worries about home care

Specialties Home Health

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I am a new grad nurse with no clinical experience besides school, and after 3 months of looking for a job, I finally got a job offer in home care private duty. Although I am excited to have a job, I have a lot of nerves. They have given classes on vent and trach, and I will be orienting for a minimum of 4 days and a maximum of 10 days. I will be orienting on a case with a vent, trach, and g-tube.

I guess I am just wondering if 4-10 days is enough to feel comfortable. If worse comes to worse I guess I can always ask for a more simple case.

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Specializes in Complex pedi to LTC/SA & now a manager.

Ask for a simple case. Inexperienced new grads have no business being thrown on a trach/vent case after 4 days of in service training. I can only guess which private duty agency did this to you. New grads don't belong in skilled home health or private duty (shift work with cases in the home or school with a medically complex child or adult). I've had to send a new grad home on a case because she wanted to pull a newly discharged infant's NGT because she wanted to see if she could reinsert it, clearly classroom training was insufficient. (To be fair this new grad clearly had issues as she attempted to ascertain temperature, heart rate, respiratory rate, lung and bowel sounds from 3 feet away without touching the child)

With adequate orientation and direct extended preceptorship (my company is a minimum of 6 months in formal orientation (classroom, lab, observation/shadowing) After a month or two the new grad can do 8-10 8hr shifts along side a qualified nurse preceptor and work a case. It's always a basic (GT, maybe mild respiratory, seizure precautions). Trach vent is a minimum 6-12 months with the company before considered for the training program.

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I too started private duty nursing right out of school. Your 1st nursing job is always scary but you'll be okay. You will learn as you go. I'm assuming they wouldn't give you a vent case in the beginning but trach care, tube feedings, etc. is super easy. You got this. You'll be surprised at how much you'll learn as you go.

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Ask for a simple case. Inexperienced new grads have no business being thrown on a trach/vent case after 4 days of in service training. I can only guess which private duty agency did this to you. New grads don't belong in skilled home health or private duty (shift work with cases in the home or school with a medically complex child or adult). I've had to send a new grad home on a case because she wanted to pull a newly discharged infant's NGT because she wanted to see if she could reinsert it, clearly classroom training was insufficient. (To be fair this new grad clearly had issues as she attempted to ascertain temperature, heart rate, respiratory rate, lung and bowel sounds from 3 feet away without touching the child)

With adequate orientation and direct extended preceptorship (my company is a minimum of 6 months in formal orientation (classroom, lab, observation/shadowing) After a month or two the new grad can do 8-10 8hr shifts along side a qualified nurse preceptor and work a case. It's always a basic (GT, maybe mild respiratory, seizure precautions). Trach vent is a minimum 6-12 months with the company before considered for the training program.

Thank you for your advice. I will go on orientation, see how it goes and let the DON know how I feel. I do agree with you 100%.

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I too started private duty nursing right out of school. Your 1st nursing job is always scary but you'll be okay. You will learn as you go. I'm assuming they wouldn't give you a vent case in the beginning but trach care, tube feedings, etc. is super easy. You got this. You'll be surprised at how much you'll learn as you go.

Thank you for your words of encouragement. They plan to give me the case I am orienting on with the vent. I guess it is the vent that worries me the most especially since it is a pediatric client.

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Specializes in Complex pedi to LTC/SA & now a manager.
Thank you for your words of encouragement. They plan to give me the case I am orienting on with the vent. I guess it is the vent that worries me the most especially since it is a pediatric client.

Don't do it. A child's life is at stake. There is so much you don't know it isn't even funny

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Specializes in Pediatrics, Emergency, Trauma.
Don't do it. A child's life is at stake. There is so much you don't know it isn't even funny

Agreed.

Advocate for yourself and DO NOT take a trach case as your first case-you need to get comfortable with taking care of "stable" kids before you go on to a complex trach case.

And even then, and "stable" kid can crump and become ill; you need to ask yourself would you know what to do in those cases...don't let it be when the child's condition is changing where you are forced to answer that question-go with your gut on this.

Best wishes.

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Specializes in Complex pedi to LTC/SA & now a manager.

Just remember children compensate until they don't. My "stable" trach elementary kids have both decannulated (pulled out trach tube) one ripped of clothing with Velcro that stuck to the ties. The other happened to hyperextend neck and coughed expelling the trach).

Would you be comfortable doing an emergency airway replacement on your own?

What if you don't hear harsh sounds but SpO2 is dropping, go to suction and can't?

Do you know & feel comfortable clearing a mucus plug and possibly doing an emergency trach replacement wherever you are?

Do you know the emergency trach replacement protocol?

What you can use if the correct or downsized trach don't pass?

How to ventilate if you can't place a trach?

When to call 911 vs physician vs clinical manager?

I watched a new grad with a non-verbal, non trach respiratory kiddo struggle and ineffectively & inefficiently suction. (Can't interfere with another agency nurse) and for the second time in less than a week watch the poor kid be wheeled out of class via EMS. She still doesn't know where she went wrong and what was inefficient with her technique. It's a bad situation that next time the kid just might plug his airway so bad kiddo needs an emergency tracheostomy. She has no idea what she doesn't know, I can tell by the questions she asks me about basic care.

Advocate for yourself and your client. DO NOT accept a trach-vent medically complex child as your first client. Request a basic case to get your feet wet

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So I decided not to take the case. I'm already so worried being a new nurse I don't want other worries on top of that especially since I have no experience with anything. Thank you everyone for your advice.

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Specializes in Complex pedi to LTC/SA & now a manager.
So I decided not to take the case. I'm already so worried being a new nurse I don't want other worries on top of that especially since I have no experience with anything. Thank you everyone for your advice.

Good for you. You need to develop your skills and "spidey senses". Have you looked at new grad residency programs? You said you are RN/BSN.

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Thank you the DON was very understanding. Yes, I am RN BSN. I will apply for a ED residency program next month hope all goes well. ^_^

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Specializes in General Surgery Assist.

This sounds exactly like me except I had 3 days office orientation and NO in home training. Its been extraordinarily frustrating to me and im looking for other jobs. Also Ive been at this job for 3 months now and I've had issues with my clinical manager as well. Good luck to you, hopefully It goes better for you than it did me.

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