Looking for variety, travel, and flexibility? These are just some of the professional and personal rewards of nursing one patient at a time.

What is today’s fastest growing job category? Home care services, according to the US Department of Labor. Reasons for the increasing demand in home care include an expanding older population with ready, disposable income, the dramatic longevity of children with chronic and debilitating health conditions, and the continued shift of healthcare delivery to the home setting.

Private duty nursing is a type of home care service that many nurses know little about. Few nursing programs even mention private duty nursing as a career option. But private duty nursing can offer an RN the opportunity to deliver the personalized care many of us were taught to provide.

Private duty nurses are professional practitioners who give direct, comprehensive care on an hourly or live-in basis. Originally, almost all graduates of US schools of nursing were employed as private duty nurses. At graduation, new nurses joined their school’s alumnae association registry. Usually, early private duty nurses took care of patients with communicable diseases, such as typhoid fever. These patients needed nursing care in the home for several months. Improved public health and transportation systems decreased the need for nurses to care for patients long-term in their homes. Over time, private duty nursing’s popularity declined.

Today, the private duty nurse takes care of the acutely or chronically ill child and adult. Psychiatric private duty nursing is also an option. The demand for maternity nursing in the home is growing with short postpartum hospital stays and the increasing number of multiple births.

As a private duty nurse, an RN can work for an agency or as a private contractor. The basic requirements for private duty nursing are current RN license with reciprocity in several states, if the nurse wants to travel, reliable transportation, and appropriate malpractice and automotive insurance if using a personal vehicle for transportation. Information about license reciprocity can be obtained from the appropriate state board of nursing or from the department of professional regulation located in the state’s capital. Also recommended is a clear understanding of the nurse practice act in the state in which the nurse is working.

The personal characteristics for success in private duty nursing include adaptability, a sense of humor, excellent manners, and the ability to establish a warm, yet professional relationship with the patient and family. Other traits for success include creativity, self-direction, and independence.

Working for an Agency

Agencies may specialize in maternal/child, pediatric, or geriatric care. Some private duty agencies are run as a division of a medical center or home care agency. Others are listed in the Yellow Pages. In addition to professional and skilled nursing services, agencies may also provide homemakers, companions, and other nonlicensed supportive care personnel. When considering an agency, find out about its standards, policies, and procedures. Is the agency licensed? Is it part of the local Chamber of Commerce? Does the Better Business Bureau have any information about the agency? Make sure the agency has a good reputation in the community and satisfied clients.

A Typical Day

Susan is an experienced pediatric nurse who found she liked the autonomy and the pace of private duty nursing after working at a children’s hospital for 10 years. Susan arrives at her patient, Elizabeth’s, home in the morning. She wakes Elizabeth up, helps her get dressed for school, suctions her tracheostomy, prepares her tube feeding, and packs the supply bag. Sometimes it gets crowded in the kitchen with other family members getting ready for their day. Susan is sensitive to the family’s need for privacy. She bundles Elizabeth up and grabs her own coat to meet the waiting school van. On the way to school, Susan suctions Elizabeth. In the classroom, Susan sits concealed behind a small screen so she will not distract the other students. Because Susan wears street clothes, she is sometimes mistaken for a teacher. She feeds Elizabeth at lunchtime and then straight caths her in the bathroom. After school, Elizabeth naps and Susan charts for the PM caregiver. Susan has worked with Elizabeth and her family for four months. As Elizabeth’s condition stabilizes, Susan’s hours will be decreased.

An Independent Contractor

Matt is an independent private duty nurse contractor. He has intensive care and oncology experience. Several years ago, he was asked to help a member of his church at home after surgery. This experience made Matt realize that other older people in his community might also need private duty home care. He receives private duty referrals from nurse colleagues, physicians, and local trust and estate attorneys.

Matt has a portfolio containing letters of recommendation, continuing education certificates, and insurance plans that cover private duty care, which he uses to market his services. He establishes a contract for services with his clients and is covered by a surety bond, which guarantees that he will meet his contractual obligations. Matt has backup coverage through a private duty agency if he cannot cover his shift. As a self-employed professional, he has set up his own retirement plan and pays his own Social Security taxes.

Matt finds that private duty nursing gives him the freedom to use a holistic approach to his practice. He is currently working with Mr. C, an 85-year-old postsurgical patient who became confused and agitated after surgery for bowel cancer, requiring a colostomy. His wife is unable to manage his care at home and hired a private duty nurse upon the advice of the family attorney. Private duty care is covered under the family’s long-term health insurance policy. Matt works with Mr. C on ambulation and mental exercises for orientation. He also includes stress reduction interventions using music and visualization.

Matt manages the colostomy care and orders all the needed supplies. He keeps the medical bills in order and categorized for Mrs. C. He drives Mr. C to medical appointments and clarifies information for Mrs. C. The family plans on using Matt’s services until Mr. and Mrs. C move to another state to be closer to their daughter.

Could Private Duty be in Your Future?

The future for private duty nursing looks healthy. All signs indicate that the demand for in-home professional services will continue to grow. The rich heritage of private duty nursing makes it a special role. It could be your path to professional and personal rewards.