I am a new grad LVN, got my license a couple months ago, and yeah- the job market is dry out there. But I answered a Craigslist ad looking for an on-call LVN for a pediatric home care position, and got an interview, which was with the mom. Although she has agency nurses, she also hires extra private duty nurses that are paid for through a trust. She didn't hire me at first but told me I was next in line. Then a couple weeks later she called saying she needed a fill-in and asked if I could come in and train for an overnight shift, and then work the next overnight shift on my own (she would be home, but I'd be the only LVN).
I was SOOOOO excited. But as the night when on I got pretty concerned. I didn't have access to the chart and all med and treatment orders and feedings were on printed paper in the kitchen in list form (not actually the Dr. order or care plan from the RN). The med bottles had the Rx info on them, but there were things that were not clearly prescribed (supplements, herbals, etc). There are also several resp. treatments, and there is a g-tube . The child is stable, not on vent or anything, but still- I didn't feel comfortable doing anything that was only being relayed to me through the typed up lists, another LVN and the mom. I have to be working under the direction of an RN or MD right? I at least wanted to be able to look up certain things.
Also, the LVN that trained me relayed to me that they break up some of the pills into smaller amounts than they are scored or prescribed. Also, she set up all the meds for the whole night at the beginning of the shift, in 30ml cups on the counter. There were other things she mentioned that were "gray area" in her words. I didn't want to be some hypervigilant know-it-all, so I didn't say much, but I was thinking to myself, OMG this is my first job, I don't want to lose my license before I even get started. The whole place is on camera, too. She suggested making sure I was aware where the cameras are placed when administering the off-doses and things like melatonin (so Im guessing that one is not prescribed by the doc.....)
I know that most likely, nothing would ever happen if I gave him a vitamin that wasn't prescribed, but it just doesnt feel right. So I let the mom know that I could not do any procedures or meds without a Dr order, but Id be happy to be there as an overnight caregiver if she needed the shift filled. She declined, because she said that he needed so many meds throughout the night, she would have to get up anyway. She also stated that no other nurse had ever asked to see Dr.'s orders, and she felt that I was ill-informed. Of course, some of her nurses are through the agency, so they have access to the chart.
Did I do the right thing by acting within my scope of practice, or did I get too skiddish and blow a great opportunity get started as an LVN??? Should I have just shown up for the shift, and then just laid it out for the mom (ex. "Ok i/ll give these meds, but only the time/amount on the bottle, not the differing amounts on the typed up list. and I cant give the suppositories or herbals unless I can read a dr order for those, maybe its in the chart, would you like me to look it up", etc)
Maybe in a way the LVN scared me off by mentioning things like the mom threatening to write to the board about people, and trying to convince the nurse to give some things by mouth even though he is NPO (according to the nurse, since I never saw the chart). I guess it made me feel like I might as well let her know before coming in, because she may really not want anyone who isnt going to do it "the way its done there" type thing. So, the end result is that I did not go in for the night, and she did let me know that she was not able to get the shift covered with only about 8 hours notice. I do feel horrible about that- but at the same time, if you are hiring a brand new nurse with one day of training, doesn't it behoove you to have a back up nurse in case it doesnt work out? what if she didnt like me? And, the reason i had been called in the first place was because she couldnt get that night covered with the 5-6 nurses she already has on staff. So I feel bad about that part but not guilty about it.
Opinions?? Suggestions on how I could have handled things differently? Similar experiences??? I welcome your input.
I am so sad that I had to turn this job down
May 23, '12
you need to protect yourself legally first and foremost. the parent who called you ill-informed is probably not an expert on the subject herself. maybe she's used to nurses who take huge risks on a regular basis so she thinks that's normal.
when we work in this area, it's true that the type of rules you see in hospitals are bent to a certain extent in home care and that we should be flexible about such things as throwing away everything you use after one use when they have a very limited amount of supplies as backup. this was told to me by the director of nursing at my first agency during orientation.
i was interested to see what i could find in the bvnpt archives and found this booklet, which is really guidelines for the consumer, including what the lvn is and isn't allowed to do, and what he or she needs in order to practice safely and within the bounds of our scope. a helpful bit of info from it's contents is:
[color=#696969]6. remember that the lvn or pt must
receive client care orders from your
my other suggestion would be to do a search of the allnurses site for this as i know it has come up many times. it won't be entirely applicable to your situation, but again should head you in the right direction. best wishes and never let someone talk you into doing something you have serious doubts about! believe me they will try!
Last edit by nursel56 on May 23, '12
: Reason: add excerpt