First RN job = part time, nights, stable pt - page 2

by itri4vt 5,410 Views | 13 Comments

I finally got an RN position after graduating from a BSN program in December! Not my first choice, but it'll give me experience (and hopefully confidence as an RN). I'm working in home health just part time right now (until... Read More


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    Don't worry about feeling dependent on the parents. This will go away with time. And as for normal orientation, that is way more than most people get most of the time. I never got to practice anything on a doll. You will do fine.
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    It sounds like you've got at least the basics! You'd be surprised how many people are able to breeze in and hope for the best . . I never had to actually manually ventilate my patient either, but you know to pull the trach out of it's obstructed, and you have the parents near by -- plus 911 if you run out of options - I'm sure they would rather you ask until you're sure -- at this stage I don't think it will come across as not confident. I always tell people that I am a stickler about details and I don't want to "think I know" I want to "know I know" and I say it in a confident tone of voice. How can you argue with that really?

    One night at the house with multiple vent cases the power went out - normally not a huge deal as it comes back on pretty fast. We have 8 hrs plus or minus on the external battery and 2 hrs on the internal - finally the dad had to fire up an old gasoline generator and we had those thick orange extension cords snaking all over the house and flashlights! I felt like Pioneer Nurse.

    When people scoff "it's so easy" in private duty well until you're on your own and things go wrong!
    Sehille4774 likes this.
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    Ha! What a fun thread.

    You sound alot like me 1.5 years ago when as a new grad, BSN I managed to get my first job doing pediatric home care with trachs and vents. Some of even basic nursing jobs in LTC or acute care had 80-140 applicants for 1 spot back in 09.

    Ironic huh...spending 4 or more years in school tediously going over the simplest task many many times in order to become competent in those General skills, only to get hired in one of the few areas of nursing where students get little or no in-school experience and end up getting only a few days training by your job in the skills that you do on a daily basis. That tells you how desperate they are in this setting or 'speciality'. This should also tell you something about your agency..it is not a good sign if you constantly being put in situations that are unsafe for you and the patient. Some agencies are pretty bad--they will do whatever it takes to placate the parents and keep a case..some seem at least concerned for their nurses and will draw the line when necessary. Weird too how you are the nurse yet the parents have more experience then you! Parents can be your best resource though...most know 'how it is" with home care training and are glad to help any new nurses for the safety of their child. Most times the parents are diligent and can be trusted for info more then the multitude of other staff members involved in a case as they have been with that child from the beginning, have seen what works, what doesn't---and ITS THEIR CHILD. I have found many charts to be lacking..especially history. Inaccurate at times.---and the supposed office manager type staff spend about 30 minutes per month with the client so dont have a full picture like the parent would. sorry.

    You seem to be asking all the right questions though..which is important because In case you haven't noticed you are self taught in many ways.

    It is July now, so I am sure you a through the worst part of this. I know it took me awhile before I started to feel relaxed---both for the pt and my license. Not an ideal way to enter nursing...but what you gonna do? Lucky for you, you should have the educational background to figure it out for yourself....some really don't but the agencys are so desperate for people they would just about take anyone I think sometimes! (see the part about doing whatever it takes to keep a case) After four years of school though and a professional license, you deserve employment, and you deserved it in the setting you trained for which was the hospital.

    Your experience is the norm with home care...their is little formal pediatric/respiratory training available to nurses (i had a total of 3 peds patients in my 5 years of school) Nursing Schools dont teach these in depth becasue peds has been de-emphasized on the NCLEX..and as for respiratory therapies like CPT, suctioning, coughalators..RT handles that usually in Acute care. So many nurses young and old entering home care are coming in with little experience just like you did and learn on the job.

    Hope all is going well. Try to get oriented to as many cases as you can so at least you can learn as much as possible. Peds and trach and vent exp. is valuable in many other settings...icu, er, nicu, picu, general practice nurse practitioner.

    I am going to pay the 300$ to take the ANCC CPN test (certified pediatric nurse) and I am going to try employment at a local ped hospital who does hire without acute care exp for many of the reasons i described above.
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    Wow, you sure hit the nail on the head!! However, just as I got comfortable with caring for the family I started with and I had actually had some fun conversations with them, my car was broken into, and I didn't want to go back to their neighborhood. I offered to drive to a friend's house 2 miles away and park there if my nursing agency would pay for a $7 cab ride... but they chose not to do that, and left the family hanging on those nights. To top it all off, one of the higher up's in the agency told the person who communicates with parents to tell them that it "just wasn't working out" and didn't want to tell them the real reason why I wasn't coming back. Luckily though I had gone back to the neighborhood to search for my stolen stuff and post flyers, and I had stopped by their house to give them a flyer and warn them to not leave stuff in the cars. So the parents called back and asked: Was it because her car was broken into?? Poor family communicator person was caught in a lie...

    I took a ventilator class last month so I was able to start working with vented kids.

    The home I'm in now is completely opposite. Parents are not involved in the care at all, it's all left up to older siblings (as well as all the cleaning of the house). I was glad to be on nights at first because of the rest of the family... so many people running around, it's chaos! The poor kid is sorta neglected whenever a nurse isn't there. I have switched out with some other nurses that forget to document meds, leave without changing poopy diapers (only to sit for 8 hours before I arrive), mix up the tubing so that the temperature probe is on the external tubing...

    I am only working nights, so my opportunity for learning new things is limited. In fact, now that I have mastered mixing G-tube meds, changing diapers, doing in-line suctioning and cough/assist machine, emptying urinary cath bags... I don't have much more I can learn. Luckily my boss got me scheduled to do the monthly trach change! I'll finally feel a little more comfortable knowing what it feels like to insert a trach. However, I may ask to start working days at a new home so that I can get practice with the routine trach care and other daily activities. I think one of my strengths as a nurse is being able to communicate with patients (esp peds) on their level, and I enjoy talking and working with them. On nights, I don't get that rewarding opportunity.

    Anyway thanks for reviving the thread so I can give an update!


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