Private Duty Nursing: Providing Personal Care Outside The Hospital
By Lee Nelson
Jessica Bissen loves going to school. She’s not taking classes, but she serves as a private duty nurse for three kids in the Omaha area. She spends one day a week with each of the children at their school, and sometimes at their homes.
“We are taking care of their medical issues foremost,” says Bissen, a registered nurse who works for the home health care department of the Children’s Hospital & Medical Center in Omaha.
She hadn’t heard of private duty nursing before getting involved in it. But that seems to be a common denominator for many people, even those in the nursing world, she says.
After working as a medical surgical nurse then a school nurse, she began working as a private duty nurse and never looked back.
“You really get to know the patient as a person, and they become family,” she says. “It’s not a job for everybody. You get to know these kids’ personalities, likes and dislikes and just their world.”
Why did you want to be a nurse in the first place?
Bissen went to college to be a pharmacist. She earned a biology degree, but then decided to become a nurse and get her nursing degree with a one-year accelerated program at Creighton University in Omaha.
“I have some nursing relatives. I wanted to be hands-on with my patients,” she says.
Tell us a little bit about how you got started as a private duty nurse
“I was working the medical surgical unit, but I was in the process of getting married. I decided that I didn’t want to be working nights anymore,” Bissen says.
So, she applied to be a school nurse through the hospital’s home health department. She later contracted to be both a school nurse and a private duty nurse.
“I didn’t know what being a private duty nurse entailed. But I have loved all of it,” she says.
Explain how it works being a private duty nurse
“I only see three patients currently, and I see them once a week,” Bissen says. “You give them medical care. But the majority of your time is getting to know them and hanging out with them.”
As a child’s private duty nurse, she becomes their teacher aid and their friend. She writes down homework assignments and helps them with that work.
“We are their support system. I love to be able to connect with them beyond their medical needs. I can tell what their personality is saying each and every day. I feel those emotions with them.”
Bissen also sees the children’s families at least once or twice a day. They do talk about the child, but a private duty nurse also finds out what is going on in their lives.
“We support them and encourage them,” she says.
Currently, the kids she works with are all at different schools. The youngest is in fourth grade; one is in 7th grade, which she has been with since kindergarten; and the 11th grader has been her patient since fourth grade.
“It’s fun. Our staffing model is a little different,” she says. “Each kiddo has six or seven daily nurses. And if they need night care, they have six or seven different nurses at night.”
This model allows more flexibility for situations when a nurse calls in sick or is on vacation. This way, the children don’t have to skip a day of school, or the parents have to take a day off from work.”
“I really think the thing I’ve learned and respect the most is how much these families go through,” she explains.
Maintaining professional boundaries is important. But it can be a struggle because so much time is spent with the patient and family. They invite the nurses to birthday parties, holiday celebrations and more because they become a part of the family.
What is a private duty nurse?
The description varies from state to state, says Paula Brenneman, manager of the Private Duty Nursing Department at Children’s Hospital & Medical Center in Omaha. But in Nebraska, nursing is provided through Medicaid for those of all ages with long-term complex health conditions. Children’s Hospital focuses on babies to those 21 years old.
“Most of the kids we care for have some kind of respiratory component and need their airway managed,” she says. “Our kids have congenital issues from heart diseases to muscular dystrophy.”
What is the difference between private duty nursing and home health care nursing?
Private Duty Nursing
Private duty nurses typically hold an LPN or RN license. They work one-on-one with families, usually pediatric clients, who require long-term skilled medical care. Many private duty nurses are self-employed or contractors and work with a select few clients while others are employed through agencies or hospitals.
Their schedules are often set by the family though, they may accompany their clients and families on vacations and to events.
They are either paid privately, through health insurance or Medicaid.
Private duty nurses rarely help the family with non-medical care. More often, non-licensed home-care providers or certified nursing assistants are hired to provide housekeeping, meal preparation, and related services.
Home-care nurses typically provide care to homebound geriatric patients requiring skilled care, they may also care for pediatric patients. These services are covered 100% by Medicaid and are usually required on a shorter-term basis of around 60 days.
Home-care nurses are usually hired through home-care agencies and work on a per diem basis. Their schedules vary, typically working 8-12 hour shifts or they may stay with a client for up to 72 hours at a time.
They may be required to provide non-medical services such as housekeeping, meal preparation, and companionship.
What special certifications, personality traits and training does it take to become a private duty nurse?
“Our nurses love kids and love helping kids,” says Brenneman. “A lot of them have hospital experience and really favor those long-term relationships.”
In a hospital setting, people come and go. This job mostly appeals to nurses that like one-on-one and giving attention to one family at a time, she adds.
Many of the patients will have either respiratory or gastrointestinal needs. They suffer from such disorders as cerebral palsy, muscular dystrophy, neurological impairments, seizures and more.
At this time, there are no organizations or associations that promote or specifically help private duty nurses. The rules and regulations are all dependent upon the state.
What is the salary range of a private duty nurse?
“For our organization, private duty nursing is valued because we are able to facilitate kids to not stay in the hospital longer,” Brenneman says. “So our organization pays our nurses the same level as our medical surgical nurses.”
She adds that home health agencies that provide similar services base their pay on Medicaid reimbursements.
What destinations and areas of the country and the world are these jobs available?
Brenneman says these jobs are available anywhere that is it reimbursable with Medicaid. And as healthcare moves outside the hospital, the outlook for jobs for private duty nurses increases.
In fact, she has a waiting list of children who need private duty nurses because her department doesn’t have enough nurses.
However, nurses can do the job without working through an agency or hospital. But you have to send in your own billing, and you don’t get any training or continuing education, such as Children’s Hospital offers to their private duty nurses.
Some people don’t feel comfortable working in people’s homes, Bissen explains. But she adds that she is not a nurse who enjoys the high pressure of working in departments such as the ICU.
“This is my kind of work. I love being able to act with them on a daily basis,” she says. “It’s a wonderful job.”