Stepping away from the hospital floor to work directly for a family can feel like a breath of fresh air. You trade the loud call lights and rigid shift rotations for one-on-one care and a schedule you actually control. However, many nurses hesitate because they aren't sure how to handle the business side of things. Moving into private duty nursing as an independent contractor means you aren't just the clinician; you are the billing department, the legal team, and the recruiter.
Finding your own clients is more than just posting an ad on a local board. It requires a specific approach to compliance, a clear understanding of your state’s Nurse Practice Act, and the confidence to discuss money upfront. When done correctly, private nursing contracts provide a level of professional autonomy and financial upside that traditional staff roles simply cannot match.
If you are ready to stop waiting for an agency to assign you a case and want to start building your own roster of private clients, here is exactly how to set up your practice, protect your license, and find families who need your expertise.
The Legal Groundwork for Independent Nursing
Before you print business cards, you must verify that your state allows nurses to function as independent contractors. In most US states, Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) can provide certain types of care independently, but the scope is often restricted compared to what you can do under hospital standing orders.
Private duty nursing typically falls into two categories: skilled care and companion/respite care. If you are providing skilled care (ventilator management, wound care, medication administration), you almost always need a physician’s order, even if the family is paying you directly. You cannot legally "prescribe" a plan of care for yourself to follow.
Furthermore, consider forming a legal business entity, such as an LLC. This separates your personal assets from your professional liabilities. While it won't protect your license from Board of Nursing action if a mistake occurs, it can protect your home and savings if you are sued for a business-related dispute.
Setting Your Rate: Don't Undercharge
One of the biggest mistakes nurses make when transitioning to private contracts is setting their rate too low. They often look at their previous hourly wage at the hospital and add a couple of dollars. This fails to account for the "hidden" costs of being self-employed.
When you work for yourself, you are responsible for the employer's share of Social Security and Medicare taxes (self-employment tax), your own health insurance, your own PTO, and your professional liability coverage. As a general rule, your private rate should be 30% to 50% higher than what you would earn as a staff nurse in a local facility.
| Role Type | Typical Facility Hourly Rate | Recommended Private Contract Rate |
|---|---|---|
| Licensed Practical Nurse (LPN) | $28 – $38 | $45 – $65 |
| Registered Nurse (RN) | $38 – $55 | $60 – $95 |
| Specialized RN (ICU/Peds/Hospice) | $45 – $70 | $85 – $130+ |
These rates vary significantly by state and the complexity of the care. A nurse managing a complex pediatric case with a tracheostomy and g-tube should charge significantly more than a nurse providing geriatric respite care or medication management.
Professional Liability Insurance
Do not rely on the insurance you had at your last hospital job. That coverage only protects you while you are acting as their employee. For private nursing contracts, you need an individual professional liability policy.
When applying for insurance, specify that you are working as an independent contractor in a home health or private duty capacity. Most policies are surprisingly affordable, often costing between $100 and $250 per year for a standard $1M/$3M policy (meaning $1 million per occurrence and $3 million aggregate). This is a non-negotiable expense. If a family refuses to work with you because you insist on having proper coverage and a contract, they are not the right client for you.
How to Find Private Clients Legally
Finding clients requires a mix of digital presence and old-school networking. Because you are a licensed professional, you must be careful not to engage in "capping and steering" or illegal solicitation depending on your local regulations.
- Discharge Planners and Case Managers: These are your best friends. Often, families are desperate to take a loved one home but the local agencies are short-staffed. Leave your professional resume and a list of your services with case managers at local hospitals and rehab centers.
- Estate Attorneys and Wealth Managers: Families who can afford private-pay nursing often work with these professionals to manage their long-term care plans.
- Specialized Niche Directories: List yourself on platforms specifically for independent clinicians rather than general gig-economy sites.
- Local Networking: Joining local community groups or senior advocacy organizations can help get your name in front of families looking for private duty nursing jobs.
Creating a Simple Nursing Contract
You don't need a twenty-page legal document, but you do need a written agreement signed by both parties before the first shift begins. This protects both you and the family. A solid contract should include:
- Services Provided: Be specific. Are you providing clinical care, or are you also doing light housekeeping and meal prep?
- The Schedule: Define the shift times and the minimum number of hours per week. Include a cancellation policy (e.g., 24-hour notice required or the family is billed for half the shift).
- Payment Terms: State your hourly rate, how often you will be paid (weekly or bi-weekly), and the payment method (direct deposit, check, etc.).
- Termination Clause: How much notice is required to end the contract? Usually, two weeks is standard, unless there is a safety issue.
- Supplies: Clarify that the family is responsible for providing all medical supplies, gloves, and equipment needed for the patient's care.
Preventing Scope Creep and Setting Boundaries
In a home setting, the lines between "nurse" and "family friend" can blur quickly. Families might ask you to run to the grocery store, walk the dog, or babysit a sibling while you are there to provide nursing care. This is known as scope creep, and it is a significant risk to your license.
If you are distracted by household chores and the patient has an adverse event, you may be held liable for negligence. From day one, be clear that your primary responsibility is the clinical safety of the patient. If you are open to performing non-clinical tasks, ensure they are documented in the contract, but never prioritize them over your nursing duties.
Physical boundaries are also important. Ensure there is a clear space for your charting and medical supplies. Avoid sharing personal financial information or getting involved in family disputes. Maintaining a professional distance ensures that you can provide objective care and makes it easier to discuss contract or rate changes in the future.
Frequently asked questions
Can I work private contracts while holding a full-time job?
Yes, many nurses take on PRN nursing jobs or private contracts to supplement their income. Just ensure your primary employer doesn't have a non-compete clause that forbids you from working with patients in the same geographical area or specialty.
Do I need a doctor's order to work privately?
If you are performing any task that falls under "skilled nursing" (like giving injections, managing a catheter, or adjusting oxygen), you must have a valid order from a physician or advanced practice provider. You are still bound by your state's Nurse Practice Act regardless of who is paying your check.
How do I handle taxes for private nursing?
Since you are an independent contractor, you will likely receive a 1099 form at the end of the year if you earned more than $600 from a family. You should set aside roughly 25-30% of every paycheck for taxes and consider making quarterly estimated payments to the IRS to avoid penalties.
What if a family asks me to do something outside my scope?
Politely but firmly decline. You can say, "As a licensed nurse, my priority is the patient's clinical safety, and that task falls outside of what I am legally allowed to do in this setting." Protecting your license is more important than being "helpful" in the moment.
Where can I find help with my nursing resume?
You can find many resources and answers to common career questions on RemoNurse, which helps you tailor your clinical experience for different types of roles, including home-based positions.
Getting the Best Roles with RemoNurse
Managing your own contracts is rewarding, but it can be time-consuming to find the right fit. If you prefer to have a professional team handle the search for you, RemoNurse can help. We find high-quality roles—including telehealth nurse jobs and new grad nursing jobs—that match your specific needs.
RemoNurse members don't just get a job board; they get a partner. We find the roles, write and submit your applications, and send a personal endorsement to the employer to make sure your resume gets to the top of the pile. To see how we can help you land your next great position, check out our pricing page today.