Private duty nursing

JustBeachyNurse, LPN · Jan 27, 2016

In most states an LPN/LVN cannot work independently without RN oversight, create a plan of care, do an initial assessment or write nursing goals. You must work with an RN created plan of care signed by a physician. Many states do not permit LVN/LPN to direct bill insurance because they cannot work independently. Check with your board of nursing first.

Nursekelli2016 · Jan 27, 2016

it is a weird set up. from my interview I discovered there is a care plan in place from several years back that hasn't changed and according to the family the insurance does not require any special paper work. We only chart on special paper document created by the RN in case of an audit . The RN is a phone call away if I needed her but is currently away due to personal reasons and will be for several months. there is also a physician I can call and we will be visiting in person every 90 days and is also the one I call for orders ect. Does this sound like it is within an LVN scope. I had called the Board and they gave me a mild answer of " if you have a doctor you can call than it should be ok" What do you think?

OrganizedChaos, LVN · Jan 27, 2016

I think for your first job out of nursing school, I wouldn't take it.

Nursekelli2016 · Jan 27, 2016

Does the supervision status seem ok though? It would just be good to know either way so maybe I can help someone in the future determine if it is a good or bad situation..

JustBeachyNurse, LPN · Jan 27, 2016

Does the supervision status seem ok though? It would just be good to know either way so maybe I can help someone in the future determine if it is a good or bad situation..

No. Care plans must be updated every 60 days. Patients must be re-certified/assessed by an RN every 60 days. LPNs must be supervised every 30 days. Medicaid/Medicare have similar standards and commercial insurance often follow. A few year old care plan will fail in an audit and you will go down with everyone else. Ignorance of the standards won't save you from failing to meet the standard of care & necessary supervision

Bad choice for a new grad. You don't know what you don't know. You have no back up

OrganizedChaos, LVN · Jan 27, 2016

No. Care plans must be updated every 60 days. Patients must be re-certified/assessed by an RN every 60 days. LPNs must be supervised every 30 days. Medicaid/Medicare have similar standards and commercial insurance often follow. A few year old care plan will fail in an audit and you will go down with everyone else. Ignorance of the standards won't save you from failing to meet the standard of care & necessary supervision
Bad choice for a new grad. You don't know what you don't know. You have no back up

This a million times this!

They will throw you under the bus as well. So get out while you still can!

Cactus Nurse · Jan 28, 2016

Agreed with above. You cannot follow a care plan that is years old?? In a month something can change. Families don't always know specifics either so having an updated care plan is important.

I am also a new grad. I've been working for a little over 2 months. I honestly don't even suggest HH straight out of school. You only see 1 patient, there's a lot of down time and there are a lot of skills you will forget. At least a facility you have a variety of patients, tx, and meds. If I have any questions I have to hope the parent knows or I can read up on it. Of course however if it's a 911 you def call or call the available nurse for questions.

Also, do you think you are getting paid more with this insurance versus even an agency? You would be surprised what new grad rates are. If you know how to interview well and sell yourself you won't get the "new grad rate".

This is is your first job, I know you are excited to work, but really think about your options. This just doesn't sound to concrete.

Good luck!

BuckyBadgerRN, ASN, RN · Jan 28, 2016

Bad situation. You're a new grad (new grads do NOT belong in home health, IMO), with an outdated careplan. No MD is going to help you muddle through a careplan, they just aren't. Please please please reconsider taking this position----for your OWN protection.

Does the supervision status seem ok though? It would just be good to know either way so maybe I can help someone in the future determine if it is a good or bad situation..

Hello_Pretty, RN · Sep 13, 2016

I work private duty and also at a home health agency (mostly Medicaid pts) in Los Angeles. They are not the same thing. I do private duty for the rich in Beverly Hills and Malibu as an LVN. I don't work outside my scope of practice. But in PD there is no "Plan of Care" because I'm being paid for private services, which are not alwaya medically necessary. For example, I got paid to do a home visit and administer 2 enemas 30 mins apart. She could have done it herself but she wanted someone else to do it. I also do 1:1 care for a client at a detox facility. I administer her meds, and help with ADLs. Most of the time she stays in bed. I write my nursing notes and turn them in each week. As a private nurse, I don't do as much "paperwork" as a facility because it is private pay. However. I do get paid very well. But the job is on-call (unless you score a job as someone's personal, private nurse which some celebrities do have.)

For the home health I'm basically a glorified babysitter. Your job details depend on the case you work. Some make you do laundry and dishes, others don't. Since the agency is reimbursed thru Medicaid, there are lots of forms to complete, assessments by the RN, and POC is done every 60 days. You also get paid crap and most patients have g-tubes, vents, or trachs.

Hello_Pretty, RN · Sep 13, 2016

That is just my personal experience in those types of jobs. They may differ where you live. I lived 2 hours from LA and they did not have private duty nursing (only thing close was care giving jobs which paid minimum wage.)

Now that I live in LA I have more opportunities. Only setback is that when I get my RN license. Hospitals in LA don't take new grads, but my previous hometown will.