthermore, I don't believe that your hospital would like that. If anything goes wrong with the patient while you are providing care for him at home, the first people the family will mostly contact is the hospital.
If you are still considering taking the job, make sure that the family knows that you are taking the job aside from the hospital. Make sure that they know you are no longer affiliated with the hospital and that the hospital cannot be held liable for your actions.
Some of these responses seem to imply that any private duty nursing is questionable employment, yet many nurses do work private duty, especially for patients who need on-going care, can provide guaranteed hours and want to ensure continuity. It would sure be helpful if such issues were addressed in school. For all the of talk of the "many opportunities" in nursing and of nurses being "professional", nursing schools don't do much to prepare nurses for anything other than working for a health facility.
Right, right.
NURSES, please understand. You own your own practice. You do not belong to the hospitals or any other facility and as long as you are practicing within your scope of practice there is nothing unethical or illegal about providing private duty without the umbrella of an employing agency. In the case, the OP cited, she was approached by the family and asked if she would do it. There is nothing wrong with that. It would be unethical if she used her employment to make contacts for her services or if she advertised her services but that is not the case here. OP, go for it. There is no reason why we always have to be employees. You can use the money, why give that away to some nursing or home health agency?
I still say you need to duoble check with HR and your employee handbook. There could be fine print in there that would prohibit this. I certainly am not saying that there is anything wrong with private duty nursing! I just see a lot of conflicts with a patient that you just cared for at your employers facility and then taking this patient on privately. The lines could blur. Obviously I am not a nurse yet, just sharing what we have been taught about simialr situations.
Gennaver, MSN
1,686 Posts
This is exactly as I have heard as well. Sure we can do private duty...just not for patients that we care for at the hospital. The family is soliciting her and want to compensate her...what will she do when the patient comes back for care in the hospital? Now she is on their personal payroll while also being an RN in the facility?
Gen