LPN grad needs advice

LexiRN2 · Nov 20, 2011

Are you going to do visits or shift work?

wecan11 · Nov 20, 2011

I'll be doing visits, 4 hours x 2. 8 AM to 5 PM.

LexiRN2 · Nov 20, 2011

I used to work as an lpn in pediatric home health and personally its not an area that I prefer. I didn't like seeing sick kids first off. It just hurt me too much. But anyway, I would suggest being prepared to deal with parents that you will not always agree with, but make sure that you are able to separate your personal opinions from your professional judgment. Its very hard not to become attached with the child and family over time, but try not to cross the professional boundaries. Depending on the cases that you're on at times you may feel like a high paid babysitter, not every child is going to be on a vent or have some terrible condition. A big part of home health nursing is teaching! Be ready to assess the family's learning needs and teach them everything that they may need to know. Oh and also, trust is a big factor when you're suddenly working in someone's home. You may feel that the family is watching you or following you around at first but don't take it personal, they are only trying to protect their territory. And if you feel very uncomfortable on a case, NEVER be afraid to ask your agency to send you to another home.

NurseLoveJoy88, ASN, RN · Nov 20, 2011

I agree with the above poster. Pediatric home health is one of those specialties where you are going to either love it or hate it. I did shift work and hated it. I was surprised because I really love children but it became depressing to me after a while dealing with sick children. Another thing is that not every child has an intellectual deficit or is on a vent so there may be times when you are basically a babysitter. I had one case where all I did was play with legos and video games the WHOLE shift, needless to say I didn't last long. Then you have to deal with not so nice parents at times. Some parents may want to cut deals with the time schedule so be prepared to stand your ground: i.e. they may say" if you stay late you can come in at a later time on your next shift and still write down the time your would normally come in" My usual response was " no" this is fraud". Good luck and keep us posted.

keencrow · Nov 20, 2011

Hello!

I would think working in a pediatric office would be most beneficial for you, especially as you have only been nursing a number of months. This type of job would expose you to various pediatric and general medical issues, giving you tremendous confidence in the home nursing arena if you wanted to do that in the future. I think you'd probably like the pace and variety of office nursing -- but that's just my opinion!

Best of Luck! :)

linda1212 · Nov 20, 2011

Hi ,

I have worked in peds home care four years now and love it. The best advice I can give is to know your patient.It is true that not all patients are trached or on vents,and if not,they are pretty easy cases. The ones who do have trachs and/or vents can keep you busy, and keep in mind when you are doing home care with these patients you are the hands on for all resp care there is no RT to come and fix the vent at moments notice , you have to call and wait till they drive to the home. Also I agree with the above posters,parents will watch you untill they feel that their child is safe in your hands. Hope that helps and good luck,

I hope you love it as much as I do.

SDALPN · Nov 20, 2011

Sounds like you are talking about private duty nursing, not home health. Its quite simple. Do what the parent asks without crossing boundaries or breaking laws. The kids are easy. The parents are what make or break you. Its all about personality, not how good of a nurse you are...in most cases. If a parent doesn't like your personality, they won't care that you are a good nurse. You can say the wrong thing (even if its the right thing) and they can send you out. Hours are hard to get and maintain. If you get a good case (expect roach infested homes , bad areas, etc.), stick with it. Can you afford to miss a week of work because your patient goes in the hospital and the agency doesn't have more work for you? I've coded a few kids in the 6 years I've been doing it. Be prepared for things to go wrong and go wrong fast. Kids crash faster. Be prepared to code a child without assistance or a code team. Parents manipulate and even play nurse against nurse. You won't know they are doing it until its too late.

I honestly don't think in a few months that you are ready for PDN. It takes lots of assessment skills and experience. Usually agencies require a year of experience before hiring a nurse for PDN. Do you know what to do when the patient runs out of HME's 2 weeks before the next supplies are due? You aren't going to call the supply company unless you enjoy getting chewed out!! What about if the last trach gets coughed out and lands in the trash where you just put a nasty diaper? How about if the Mic-Key button completely falls apart and you have none left? (I've had this happen before they were recalled) The agency can't and won't train you for every possible scenario. You have to work with what you have. What if you run out of trach ties? Do you know how to use a "shoelace" tie? When this type of thing happens, usually the parents are at work and you are alone. Don't forget that families like using nanny cams, so this could be caught on tape and used against you if you make a mistake.

You can read more about PDN under the specialty tab.

LexiRN2 · Nov 21, 2011

SDALPN is right about a lot of that, but most agencies will not send nurses new to home health to the hardest cases. She'll more than likely be sent to an "easier" case to start out and make sure that she's ready to handle the tougher kids. Very true about parents manipulating nurses and playing them against eachother though!

wecan11 · Nov 21, 2011

Sounds like you are talking about private duty nursing, not home health. Its quite simple. Do what the parent asks without crossing boundaries or breaking laws. The kids are easy. The parents are what make or break you. Its all about personality, not how good of a nurse you are...in most cases. If a parent doesn't like your personality, they won't care that you are a good nurse. You can say the wrong thing (even if its the right thing) and they can send you out. Hours are hard to get and maintain. If you get a good case (expect roach infested homes , bad areas, etc.), stick with it. Can you afford to miss a week of work because your patient goes in the hospital and the agency doesn't have more work for you? I've coded a few kids in the 6 years I've been doing it. Be prepared for things to go wrong and go wrong fast. Kids crash faster. Be prepared to code a child without assistance or a code team. Parents manipulate and even play nurse against nurse. You won't know they are doing it until its too late.
I honestly don't think in a few months that you are ready for PDN. It takes lots of assessment skills and experience. Usually agencies require a year of experience before hiring a nurse for PDN. Do you know what to do when the patient runs out of HME's 2 weeks before the next supplies are due? You aren't going to call the supply company unless you enjoy getting chewed out!! What about if the last trach gets coughed out and lands in the trash where you just put a nasty diaper? How about if the Mic-Key button completely falls apart and you have none left? (I've had this happen before they were recalled) The agency can't and won't train you for every possible scenario. You have to work with what you have. What if you run out of trach ties? Do you know how to use a "shoelace" tie? When this type of thing happens, usually the parents are at work and you are alone. Don't forget that families like using nanny cams, so this could be caught on tape and used against you if you make a mistake.
You can read more about PDN under the specialty tab.

Thank you for the good advice!! Ive been reviewing my Pediatric's textbook, reputable YouTube video's on NG tube cleaning/changes, G tube changes and assessment procedures. I start training Tuesday. What else should I be reviewing?

What are HME's ?

Thank You..

:)

SDALPN · Nov 21, 2011

NG tubes are kinda rare in PDN. HME's connect to the trach to warm/filter/humidify the air. Some people call them a "nose" or T-vent. Nobody is going to tell you what to do if you run out. But at some point it will happen. Sure, you can use the humidifier in place of it. But what if you run out of sterile H2O for inhalation? Then what? My point about all of that is that you probably aren't ready to do PDN.

They probably will send you to an easier case to start out. But that doesn't mean it won't be a roach infested drug house. I've had the SWAT team barge in to homes I've worked in twice!! One was on a vent case, another on a "basic peds" case. Just because its an "easy case" doesn't mean bad things won't happen.

There is a culture to PDN. If you don't follow the unsaid rules, it can get ugly for you real quick. Some of the unsaid rules are standard case to case. Others are case specific. If I come in behind a new nurse and see things wrong, I'm going to leave a nice note (don't expect this from all nurses, some won't be so nice). If it isn't corrected and it will cause harm the supervisor will be notified next.

If you still really want to do this, keep reading in this forum. There is all kinds of info on here. Read the horror stories. And CYA!!!

I had a parent just tonight tell me I wasn't supposed to give meds that were due at the end of my shift. I explained to her that we have an hr before and after and that typically the meds that are due at the time we are clocking out are given just prior to leaving. And that if she wanted to give the meds, she could. The parents don't know/understand the laws. Even after explaining, some don't care. This same parent forgot to pick up meds tonight. Any other agency I've been with would just say document why a dose was missed and that the parent is aware. The agency I'm with now says to call them and the Dr. to inform them and also make sure the parent is informed and that its documented or they will write us up for a med error...even though its not our fault that the med wasn't there. Its silly....documentation is all thats really necessary and one missed dose of the med that was almost out wouldn't harm the pt. They won't tell you this in orientation....but when it happens, they will be quick to write you up.

Oh yeah, you will also be expected to take care of the medical equipment. The equip. company will maintain it, but you must take care of it. You must know how often a filter gets changed or cleaned. And how to troubleshoot before calling the equip company so they don't chew you out. If you screw up there, the equipment company will call your agency and inform them. You won't know until your boss calls you.

Care plans/485's....they are your nursing Bible. But beware, your supervisor can screw that up and still make it your fault.

LexiRN2 · Nov 23, 2011

wecan11- I think you'll be fine! Everyone has their own opinions and experiences and it will be a great learning opportunity for you! At worst, if you don't like it you can always just find another job in a different area. That's the wonderful part of nursing, there's a ton of different areas/specialties that you can try! Good luck!