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by Alibaba

Updated Aug 06, 2007 at 05:06 PM by Alibaba

So, my buddy got this job at a LTC. Pay is not great, but 5 minutes from the house, doing double weekends (no baylor either).
The problem is she thought she was going into a regular LTC with older folk. This place however has a skilled unit (everyone is on vents and IVs, feeding tubes plus), a regular LTC type unit and the third unit (which is to be hers) has half regular LTC residents and the other half is peds (youngest 3, oldest 16) All have trachs and feeding tubes and a couple have vents.
On interview, she made it clear that she has never done peds since she's only done LTC (and you don't really see peds in that setting) and the ADON said no prob.
This weekend, she did 2 shifts orientation on her floor (NOCs) and they have her scheduled by herself starting next weekend. She is totally freaked out coz she's never done peds and is completely uncomfortable with it.
I told her I wouldn't take that unit and if she thinks she maybe can manage, she needs to ask for more orientation. Well, they said that normal orientation is 2 shifts and they don't feel she needs special orientation on the peds coz they consider them just like the regular LTC residents.
What do you think? What would you do??

[biker nurse]

Re: would you do it?

NO WAY I'D RUN FAR AWAY FROM THAT PLACE!!! I worked way to hard for my licence.(I've done LTC for over 13 years and it would take more than 2 shifts to put me with babies) under 50 is a baby in LTC!!

[Elvish]

Re: would you do it?

I would either demand more orientation or I would walk.
Children are NOT small adults, and two shifts is NOT a long enough orientation to peds. I wouldn't risk my license.

[Happy2CU]

Re: would you do it?

No way, no how. I would tell her to run, not walk away from that facility unless she gets considerable more training and orientation to the peds pts. I am blown away by the idea that the facility considers them just like regular LTC residents. On my opinion, that is just a BIG problem waiting to happen. Not worth risking her license, not worth the liability, not fair also to the peds patients who need the care of someone who is familar with their needs.

[luvschoolnursing]

Re: would you do it?

When I went from med-surg to school nursing (read-mostly healthy kids) there was a HUGE learning curve. I can't imagine doing it with trached/vented kids without further orientation. Kids are definitely not little adults.

[Alibaba]

Re: would you do it?

thanks for your opinions...
As soon as she told me that,, my first reaction was NO WAY! I don't think it's fair to the nurse or to the patients to throw a nurse onto the floor like that esp. with peds...I thought maybe I was being paranoid because I am not a peds nurse and I admire and respect anyone that can do peds day in day out. Am glad other nurses see it my way.
I mean, they plain refused to give her extra orientation and made her feel bad for asking for more (she's been a nurse for 3 years). Just their reaction alone would make me not want to go back there!

[nurse educate]

Re: would you do it?

Originally Posted by luvschoolnursing

When I went from med-surg to school nursing (read-mostly healthy kids) there was a HUGE learning curve. I can't imagine doing it with trached/vented kids without further orientation. Kids are definitely not little adults.

School nursing is way different than peds LTC. Like you said, those are healthy kids. These are chronically ill kids where many of the norms do not apply.

I'm not saying your friend should aceept an assignment she is unconfortabl;e with. But honestly, peds LTC/chronic patients are not that much different than adults. The trachs, vents, tubes and all are essentially the same (I stress essentailly, not exactly, I know). I could understand being a bit intimidated by it at first (smaller and more fragile tubes), but once you get used to it, it is not that much different. The psychosocial aspect is very different though. Dealing with the parents, many of which are in such denial. takes a lot of adjustment.

If I were your frined, since there is no orientation, I would be proactive and orient myself. Ask the NM if she can shadow a nurse on that unit for a shift. Talk to the team, including the therapists, resp therapy, etc, and get acclimated to the differences (vent settings, types of trachs, mobility equipment, drug clacs, solution and fluid amounts, etc) and make a little notebook. Try to convince her that this could be an opportunity to discover a new niche, rather than going in in fear.

I hate to say this, because while I don't agree with it, it's a part of nursing that doubtfully willl change any time soon. I can't tell you how many units I've had to float to where I was unconfortable, yet it was considered within my units 'floating radius'. As a peds nurse, we can go to NICU, PICU, Peds ED, nursery, postpartum and antepartum. And on the antepartum unit, there are gyn surical patients. Tell me what a 60 yr old with a hysterectomy has to do with Peds patients?

[pagandeva2000]

Re: would you do it?

I would be uncomfortable, but I also agree with what nurse educate shared; maybe see if she can shadow someone on her own to see it for herself. If she believes she still can't handle it, then, I would say to step off. Sometimes, a new challenge may not be a bad thing, but you have to be ready for it.

I really don't care to deal with pediatric patients that much, so, I may be jaded. I had a peds home case and the child was a bit difficult. I had to really be patient with the fact that they do not reason the same way as adults. On the lighter side of it, at home, there were no calculations (I have a deep fear of math) and the MAR was simple...a teaspoon of this or that.

[pagandeva2000]

Re: would you do it?

Originally Posted by Arwen_U

I would either demand more orientation or I would walk.
Children are NOT small adults, and two shifts is NOT a long enough orientation to peds. I wouldn't risk my license.

Just wanted to mention that I really like your Avatar!

[Elvish]

Re: would you do it?

Originally Posted by pagandeva2000

Just wanted to mention that I really like your Avatar!

Thank you! Northernsun.com has some pretty interesting things, that's where I picked it up. It's a 'progressive' site, even though I wouldn't consider myself a hardcore progressive....

Back to the topic at hand...I feel that even an experienced nurse should have more than a couple shifts worth of orientation to a population s/he's never worked with. I had been a nurse for 4 years, I even had experience with babies, but I sure got 5 weeks of orientation before they threw me out by myself on OB/antepartum/nursery. Just my $.02. Either way, best of luck to your friend.