Private Duty Nursing Brings It Home

Having a nurse in the house means a better quality of life for patients and peace of mind for parents.

Like many of our patients, Joshua had a tough beginning. He was born at 25 weeks, is trach- and ventilator-dependent and required extensive treatment in our Newborn Intensive Care Unit. As he progressed, his care team and family began to make detailed plans for his eventual discharge. Just before his first birthday, Joshua’s parents took him home, where he was welcomed by his two sisters, his brother and one other person—a Home Care private duty nurse (PDN).

Collaboration Is Key

His Home Care plan ensured that Joshua had everything he needed to be cared for safely in his own environment. Home Care Pharmacy and Home Medical Equipment delivered his supplies, medical equipment and formula. Home Care private duty nursing, respiratory and OT/PT/speech therapies were all in place. It was truly a team effort.

Because of the level of care Joshua would need, an ICU was set up in his home. This ICU uses a lot of the same technology as our inpatient units and includes:

  • A white board that keeps important information in sight for both parents and nurses
  • Visual cues (fliers/posters) for trach safety posted above the crib for staff and family to use in case of an emergency
  • Shelves full of equipment and medication
  • A laptop to document Joshua’s treatment and access his orders.

“It takes a lot of planning to create a safe and efficient environment for the patient and also a safe workplace for our staff to work,” said Susanne M. Evans, RN, BSN, clinical director, StarShine Hospice and Private Duty Nursing. “Besides extensive clinical training, it’s also important to maintain respect for the family’s home and be sensitive to the family’s cultural practices. Our nurses are trained in that regard.”

Private Duty Nurses Statistics

Overview of PDN Program

  • Eligibility - infant to age 22
  • Continuous skilled nursing care for children with medical complexity and technology dependence -- In-home or beyond (e.g., school, community, and wherever the child or family goes) -- RN and LPN skill level -- Care is provided in shifts of care; typical patient receives two 8-hour shifts of care per day -- Average daily census, 20 patients

One of Joshua’s nurses is Tiara West, LPN. It’s her (and all PDNs’) responsibility to coordinate and administer Joshua’s care. It can be a challenge, but it’s one West embraces and is well prepared to handle.

“Since I was a child, I wanted to be a nurse and work with babies and small children. After being a nurse for over 10 years and working in different settings, I was given the opportunity to work at Cincinnati Children's,” said West. “I am a mother myself to two kids, as well as being an aunt. I knew I could take care of a baby, and with the training that Cincinnati Children's gave me, I knew how to care for Joshua’s complex medical needs.”

In addition to the clinical care that the nurses provide, developmental and playtime activities are an important part of the day to continue his normal childhood development.

“Joshua is the happiest little guy. He has a big personality and isn't shy about showing it. He gains new skills every day. He has mastered sitting up, rolling over, standing and reaching for toys. He loves his toy cars, and we’re working daily with tasting foods. He interacts with his three older siblings, and they love to help with his care. When I leave, they always tell me ‘thank you for taking care of our baby Shua,’” said West.

The training, planning and personalized care that West and her colleagues provide are greatly appreciated by Joshua’s mom, Leah.

“While I would love to spend all day long sitting on the floor playing with little Joshua, many other needs of the family need to be addressed too. Having a nurse in the house during the day allows him time to integrate his therapies into his daily life, enabling him to advance in his developmental growth. He can also safely explore his surroundings while under constant watch, as is necessary for the safety of a trach patient.”

Additionally, when caring for their other children, it is easy for parents to forget to give a medication, or even miss a feeding. The nurses keep Joshua on his feeding schedule, allowing him optimal nutrition for optimal physical and mental growth.” 

And sleep?

“Obviously, having a nurse overnight allows us to simply get some well-deserved sleep, knowing that our Joshua is in safe hands,” Leah adds.

West has advice for others interested in becoming a private duty nurse:

“Working in the home environment has challenges and positives. Developing a trusting relationship with families takes time. So stick with it, and you will find your place. The positives are that you get a lot of one-on-one time with your patient. You’re able to give your full attention to that child's needs. You’re not being pulled multiple ways by other patients’ needs. I am blessed that Joshua's parent have allowed me to be a part of his life story.”


Tiara West, LPN, enters information into Joshua's chart.

Joshua loves being at home with his parents, brother and sisters.

Joshua has everything he needs in his home-based ICU.

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