New to private duty, how do I do this well

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I have a question for private duty nurses out there. I am an LPN, have accepted a position as a PDN for a very complex private patient. I will have a ton of support, both from my agency and from the hospital the patient is coming out of. I have been very burned out on in-patient care, was tired of not being able to spend quality time with my patients and was looking for a way out of the profession completely, and then this opportunity just fell into my lap. Funny how stuff like that happens. I am experienced in the level of patient care involved, however I'm used to doing it for a lot of patients at the same time and running around like a lunatic to do it and never feeling like I've done enough.

So here I am with a lot of time to do so much and I'm not sure how that works. So I have some questions about the routine of a twelve-hour private day shift.

What is the routine of the day? Aside from med pass times, what is the structure, what needs to happen when?What other things am I responsible for besides all the stuff I would be responsible for in an in-patient facility? In your experience working with private care, what are the things you expect coming on to a shift, what are the things you hope the outgoing nurses will have done. What things happen that make you want to pull out your hair in frustration and how can a team of PDN nurses work collaboratively to resolve those issues? What are the expectations of the families? What kind of weird family glitches are common, and how do I work to step around them gracefully? Those are questions I can think of right now, any other advice you can give me would be appreciated.

Thanks!

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Specializes in med-surg, teaching, cardiac, priv. duty.

hi! Well...I'd recommend reading through old posts under this private duty forum. That will give you an idea of some of the issues you can encounter. Routine will vary from pt to pt. Basically it is like the hospital except you only have one patient. And the pt is more stable, or they would not be at home. Read your care plan and confer with the family or other nurses to clarify the specific times for things.

Families can be the one frustrating aspect of PD. I have seen families respond in polar opposite ways. Some are super involved and hover, and the nurses feel smothered and unable to do their job at times. Other families withdraw totally, and let the nurses take over. My biggest advice: keep a professional boundary between you and the family. Many nurses seem to have problems with this, and it leads to nothing but trouble. Many of these families can be very "needy". If you give an inch, they will take a mile. Only do what is on the care plan!!!!! If you start doing things not on the careplan (cleaning, laundry, dishes, errands,etc) things can rapidly get out hand. Remember you are the nurse, and not the family's personal friend. I am not saying you can't be friendly and pleasant with the family. But keep a professional boundary. You should not give the family your phone number - communication should go through the agency. If you get too close with the family, it is very easy to lose objectivity without even realizing it. Once you lose objectivity, it is easy to start making unsafe and risky nursing decisions.

So, those are my 2 cents....

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I am also a new nurse who just took on a private duty job. The pt and family seem really nice, but I was asked to do some traveling with the pt, which would be 24 hour care for 4 days. I get paid 6 hours by the agency, and if we are with the pt. longer that has to come out of pocket. The pt. offered me $50 extra per day. I thought this was unreasonable as I would be working the whole time. I told the pt. I still wanted to be paid for at least 8 more hours, and not charge for the night, even though I'd still have to get up and reposition and all that good stuff during the night. Was this unreasonable of me? He turned that down and said it was too much. I just want to know if I was out of line.

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Specializes in med-surg, teaching, cardiac, priv. duty.
I am also a new nurse who just took on a private duty job. The pt and family seem really nice, but I was asked to do some traveling with the pt, which would be 24 hour care for 4 days. I get paid 6 hours by the agency, and if we are with the pt. longer that has to come out of pocket. The pt. offered me $50 extra per day. I thought this was unreasonable as I would be working the whole time. I told the pt. I still wanted to be paid for at least 8 more hours, and not charge for the night, even though I'd still have to get up and reposition and all that good stuff during the night. Was this unreasonable of me? He turned that down and said it was too much. I just want to know if I was out of line.

I have never had a private pay situation, but I do not think you were out of line. $50 extra a day? For being there 18 more hours? That is hardly anything!! That would be like $2.70 an hour! Not even close to minimum wage!

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Specializes in Step-down ICU.

I am not trying to hijack the thread, but I am a new nurse that will be orienting on a private duty case starting Wednesday! I am nervous/scared/excited, a wide range of emotions. My patient has ALS and has a vent/trach. I think this would be a great job to learn new skills and to gain experience, but I have NO idea of what to expect. Any advice, words of wisdom, inspiration for Me? Thanks everyone!

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Specializes in Home Health, PDN, LTC, subacute.

Read as many of the past nurse's notes on the case as you can. You should find copies in the house or ask your office for them. They will give you a good idea as to the patient's daily or nightly routine. At least you will know where to start. Private duty patients are used to "training" nurses and usually will have no problem telling you what they want. Best of luck!

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