What's it like to be a private duty RN?

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Just....what's it like? Is it terribly boring to hang out for eight to 10 hours at someone's home ? Of course you are doing your nursing process and duties; but compared to the 12 hour shifts of an ICU.....what happens between repositioning, cleaning the patient, turning them, suctioning them, assessing and monitoring, giving meds? How close do you find you get personally to the patient and the family? Are your professional boundaries challenged? Are you able to provide the therapeutic relationship ongoing without having conflicts arise around professional boundaries?

Any information would be appreciated. Myself, worked within hospitals for my entire career most recently ICU. Know private duty is less money but not interested in money much anymore. Being able to feel calm and actually help people would be nice.

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Specializes in Peds(PICU, NICU float), PDN, ICU.
Just....what's it like? Is it terribly boring to hang out for eight to 10 hours at someone's home ? Of course you are doing your nursing process and duties; but compared to the 12 hour shifts of an ICU.....what happens between repositioning, cleaning the patient, turning them, suctioning them, assessing and monitoring, giving meds? How close do you find you get personally to the patient and the family? Are your professional boundaries challenged? Are you able to provide the therapeutic relationship ongoing without having conflicts arise around professional boundaries?

Any information would be appreciated. Myself, worked within hospitals for my entire career most recently ICU. Know private duty is less money but not interested in money much anymore. Being able to feel calm and actually help people would be nice.

It can be boring, depends on the case. I prefer the more complex cases (but I'll do any level of care since I have bills to pay). The more complex cases typically keep you busier. Between tasks, you can play with the child if that's possible. You can also (depending on family/case) use your phone/laptop/tablet/sewing project or whatever.

You control how close you get and if you feel uncomfortable, you can change cases. You choose who you work with and what days/hours you work to an extent. You have to be careful about professional boundaries.

You can get a feel for how things work by reading through the posts here. You can read about the crazies and the most wonderful families ever. No case is the same. But at the same time, after doing this for about 10 years, there are patterns and similarities too. You may have a case where its calm and you may end up with the single mom on welfare with 6 kids that are out of control while the mom spends her day drinking.

Make sure you choose a quality agency with plenty of cases. Wait...did I just say quality and agency in the same sentence? Just be careful who you work for :-)

You could also consider being a case manager/clinical manager. They oversee the cases and are busier than nurses in the home. But more detached because they aren't in the home constantly. They still use skills because they assess the pt on a regular basis as well as take calls from nurses about issues with the pts. They also write care plans, communicate with Dr offices, and do other administrative tasks.

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Specializes in nurseline,med surg, PD.

I have done private duty for almost 5 years and I totally agree with the above poster. Some days can be excruciatingly boring but other days might be interesting. Just like any job. I do a lot of reading at work. One of the best things is that people are generally not breathing down your back.

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Also keep in mind that if the Homecare client is admitted into the hospital your hours will be reduced until they are discharged back home. If I was an RN, I would defiantly pursue Case Manager/ Superviser like SDALPN suggested.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

You can also work multiple cases or float so you don't lose as many hours if a pt is hospitalized. But if cold/flu season is that bad, expect a few kids to be hospitalized. I like floating to keep up skills and so I don't get bored doing the same thing over and over. Plus it helps if one is hospitalized. Already being oriented to multiple cases increases the chance of getting work. Some nurses even work for multiple agencies to keep work available.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Things I like about PDN:

*I don't have to deal with many people -- I don't have to deal with doctors, therapists, other nurses, aides/techs/whatever, managers, administrators, etc.

*I have a lot of downtime -- I can read, surf the 'net, catch up on emails, pay my bills, etc.

*I have very little stress at work compared to hospital or LTC work -- only one patient, no call bells going off, no list of 30 patients all needing meds/treatments all at the same time, etc. Keep just one person alive at a time.... easy peasy!

*I actually get to do hands-on nursing care, rather than just being a charting robot checking off the same boxes on the computer over and over and over again about skin integrity and fall risk.

*I get to know my patient, physically and emotionally, and have a sense of pride in knowing I've done a good job in taking care of them. Seeing a case of diaper rash go from red-and-raw to all-but-gone over the course of three days of 12-hour shifts (or a pressure ulcer, etc.), and knowing that YOU were the one primarily responsible for the patient's healing because of the quality of the nursing care you provided is very rewarding personally. There is also a sense of satisfaction/fulfillment in having a patient's face light up when they see you arrive and they realize that you will be their nurse that shift, and that makes them happy.... everyone loves being loved!

*I get to provide respite to parents who are absolutely exhausted from caring for and worrying about their child. I can't make their child be completely normal, but I can allow the parents a short vacation from the stresses of having a special needs child, so they can rest and replenish their energy to wake up and do it all over again the next day, and to allow them to have a bit of time to spend with their spouse and other children to maintain the health and happiness of the family unit in general.

*I get to "think outside the box" a little, exercising some creativity that wouldn't be possible in a facility with strict rules and protocols in place. Finding ways to meet a patient's or family's needs is very fulfilling. Ditto for advocating for my patient -- I don't need to worry about facility politics and stepping on someone's toes just to get my patient's needs met.

*I get to learn skills and procedures and products that I wouldn't necessarily be exposed to in a typical facility setting where there are specialists for everything. I now know how to change out a trach (only Respiratory Therapists or doctors do that in facilities around here), change out a Mic-Key (only GI docs do that here), do a variety of range of motion and therapy exercises (Physical Therapists do all that in the hospitals here), work with a ventilator (RT's realm), etc.

*There is a lot of autonomy. While I do have orders for everything I do, I also have leeway in many things and I can use my professional judgment.

Things I dislike about PDN:

*It can be boring/tedious, if the patient is relatively stable. Doing the exact same thing every single shift.

*It can be quiet -- there is nobody to talk to in the middle of the night when you're having trouble keeping yourself awake. If you thrive on being a member of an energetic team, it may be too isolated for you.

*It can be financially unpredictable -- these are medically fragile individuals, and they can be hospitalized regularly and without warning, which means that you're unexpectedly without a paycheck until they come home. You also "serve at the pleasure of" the patient's parents/caregivers.... if you sneeze too loudly or don't fold the towels *just so* or park a little bit too far to the left, you may find yourself off the schedule (and without an income) through no fault of your own.

*Parents of special needs kids can be control freaks. I mostly let it roll off me like water on a duck's back, but it can get old going to a house knowing every time that you're going to get scolded for doing something that you didn't do, or for doing something the way they told you to, but they changed their mind in the meantime and now you're "doing it wrong". (Conversely, parents can also be amazingly appreciative of the care you offer... you just never know which kind you're going to get with each assignment.)

*It's really easy to get sucked in and feel responsible for your patient(s). I'm currently working six nights a week for two different agencies to make sure my patients have as much coverage as possible. (I also have some extra bills to pay right now.) I've requested to cut back hours with one patient for next month, but I'll still be working five nights a week, 10-14 hours per shift (not including commute time).

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Wow. Thanks you guys. Is it mostly children that are being cared for or do you also have a population of elders/quad/para/...etc? Yes, I will continue reading other posts within this specialty section. Thanks!!!

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Patients can come from any age group. Agencies may concentrate on one patient population, but most will accept any viable case that presents itself, especially in areas where agencies compete for more limited business.

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Specializes in Peds(PICU, NICU float), PDN, ICU.
Wow. Thanks you guys. Is it mostly children that are being cared for or do you also have a population of elders/quad/para/...etc? Yes, I will continue reading other posts within this specialty section. Thanks!!!

All ages. Peds nurses are harder for agencies to get. And my understanding (could be wrong) is that peds cases pay the agency more so they push for peds nurses. We get everything from quads to walking/talking neck breathers. There is a thread here about the diagnoses we've had in this job. CP and seizures are probably the most common. But we get lots with rare diseases.

I'll add, the biggest frustration in this job is probably the parents. Not all of them are difficult. But many of them can make a great job feel like the worst job in the world. The next largest frustration would be the environment. Either inside the home or the location of the home...or both. A bad agency or bad office staff can ruin the experience too. The agencies think the family is always right. I've been written up over silly things and complaints from families about things that never happened. The families will lie when they let you go instead of just telling the agency it was a personality issue. And trust me, no matter how awesome of a nurse you are and how nice you are, they will find a reason to hate you if they choose. Check out the trach boards on FB for parents to see their side. One parent got rid of a nurse for taking a trip to Africa once every two years, but the nurse reliably staffed the case otherwise. Glassdoor is a good resource to learn about different agencies. Hope that helps.

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Yes to what everyone else posted, and I always get to eat my meal and go to the bathroom... drink coffee, etc.

But, I also get no paid vacation, sick, or personal days. That is not fun when it's your only source of a paycheck.

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Specializes in HH, Peds, Rehab, Clinical.

I did PDN for about 18 mos---best paying nursing job I had! I did nights and it got pretty boring most nights. My little one was very stable and most nights required little more than keeping her Kangaroo pump filled and doing diaper changes---other than regular assessments, of course. It got to be very mentally taxing and I did finally have to get into another area of nursing.

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Specializes in pediatrics; PICU; NICU.

Peds cases do not pay the highest for the agency. Most Peds cases are paid by Medicaid & are paid very low.

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