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I quit the one case a couple months ago after one day on the job. I took sometime off to assess my life. Since my company is agency home health I remain employed, just inactive status when not working.

Well, I went on Friday to oriented for 2 hours (all this ageny pays for) with a new client I am scared again this client is ALS, and has a Vent and needs suctioning quiet frequently. Tomorrow I go for 10 hours but her husband will be there to help me with lifting and answer questions. They ask me to take the case which is 4 evenings a week 6pm to 12pm. I love the hours, the house is extremely clean and in a nice neighborhood. Once again I have little to no understanding where Vents are concerned. So am I to keep turning down cases that will work for me because no one has time to go over the Vent thoroughly? The Vent is self sufficient meaning it runs itself, but I feel inadequate. Any advice?

You need to go thru an appropriate training program in using a vent. Simple as that. The family is paying the agency for someone that has expertise in that area to give them time off and relief of mind. What happens if there is an issue with the vent? And they do happen. What are you going to do? Do you know how to trouble shoot it?

It is my opinion, but you should not be taking any type of case like this without having appropriate experience. If a problem arises, you can lose your license over it. If this si the only type of case that this agency has, then maybe you shoud look for another.

And what if the family goes out, and you are the only one there, and there is a problem with the vent? What are you going to do then? That patient will still require being bagged with oxygen to breathe while you are trying to assess what is going on..........do you feel comfortable doing that? What if the tube comes out? Can you put a trach tube in? Have you done it before?

These are serious things that you need to consider first.

You need to go thru an appropriate training program in using a vent. Simple as that. The family is paying the agency for someone that has expertise in that area to give them time off and relief of mind. What happens if there is an issue with the vent? And they do happen. What are you going to do? Do you know how to trouble shoot it?

It is my opinion, but you should not be taking any type of case like this without having appropriate experience. If a problem arises, you can lose your license over it. If this si the only type of case that this agency has, then maybe you shoud look for another.

And what if the family goes out, and you are the only one there, and there is a problem with the vent? What are you going to do then? That patient will still require being bagged with oxygen to breathe while you are trying to assess what is going on..........do you feel comfortable doing that? What if the tube comes out? Can you put a trach tube in? Have you done it before?

These are serious things that you need to consider first.

So where do you get thorough training since you have brought it up?

No, I've never put a trach tube in before. Her husband is trained to. Also, she has 3 Vent machines and lots of batteries. The machine readings are self explanatory. I've worked acute medicine, but never Vents basically no standand hospital nurse does unless you work in the Respiratory unit. I just do not like it, and if the trach comes out 911 will be called.

They do not train us like your suggesting and I've surf every company in three of the surrounding states that I know of in HH, and the traning is not thorough at any of them, it is just not. I've talked to the other LPN's, and RN's, and you learn most of what you know on the job by being there often. Tomorrow I will discuss this with the family all these question you brough up. I do not think there is a lot anyone can do if these problems do arise. You do you best with what you know.

So where do you get thorough training since you have brought it up?

No, I've never put a trach tube in before. Her husband is trained to. Also, she has 3 Vent machines and lots of batteries. The machine readings are self explanatory. I've worked acute medicine, but never Vents basically no standand hospital nurse does unless you work in the Respiratory unit. I just do not like it, and if the trach comes out 911 will be called.

They do not train us like your suggesting and I've surf every company in three of the surrounding states that I know of in HH, and the traning is not thorough at any of them, it is just not. I've talked to the other LPN's, and RN's, and you learn most of what you know on the job by being there often. Tomorrow I will discuss this with the family all these question you brough up. I do not think there is a lot anyone can do if these problems do arise. You do you best with what you know.

I think you are putting yourself at serious risk...not to mention, you level of service is not fair to the patient or the family. I know that you don't often run into vents in the hospital, but I worked on a vent unit at a rehab/ltc/brain injury facility....I know too there are usually LTAC's that take vents....maybe you could try to get some prn hours at a facility like this for the benefit of going through the orientation re: the vents. And even still, when I worked at that vent facility, I was still not thoroughly oriented to vents....I came in on my day off and spent the day with respiratory therapy until I could suction, do trach care, and problem solved the vents in my sleep. I also agree re: the trach....they seem to LOVE to come out at times...and calling 911 could be a death sentence for that pt...sometimes takes them a bit to get there, esp when you are the nurse who is there and would be expected to know what to do. There has to be someone to train you...I mean, afterall, someone trained the family member. It's not that it's hard or anything, but it can be very serious quickly...and you assuming that role says that you are prepared for any potential problems. You really need to seek further training ASAP or not take those pts.....Your license is just waiting to be jeopardized.

Kathryn

So where do you get thorough training since you have brought it up?

No, I've never put a trach tube in before. Her husband is trained to. Also, she has 3 Vent machines and lots of batteries. The machine readings are self explanatory. I've worked acute medicine, but never Vents basically no standand hospital nurse does unless you work in the Respiratory unit. I just do not like it, and if the trach comes out 911 will be called.

They do not train us like your suggesting and I've surf every company in three of the surrounding states that I know of in HH, and the traning is not thorough at any of them, it is just not. I've talked to the other LPN's, and RN's, and you learn most of what you know on the job by being there often. Tomorrow I will discuss this with the family all these question you brough up. I do not think there is a lot anyone can do if these problems do arise. You do you best with what you know.

Most home health agencies require that you have previous experience caring for that type of patient, such as in a LTC facility that takes care of vent patients, etc. If the family is always going to be there, then they do not necessarily need the care. The time is provided to them so they can get some free time. Even if there are three other machines there, what happens if you have issues with one and have to get the other one set up to use, who si going to be hand bagging this patient?

You can say as much as you want on the topic, but it is not safe...period. Your license is at stake, if you are wiling to take a chance at losing it, then go right ahead. All of us here said the same thing to you last time.

You say that there is not much that you can do, but that is where you are majorly wrong. You are being paid for your expertise to be there, especially if a problem arises. If the trach tube comes out, it needs to be replaced since that is their airway. Dialing 911 is not an adequate answer. You need to be able to bag the patient as well as suction them at the same time.

Same as with all of the peds patients that are at home on vents. The agencies that are reputable require at least two years of experience with taking care of vented children.

Are nurses really supposed to put the tube back in I am not talking about the inner canula, but the anchor canula? What about trauma and damage to the tissues, and airway more by the attempt? Isn't it better to manually ventilate with a bag and O2 at 100 percent and call 911? I mean in most nursing homes trach displaced Pts are sent to the ER, so I thought?

I think you are putting yourself at serious risk...not to mention, you level of service is not fair to the patient or the family. I know that you don't often run into vents in the hospital, but I worked on a vent unit at a rehab/ltc/brain injury facility....I know too there are usually LTAC's that take vents....maybe you could try to get some prn hours at a facility like this for the benefit of going through the orientation re: the vents. And even still, when I worked at that vent facility, I was still not thoroughly oriented to vents....I came in on my day off and spent the day with respiratory therapy until I could suction, do trach care, and problem solved the vents in my sleep. I also agree re: the trach....they seem to LOVE to come out at times...and calling 911 could be a death sentence for that pt...sometimes takes them a bit to get there, esp when you are the nurse who is there and would be expected to know what to do. There has to be someone to train you...I mean, afterall, someone trained the family member. It's not that it's hard or anything, but it can be very serious quickly...and you assuming that role says that you are prepared for any potential problems. You really need to seek further training ASAP or not take those pts.....Your license is just waiting to be jeopardized.

Kathryn

They actually slide back in quite quickly if you know what to do.

Nursing homes can do as they please, but if you are hired to be able to provide appropriate care to this patient, and you do not have the training, then you can lose your license. Simple as that.

You may not be able to manually ventilate if the trach collapses, so that is why the husband was even trained in being able to put the tube back in. They also get routinely changed, they are not left in permanently.

Children that go to school with trachs have additional trach tubes with them so that they can be replaced. The staff is aware that it can take too long for EMS to get there.

You are free to do as you want, but there is no way that I would jeapordize my license for something that I know nothing about. Once you lose your license, you will never work as a nurse again.

If you felt really comfortable with this, I don't think that you would be taking the time to post about it. These are the same exact issues that were brought up the last time.

So I gather you can do all these things yourself? I want to be safe and I worked cardiac telemetry so I know how to bag and I know how to suction. And just because a person is well train that doesn't mean they can accomplish this task either. Calling 911 is safe it is backup and I can't believe you said that, not acceptable answer. That is an emergency who is to say an experience nurse could get the trach back in it is just not accepted to believe just because your expertise or experienced your going to be perfect.

I think I am smart enough to know what to do in emergency. I value my license, yes and I do not want to lose it, so I will discuss this thoroughly tomorrow.

Your there to give nursing care to the best of your ability within your scope of practice. The family knows of my limited knowledge with Vents, but they want me there for supportive reasons. The husband will be there to help me out the first week as he has done with all the other nurses.

Thanks

Most home health agencies require that you have previous experience caring for that type of patient, such as in a LTC facility that takes care of vent patients, etc. If the family is always going to be there, then they do not necessarily need the care. The time is provided to them so they can get some free time. Even if there are three other machines there, what happens if you have issues with one and have to get the other one set up to use, who si going to be hand bagging this patient?

You can say as much as you want on the topic, but it is not safe...period. Your license is at stake, if you are wiling to take a chance at losing it, then go right ahead. All of us here said the same thing to you last time.

You say that there is not much that you can do, but that is where you are majorly wrong. You are being paid for your expertise to be there, especially if a problem arises. If the trach tube comes out, it needs to be replaced since that is their airway. Dialing 911 is not an adequate answer. You need to be able to bag the patient as well as suction them at the same time.

Same as with all of the peds patients that are at home on vents. The agencies that are reputable require at least two years of experience with taking care of vented children.

Specializes in Nephrology, Cardiology, ER, ICU.

My concern is that as the "home health nurse" you are to be considered the expert in the case of this home-vent patient. It is only acceptable to take this case with the appropriate orientation and comfort level. If you are truly in the home in a "supportive" role, then once the insurance source gets wind of this, they will be yanking home health care out of this home. Nurses are in this home to provide the expert level of vent care that this patient requires. I hope that your agency provides a thorough training period - having the spouse train you is not adequate at all. In a court of law what would your reply be if asked what training you had in order to make you able to care for this medically complex and fragile patient? Answering that the spouse taught me is not something I would want to say. Good luck - I hope that you are able to increase your comfort level.

Specializes in Vents, Telemetry, Home Care, Home infusion.

I'm sorry to sound harsh but am LIVID that you would ever consider accepting an assignment with patient care responsibilities that you know you do not possess!! :angryfire What about professional accountability here?

You potentially are jeopardizing this patients life along with your own license.

Any agency that KNOWINGLY places an LPN/RN without any trach or vent experience as a professional caregiver for a vent dependent client ought to be reported to the state and shut down.

Two hours orientation to a new private duty client is adequate if you are experienced in trach and vent care. What you are thing about doing is also committing insurance FRAUD for the insurance company is paying for NURSING CARE that this patient WILL NOT RECEIVE.

Now, how to receive vent/trach care.

a. Most vent DME companies will sent a Respiratory therapist to an agency to teach nurses ventilator care.

b. Research / look online for articles on "Care of the ventilator dependent client."

c. Call area hospitals/facilities with respiratory ICU or long term care hospitals (LTAC) to see if they have training courses.

d. Buy a book on Respiratory Nursing Care. After 1-2 weeks trach stoma is considered mature and RN's are quite capable of changing inner and outer cannulas.

e. After doing at least one of the above, request orientation with a preceptor so that you do hands on trach care, suctioning, ventilator circuit change and cleaning at least twice. Then you should spend a second shift as primary nurse with preceptor letting you do all the care and being support person.

If your agency won't provide this type of paid orientation, then either go on your own time to gain the experience to be a safe practitioner or refuse the assignment.

I worked with vent patients 5+years in the hospital then moved to homecare with many vent dependent clients so this type of nursing is near and dear to my heart.

Please reconsider this assignment.

Specializes in ER.
Calling 911 is safe it is backup and I can't believe you said that, not acceptable answer.

It's only safe if your client can hold his breath that long...I'll bet he can't.

You need a working knowledge of that vent, and a plan if it fails. You need a way to maintain an airway and ventilation should something go awry. Call the supplier and/or their respiratory care practitioner and ask for an inservice. For your sake and your patient's sake.

Accepting responsibility for a patient outside your experience level can be construed as unprofessional and worse. Failing to seek necessary info/support/education in order to adequately care for your patient could be construed as negligent and worse.

You're taking chances with your license IMHO...as others have warned as well. Take care.

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