What are the Not So Good Things about working Private Duty

MusicNurseCarrlee, LPN, LVN · Jul 22, 2011

You are not alone in your feelings. Private duty is a huge undertaking and should be considered carefully. Working with one patient, a nurse is able to provide focused, individualized care and this can be appealing compared to larger patient loads. There is, however, quite a bit of politics involved in private duty nursing. If working through an agency, contracts and agreements are negotiated before and during your placement and you may not be aware of/allowed to know their specifics. The nurse takes on great liability should anything go wrong in the private duty setting(it will be your word/documentation against...). Families are very much involved in the circle of care in private duty and any dynamics/issues that exist there carry over into the nurse's work. I think it is neccessary to be extremely flexible, have thick skin, maintain professional and therapeutic boundaries, carry malpractice insurance and have backup/alternative employment when providing private duty nursing care.

caliotter3 · Jul 22, 2011

You have no backup from an employing agency. Just you and your client/employer. Even with a good written contract, if the employer wants to mess over you it is easier for them to do so. Of course they usually act as if they have a greater pull on you and your time, because they usually pay better, and for this, and any other advantages, they expect a greater level of loyalty.

Blackcat99 · Jul 22, 2011

It can get boring-doing the same thing day after day. I also like to do things "my way" sometimes. However, I can't because "Mom" wants it done "her way." :crying2:

pat8585 · Jul 22, 2011

thanks to everyone for their replies. I am finding out there is A LOT of politics

and that no matter how much you try to do your best for a client they will step over you if they feel like it, sadly.:icon_roll

caliotter3 · Jul 22, 2011

thanks to everyone for their replies. I am finding out there is A LOT of politics
and that no matter how much you try to do your best for a client they will step over you if they feel like it, sadly.:icon_roll

No truer words were ever spoken. Shoot, look how Tiger Woods has just treated Steve Williams after all those years of loyalty.

tothepointeLVN, LVN · Jul 22, 2011

Alot of the times you end up having to do things the "wrong" way to please your client. Thats the part I don't like. I usually find it's something along the lines of the client wanting vigorous and constant suctioning or GT feeding to b run as bolus and not pump. Overfeeding the kids too annoy me but thats a minor thing

Blackcat99 · Jul 22, 2011

What makes me crazy is that Mom says it is not necessary to elevate the head of his bed when he is receiving his tube feedings!!!! :uhoh3: As soon as Mom leaves for the day -up up up goes the head of his bed. :lol2:

However, I can't leave this job because I love this little boy so much!!!!:redbeathe

tothepointeLVN, LVN · Jul 22, 2011

Uh Oh Blackcat. You don't want to get stuck in THAT hole. Yes I like my patients but I can walk away and have at anytime.

Blackcat99 · Jul 22, 2011

Uh Oh Blackcat. You don't want to get stuck in THAT hole. Yes I like my patients but I can walk away and have at anytime.

Yes, I know I am a fool. But he is just so cute and precious. I think about getting another job sometimes.

However, when I look into his eyes I think I must stay with him.:redbeathe

dirtyhippiegirl, BSN, RN · Jul 23, 2011

I think the worst part is that as a new grad, I'm basically digging my own grave by going into private duty/home health nursing. From what I understand, it's basically impossible to get out of the LTC arena once you start. (But no hospitals will hire me and I need a job.)

I'm with an agency and am not getting any good hours. The regular cases are taken up by more experienced nurses. I am getting last minute calls, which I always take (need the money) but I have no hours next week because the full-time patient I was going to take got snatched up by someone with more seniority.

Feels like things are either super boring or super stressful because you have a kiddo who loves pulling out their g-tube/trach etc..

Family stuff is nuts. I'm either with families that totally ignore me even if I have an important question or with families that want to over-compensate so much that I don't feel like I'm doing my job because they're doing everything.

The kid that I routinely take care of the most these days is pretty easy (when I get hours) -- but her grandfather (main caregiver because her mom works full-time) has weird-ass expectations. Nothing overtly dangerous like blackcat's scenario. But he flipped out at me when I primed her feeding tube with water. And when I was cleaning her nebulizer stuff in the sink. ("You don't have to clean that!")

Kyasi · Jul 23, 2011

The main PRO about home care for me was the flexibility. It took me awhile to learn to say no to the scheduler and to only work when it was best for me and my young family at the time. Once I mastered that and got over the guilt of saying no, it was much better. The scheduler for the agency I worked for would know of holes in the schedule but would wait till the night before to call. It drove me mad.

I have learned that families can and will turn on you in a New York minute. I never allowed myself (hard as it can be) to become too attached to a patient. I was with one child for 9 years. The hours were great and I loved the case. The family was dysfunctional and there was a divorce and remarriage in the mix. New wife apparently didn't like that I was the primary nurse (set up by the father, her new husband, who had adopted this child) When I left voluntarily after a short medical LOA, during which time I decided it was time for me to stop doing private duty, the parents were upset that I would leave. The new wife told the other nurses that I was having an affair with her husband. The nurses that knew me well knew this wasn't true, but what about the new nurses on the case? I was disgusted by it all and it made me wonder at all the sacrifices I made over the years to help keep that case staffed and running smoothly. It was a kick in the teeth to me. I was with this case when the Dad was married to his first wife so I knew him longer and I was instrumental in working with the court system to get him custody of this child (he was the better parent) and also in getting a donation of a lift van for the child from a wealthy patient that I also cared for. So I was angry and hurt by all this. The Dad didn't seem to feel the need to set the record straight. That was the thanks I got for 9 years of service.

Despite all that, I don't regret any of my home care experiences.

Kyasi