What to Look for in a Pediatric Private Duty Nurse (and Red Flags to Avoid)

Written By Brooke Lawton

Whether you're welcoming a new private duty nurse or evaluating a nurse who's already caring for your child, knowing what "good" looks like — and what doesn't — matters. Most families aren't trained to evaluate clinical skill, but there are concrete credentials to verify and behaviors to watch for that don't require a nursing background to spot.

1. Verify the License — Every Time, Not Just Once

In Florida, private duty nurses are licensed as either a Registered Nurse (RN) or Licensed Practical Nurse (LPN) through the Florida Board of Nursing. Verify any nurse's license status directly through Nursys, the official license verification system for Florida RNs and LPNs — it will show whether the license is active, expired, or subject to disciplinary action. This isn't a one-time check: ask your agency how often they re-verify licenses and background screenings for nurses on your child's case, since licenses can lapse or change status over time. A well-run agency should be independently verifying and re-checking every nurse's active license on a routine basis — not just at hiring — as a standard part of how they staff your child's case.

2. Understand RN vs. LPN — and Why It Matters for Your Child

Under Florida law, RNs and LPNs have different scopes of practice. An RN is trained and authorized to perform nursing assessment, diagnosis, care planning, and evaluation, and to supervise other staff; an LPN provides care under the direction of an RN or physician and is responsible for the tasks within their training and experience. Whether your child's case is authorized for RN-level care, LPN-level care, or either is determined by your child's prescribing physician through the plan of care, and confirmed by your Medicaid managed care plan's prior authorization — generally based on the complexity and stability of your child's condition. More complex or unstable needs (frequent status changes, complex ventilator settings, unstable seizure activity) typically call for RN-level care, while stable, routine tasks may be authorized for either credential. Ask your agency or care coordinator to confirm what your child's specific authorization allows, and which credential is assigned to your child's case and why.

3. Look for Real Pediatric and Condition-Specific Experience

A nursing license alone doesn't guarantee comfort with a ventilator, a G-tube, or seizure precautions. Ask how much of the nurse's recent experience has been pediatric versus adult care, and how much of that has involved your child's specific condition. Ask your agency what training and competency check-offs they require before assigning a nurse to your child's case — most agencies run their own skills validation (a return demonstration of trach care, G-tube management, ventilator troubleshooting, and similar tasks) on top of a nurse's base license, and a strong agency can walk you through exactly what that process looks like and how often it's repeated. It's also reasonable to request additional orientation time with your child's care team if a nurse is new to a particular piece of equipment or condition.

4. Watch How They Communicate and Document

A strong nurse documents care consistently, communicates changes in your child's condition clearly, and asks questions when something is unclear rather than guessing. Notice whether they follow the written care plan and physician orders as written, or seem to freelance based on what they think is best. Good communication isn't just pleasant — it's a safety signal, since it means changes in your child's condition are more likely to be caught and escalated in time.

5. Red Flags to Watch For

Some signs are worth raising with your agency right away rather than waiting to see if they improve: a license that doesn't verify as active on Nursys, resistance to answering direct questions about training or experience with your child's condition, inconsistent or missing documentation, repeated late arrivals or no-shows without notice, deviating from the physician's care plan without discussing it with you or the prescribing doctor, or a pattern of not escalating changes in your child's condition. An agency that can't clearly explain how or how often it verifies its nurses' licenses and background screenings is also worth a direct follow-up question before you agree to services from any nurse they send. Any one of these is worth a conversation with your agency; a pattern of them is worth requesting a different nurse.

6. Use the Trial Period, and Trust Your Instincts

Most agencies allow an introductory period before a nurse's assignment becomes ongoing — use it. Fit matters for a role this close to your family, and a nurse who is clinically competent but a poor fit for your household is a legitimate reason to request a change. You don't need a dramatic incident to ask for a different nurse; "this isn't working for our family" is a reasonable request on its own.

7. What to Do If You Have Concerns

Start with your home health agency directly — a good agency wants to know about problems early. If a concern involves a potential licensure or practice issue, you can also file a complaint with the Florida Department of Health's Medical Quality Assurance division, which oversees nursing licensure and discipline. For a broader list of questions to ask when evaluating the agency itself (not just an individual nurse), see our guide on choosing a pediatric home health agency in Florida.

Ready to Talk Through Your Child's Care Team?

Home Heart Florida works with Florida families to coordinate private duty nursing and FHHA family caregiving for medically fragile children. Contact us or call 844-721-1433 to talk through your child's needs.

Clinically reviewed by Christina Viamontes, MSN, RN

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Disclaimer

This article is for general informational and educational purposes only and is not intended as medical, legal, or professional advice. It does not replace consultation with your child's physician, care team, or other qualified healthcare provider, and reading it does not create a provider-patient relationship with Home Heart Florida. Always follow the specific instructions and care plan provided by your child's medical team, and consult your child's doctor with any questions about your child's individual condition or care. If you believe your child is experiencing a medical emergency, call 911 immediately.


Brooke Lawton
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