Private Duty Nursing vs. Agency Nursing

[AreaNurse]

As an agency nurse, I'm still working for a middleman that takes more than half my pay because they connect me with clients that need my services. I've worked in various facilities that gave me the toughest assignments while the agency made more than twice my pay by literally sleeping. (I worked midnights!)

Who doesn't love one-on-one nursing? You can't do this working for hospitals or facilities. Our time is spent away from our patients charting properly to avoid being sued.

I work at a sub-acute rehab facility for the largest Catholic Healthcare Organization in Illinois. Besides passing out meds, doing some treatments for 15 plus patient for the majority of my 8 hour shift, I chart and do clerical work mainly to protect a license I've worked hard to earn. All the while I feel this Corporation is taking advantage of me, and they treat me and my nursing coworkers as unprofessional by always threatening 'write-ups.'

And in today's economy, they stress in no uncertain terms how we should be lucky we have jobs. In fact, they take advantage of that and squeeze more out of us for their greedy gain.

And where is nursing management in all this? Aren't they supposed to be our advocate? Instead, the majority of them are clawing their way up the corporate ladder only to be stressed out to make a few extras dollars just to become a higher up pawn in Corporate America's game/gain.

These Corporate giants, even though part of a non-for-profit organization, with their large salaries are laughing all the way to their vacations villas mostly on our hard work!

How would hospitals and facilities function without nurses?

I feel nurses are second only to patients.

Nurses are SO underpaid and unappreciated!

At one point I wasn't familiar with Private Duty Care because the nursing program prepared me to work closely with patients in a professional setting, they did not prepare me for that special kind of one-on-one care. That's when I realized private duty means you should be working with one patient as opposed to fifty and working for an agency doesn't always get you private duty.

However, as a Private Duty Care Provider, minus the Agency, I can be my own boss, work close to home and choose my own schedule. I realize my license must be current and I need a clear understanding of my state's professional practice act.

Having malpractice insurance is optional but very much encouraged and not that expensive when compared to what I'm handing over to the agency every single hour I work. Besides, even though nurses are covered by an agency, hospital or facilities' malpractice insurance, if it came down to us or them in the courtroom, who do you think they're going to protect?

In addition, I know it is my responsibility to pay state and federal income taxes. But wouldn't it be worth it not have to share my hard earned wages with an Agency just by doing a little initial homework upfront?

So, I thought about taking an ad out in the local classifieds as a private duty nurse only to discover this was much too expensive, and I had to question how many people were looking for a private duty nurse via the classifieds.

I soon found that many nurses are asking the same question.

How can we affordably go about getting a private duty job without handing over the majority of our wages with an agency?

[Sam J.]

Having malpractice insurance is optional? Not really. And it's so cheap you won't belive it- about $200/year for a million in coverage.

After you get that, next step is to get bonded (theft/dishonesty coverage). It's also cheap. You can get $50,000 coverage for about $300/year. This sort of assures your client that if their Persian rug goes missing, their private nurse has coverage if they file a claim. Bonding is considered 'feel good' insurance because it's not what it appears- say that rug cost $20,000. The patient files a claim. You, the bonded nurse, has to pay that $20,000, then the bonding company will investigate the loss. If it's proven you did not steal it, then they refund the $20,000 to you. But you need to present yourself to clients (who are normally wealthy) as 'licensed, bonded, and insured' to set your clients and their referral sources at ease. It's the status quo catch phrase that you see every type of business advertise, regardless if it really means much, practially speaking.

Then talk to doctors and case managers and wealth/trust fund managers/laywers and discharge planners to let them know you are available. You are looking for wealthy clients- they know agencies keep half the money they pay out, and the wealthy are more interested in saving a buck than most people, this is how they got that way. And since they usually want more of a ccompanion that true nursing care, it has to be paid for privately. Once you find your first private duty, word of mouth will take care of you after you prove yourself. Good help is hard to find- you'll hear that often.

[meanmaryjean, DNP, RN]

The fundamental error you make here is saying that your employer 'takes half your pay'. The agency is the entity contracting the agreement. From the agreed upon price paid to the agency, your wage is paid. The amount paid to the agency is NOT YOURS. You are getting 100% of the wage/ rate you agreed upon. No one is cheating you.

[Sam J.]

Or you can look at it from the point that the agency keeps half or more of what the client/patient pays the agency. As far as private pay clients- they are all fully aware of that, hence the market for private duty, privately paid nurses, such as live ins. The exception is skilled home health care which results from a hospital stay or the like- in that case, nobody would pay privately because Medicare or other health plans generally cover that, so the clients aren't involved in the actual or true cost. In fact, many patients that receive home health care have no idea of the actual cost, or that the nurse is paid half or less of the total charges.

If the poster is asking about providing skilled nursing care privately and independently, either in a facility or in the home setting, rather than unskilled care even though she/he is a nurse, that's another story- a nurse can't legally provide skilled private duty care without oversight, and that's why agencies are so expensive- they have state and federal regulations to comply with and lots of other types of overhead, staff training, etc. they are required to provide.

[caliotter3]

Most of the people I've met, and I, have got private duty gigs through word of mouth. Establish, and maintain a good reputation with your client and often they will be only too happy to recommend you to others who may need your services.

[AreaNurse]

Sam, thank you SO much! This info is quite enlightening and I will definately be looking into this.

[AreaNurse]

Thats how I feel. I feel I'm being cheated because nurses are underpaid and unappreciated.

I think this started when I worked for agencies years ago and if I showed up for an assignment and they forgot to cancel me, I would get the four hours pay just for showing up. That was until the AGENCIES started taking HALF that.

Seriously? Did they get out of their nice warm beds to show up at the assignment?

Of course that's the way of the world...

[Sam J.]

You must also hail from the Dark Ages, when you got 4 hours pay if you were cancelled within 4 hours of the shift? Then it became 2 hours within the shift start time, and the pay was for 2 hours. Then it became 1 hour notice of cancellation. Finally, they eliminated all pay if you were cancelled at any time, so facilities ordered even MORE agency nurses, just in case someone called off at the last minute, because they had no financial penalty if they cancelled any of them at the last minute? I've even been cancelled AFTER I started a shift, because a DON convinced her own staff to stay over (by offering bonuses, etc.), and so I only got paid for the time I was 'on the clock'. And so my agency days came to a permament end. Pity- long ago I used to get LOTS of 4 hour pay for cancelled shifts, and 4 hours for NOT working sure beat 8 hours of WORKING.

[systoly]

"...However, as a Private Duty Care Provider, minus the Agency, I can be my own boss, work close to home and choose my own schedule. I realize my license must be current and I need a clear understanding of my state’s professional practice act..."

Actually, this is true of my present employment with an agency.

I'd be concerned that I'd have much fewer choices about proximity and hours if i was on my own.

I'd still be my own boos 'though

[tammygartley]

As an LVN is it legal and ethical to work independent from any agencies? I currently work in Home Health because I do value the one on one individualized care for for my patients. I am a Hospice Nurse and I also work some private Duty cases for pediatric cases that have trach, colostomy, gtubes. I do feel under paid and under valued by these agencies. I happen to know that for a SN the agencies charge $60.00 an hour and I only make $21.42 an hour. I would very much like to work as a concierge home health "private nurse" I am currently insured with personal malpractice coverage. I will now look into getting bonded also. How does one become their own boss? I have many clients/patients that do try to hire me outside the agency that I am contracted with. I would like to make the $60.00 an hour... I thought we were not "allowed" to advertise and function as singular entities. Is anyone out there working independently now? No agencies/hospitals? I realize that as a private nurse I would definitely be in constant communication with clients/patients attending physicians to provide and maintain individualized order care. ?? I work mostly southern Orange County Ca. Am abundance of wealthy clients. I just never knew how to go about or consider working independently.. Help me understand... Can I legally and ethically do this without jeopardizing my license?

How does one file there taxes? Independent contractor?

[tammygartley]

As an LVN is it legal and ethical to work independent from any agencies? I currently work in Home Health because I do value the one on one individualized care for my patients. I am a Hospice Nurse and I also work some private Duty cases for pediatric cases that have trach, colostomy, gtubes. I do feel under paid and under valued by these agencies. I happen to know that for an SN the agencies charge $60.00 an hour and I only make $21.42 an hour. I would very much like to work as a concierge home health "private nurse" I am currently insured with personal malpractice coverage. I will now look into getting bonded also. How does one become their own boss? I have many clients/patients that do try to hire me outside the agency that I am contracted with that does provide them or their loved one care. I would like to make the $60.00 an hour... I thought we were not "allowed" to advertise and function as singular entities. Is anyone out there working independently now? No agencies/hospitals? I realize that as a private nurse I would definitely be in constant communication with clients/patients attending physicians to provide and maintain individualized ordered care. ?? I work mostly Southern Orange County Ca. An abundance of wealthy clients. I just never knew how to go about or consider working independently.. Help me understand... Can I legally and ethically do this without jeopardizing my license?

[Sam J.]

An LVN can't work independently. No way. If you want to be a private duty nurse, stick to personal care and other tasks (housekeeping, etc.) that don't require any state license or oversight. Don't even promote yourself as being a licensed nurse unless you want to become unlicensed, in a hurry. But if a client knows you have a license, many will hire you over an unlicensed caregiver, just because they feel they get more bang for their bucks. BTW, an LVN making $21.42/hour in home health is unusually good money- more than RNs make in many places, even some hospitals. But if you think a private client will pay you $60/hour, dream on. Maybe $15, if you're lucky. Those patients are not paying your agency $60/hour, their insurance pays for it. They can easily get a private caregiver for $10/hour, or even $100 per day for a live-in.