New At This, Have Questions

[Katillac, RN]

Hello, All.

I'm considering taking a private duty case. Geriatric patient, no agency involved, paid privately (and well) by family. Please excuse my ignorance, but what are my obligations here in terms of obtaining orders? For those of you who have this kind of case how do you go about obtaining them? I plan to develop a plan of care for my own peace of mind in order to have clarity with all about what I'm doing, but is that a nurse practice requirement? Also, I have a feeling that I'm going to be asked to be an independent contractor, even though I really won't be in that the family will have control over when where and how I work, I'll be paid by the hour, etc. Anyone have a sense of how to handle this?

Anyone have any good books, articles about all of this? Thanks in advance for any help.

Kat

[Daytonite, BSN, RN]

I did private duty for a number of years and my mother ran an agency.

You must understand that the family is doing this because they want control of the nurses. I did this enough to wonder why. Either they want to pay less than what the agencies pay or they are trying to get around some laws or taxes. So, think about that. They may have also had agency nurses and had problems of some kind. What comes to mind there is good principles of nursing. I have seen families who dismissed one nurse after another because they refused to do what the family wanted for the patient because it just didn't follow good principles of nursing. Some families were just terribly demanding of the nurses to the point that they were difficult to work with and so they just went through a parade of nurses. The nature of the business is that you work with wealthy people and some of the cheapest are millionaires, believe me.

Other problems I've heard of with privately handled cases:

• the family want you to do things beyond what a nurse does
  
• the family or patient will direct you to do things you know are not right for the patient
  
• not getting paid on time
  
• paychecks that bounce
  
• getting paid less than being contracted for
  
• working longer hours than what was originally agreed to
  
• not getting days off
  
• getting accused of stealing
  
• being dismissed from the case for no apparent or a bogus reason
  
• having to stay with the patient when the next nurse doesn't show up for work (you can't abandon the patient and because it's a private case there are often no relief nurses to call)
  
• other nurses on the case bringing their children or spouses to the job with them
  
• there is no one else to go to with unresolved problems if the family ignores you
  
• can't reach any one in the family when there is a problem
  
• can't reach the doctor when there is a problem
  
• have to rely on 911 if there is an emergency--did you know that a resident has to pay for 911 services? They may complain later about that (remember you taking about business here)

[Katillac, RN]

Thanks so much for the things to consider when considering a private pay case! I really appreciate all the input. Now, anyone know about the question of getting orders and how that should be handled? Thanks in advance.