One case only or a whole bunch of them?

poppycat, ADN, BSN · Oct 6, 2012

I work for 2 private duty agencies and only take care of 1 patient with each. I know for a fact one of the families would not accept the "revolving door" effect. They want consistency. There are currently 6 nurses on this case & no unfilled shifts. If a nurse calls off, the family takes care of the patient that shift & they are ok with this.

I personally would not like working with a different patient every day. Part of what I like about private duty is the chance to get to know my patients very well and you can't do that if you see someone new every day.

CloudySue · Oct 6, 2012

The good thing I will say about having so many clients is the variety, and that it keeps my skills fresh. I have a bit of everything: gtubes, B/CPAPs, trachs, glucose checks, O2 admin, seizure precs, etc. Plus I've learned a mountain of knowledge, treatments, and care for all sorts of conditions: SMA, Duchenne's MD, lissencephaly, Q6 chromosomal deletion, shaken baby syndrome, epilepsy, CP, prematurity & BPD, tracheomalacia, hyperinsulinism, Rett Syndrome... that's more than 10 kids I've worked with in the past year. (Right now I have 6-7 active cases I go to.) So it's not all bad, for me and my ongoing education, that is. Plus, some of those places would drive me crazy if I had to be there every day! As far as the parents go... I've always tried to be respectful and friendly, not too intrusive, not to be too chatty but still giving them the opportunity to get to know me so they are more comfortable with me and remember me for next time.

allnurses Guide · Oct 6, 2012

I'm not aware of any agency in my area (either from experience or word-of-mouth from other nurses) that rotates nurses like that. I can see how it could be beneficial given so many instances we hear about where the nurse crossed the professional boundary line with families.

Most families prefer to have fewer nurses working more hours. I found that things work out best for the patient/client generally with 3-4 nurses during the week. Weekends there is a higher number of newer nurses.

If you enjoy the variety and the families don't object enough to switch agencies might as well stick with the status quo. You're lucky to have that many cases close enough to avoid driving to the ends of the earth and back. Los Angeles is notorious for that!

HisTreasure, BSN, RN · Oct 8, 2012

I would hate that! I've met 7 nurses over the past weekend for our foster son and I have to tell ya, I really don't want to meet another anytime soon. I've picked 4 for my core team and 2 as backups to be trained. I would appreciate the consistency over the the perceived stability. When I did private duty none of my agencies had that policy, although I can see the value in learning and maintaining new skills. I did home care as well and loved the visiting because of the variety, education, and skill-building. I know, as most special needs moms do, that not every shift is going to be covered and that's ok. In fact, there are empties on the schedule right now and I'm not too concerned with filling them with yet another stranger in my home.

CloudySue · Oct 8, 2012

It's not a "policy", per se, it just kinda... happens that way. :cautious:

PediLove2147, BSN, RN · Oct 8, 2012

When I did private duty nurses I had two kids that I took care of. I was not trained on any other cases as a back-up and I don't remember hearing anyone that did. I liked getting to know my kids and what worked/didn't work. I can imagine this revolving door thing is VERY hard on the parents too. I can see why you like it though seeing my biggest issue with private duty nursing was boredom.

Are you asking out of curiosity or are you getting sick of this "policy" and looking to go elsewhere?

CloudySue · Oct 9, 2012

Good question! I have no interest in going anywhere else. This office is actually very well run and staffed w great people. I've worked in enough bad places (nursing AND non-nursing) to realize when I have a good thing. No place is perfect, so I weigh my pros and cons. Skipping around with clients is a con that's definitely not as bad as being managed poorly.

When parents discuss the revolving door issue, I tell them that it's still a fantastic office that's run well and overall, they usually agree. That's why they stay too.

I was just putting the question out there because I was just curious how odd/normal this way of running an agency is.

ventmommy · Oct 11, 2012

I would not have stayed with an agency that staffed like that. It's unreasonable for an agency to assume that a nurse can be proficient on every child if they see that child once or twice a month. I would have NEVER been able to leave my house with staffing like that.

If a regular nurse called out and they couldn't fill the spot with another regular nurse on OT, then they could just leave the shift unfilled. Staying awake all night to care for our son was better for us than staying awake to supervise an unoriented nurse who wasn't familiar with our son's vital signs, expressions, cares, emergency procedures, etc.

Adele_Michal7, ASN, RN · Feb 10, 2013

That's really odd. I wonder why they operate that way. The agency I've worked for liked to have consistency with scheduling. It's better for everyone that way!

nursearoo · Feb 10, 2013

Last week I worked at 5 different homes in 6 days. My agency does not put a "main" nurse at any case, they prefer to schedule at LEAST 10-12 nurses per case every month (as per MAR signatures). While the variety of work can be nice, it's very hard to become proficient with a case quickly. Parents lament to me that they feel like their homes are revolving doors, and they are constantly having to update nurses over and over and over, to be sure everyone gets new information when it comes up. They generally prefer having a small handful of staff for their children, so they can have consistency, plus feel more comfortable in their own homes. However on the flip side, there's a very low incidence of unstaffed shifts. It's much easier for the agency to fill them in a pinch.
What does your agency do? Are you a regular nurse at the same case most or all the time, or do you float all over the area like I do? What do you like/dislike about the way you work?

See, what I have found is when a family has only a couple of nurses, it will be harder to staff in the event someone is out sick or whatnot, a perfect example I just went through myself, the case had 2 regular nurses, one does 4 nights out of the week, the other does 3....the one who does 4 nights just got into a very bad car accident on the way to work, so that nurse has been out for about 2 months now......so 4 nights a week are not able to be staffed, until I ended up filling in ( family is rude & just plain nasty now) so for me personally I prefer a bunch of different places, that way IF someone is out ( like my example I gave) then the better chance of having the shifts filled.....I totally understand "revolving" door issue & having a bunch of different people in & out ( I had home nursing myself for my child who has since passed away), but when there ends up being only a couple of regular staff, it makes it nearly impossible to get the shifts filled in the unfortunate event that someone is unable to work......alot of people seem to not think outside the box like that....

luv4nursing10 · Feb 22, 2013

I work for private duty and currently I have 2 cases. One case I work 2 days (32hrs) and one day on another case. My agency assigns you to a case for the time they need care. I had another case that ended and was tranfered to another one within 3 days. I find that the parents like it better when there are regular nurses there so they get to know the patient and develop comunication and relationship. Working in homecare is alot different from hospital nursing.