New grad advice

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Hello AN,

Here is my situation. I graduated in May 2014. Was hired on the spot for a private home health angency. There were many things that stuck out to me and would have made any nurse run out the door. Since I'm here humbling seeking your advice I will let you in on as much detail as possible.

As the so called hiring process commenced, I found out the thr owner of said agency is also the owner of a night club... wierd... I thought but as I am eager to get started I decided to continue on. Later I find out the said owner... married...also sleeps around with his staff... grossed out by this I still continued.

The above mentioned are just so you can get a feel of the environment.

Here are my true issues and why I am contemplating on seeking other options. I probably got 1 week of "orientation". The nurse manager went out on visits with me three days. I feel totally unprepared. I let the nurse manager know that I need more training. I am alone and do not know what I'm doing. She tells me she can't because she has others to train.

I get hounded about documentation. If any of you know oasis then yoi understand me when, as a new nurse, it's not uncommon to take ones time in dcumenting and how easy you can fall behind. Documentation is another issue, I'm not properly trained to do this, I've also seeked out help but got the same response.

I know that as a new grad I should be thankful to have employement. Trust me I am, that's why I am still around. At the same time, i fear loosing my license because my nurse manager tells me to boil a catheter and reuse it (i did not do that by the way), or I go to patients house for medication management but I have no idea the medications he's taking. It's hard for me to take the time and look up meditations because they give patients that i have to see right now. .. asap.

Also I was hired for mon-fri schedule, so far I have to request sat and sun off because they keep placing patients on mt schedule.

I live with my husband and he is supportive of the idead of me looking for other options. At this point I rather focus my efforts in looking else were, seeing that this job is giving me high anxiety and literally making me sick to my stomach.

Please let me know your thoughts...

Thank you

The minute you start fearing for your license is the minute you need to get out.

Home health is scary enough as a new grad, if they are willing to hire you, they should at least give you a proper orientation.

I know how it is being a new grad trying to find work, but, I don't believe this is the answer. Use this experience on your resume if you feel comfortable and try to find a new position.

I personally would rather be back on the hunt for a job than to go to work fearing for my license everyday, or worse, provide unsafe care for my patients. I am sorry that you are in this unfortunate situation but I feel that there are many red flags and I would get out as soon as you can. you worked hard for your license, protect it. Best wishes.

Specializes in Pediatrics, Emergency, Trauma.

Just FYI, catheters are boiled in home health, due to some insurance requirements for the pts; it does no good throwing out supplies and leaving the pt short of required supplies; best to know and contact the insurance company as well as the supply company to be clear as of what the pt is allotted under their insurance in terms of supplies.

Now, on to the other issues:

-what the owner does to his office staff is really non essential, as long as the owner is not making sexual passes at you.

-this is the MAIN issue to me: you need more training; understanding OASIS and CMS and insurance regulations are a HUGE part in HH; what the nurse manager explained to you is total BS; it's a total "sink or swim" mentality, and that alone is a red flag for you to either look for a position outside HH, or align yourself with a company that provides extensive training-there are plenty out there that do so.

Best wishes.

Just FYI, catheters are boiled in home health, due to some insurance requirements for the pts; it does no good throwing out supplies and leaving the pt short of required supplies; best to know and contact the insurance company as well as the supply company to be clear as of what the pt is allotted under their insurance in terms of supplies.

Learned something new. Thanks for the FYI.

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

Yes many items single use and sterile technique, (such as enteral feed bags , syringes , catheters and more) in a hospital or other facility are clean technique and reused in the home environment. Check with DME if need cleaning instructions ( some catheters will degrade with boiling, for example, so washing with boiling hot water (as opposed to putting in a pot and soaking/boiling) the item.

It freaks some nurses out when transitioning to the home environment when they find out that many items must be reused.

These three nurses who responded to already are correct about not putting your license in danger! I didn't know about boiling a catheter either-that's kind of nasty, but I guess if it is typical there is no fighting it.

The reason I decided to add my 2 cents is that I was also hired as a new grad in home health (private duty nursing in peds) and I only lasted 4 shifts.

The agency that hired me appeared to be a good agency. I didn't have reason to question the things you did. No sexual harassment and certainly no night club. It is a national agency that is recently operational in my area. My first shift was precepted, the nurse that was with me taught me quite a bit, but no where near what I needed to know. The second shift, she met me at the home, told me I did so well the previous night that I could be left alone and she left! This was a high acuity vented non-ambulatory toddler with a list of comorbidities as long as your arm.

When I expressed concern about being left alone without more training I was told to call her if I had any issues and that I would be "fine". In the middle of the night, the kid pulls out his PEG and I had no idea the procedure for replacing it. Called the nurse, she was obviously unhappy about being woken up and told me to wing it. Really? I managed but I felt like I was drowning. Next shift, the child is agitated, all vitals stable, but he was in obvious distress. No one to call, so I tried nurse nappytime and again was given no direction. Last shift, the family had run out of saline bullets to suction the trach and I was told to use tap water in a syringe. Puh-lese! There was no way I was going to do that, called the agency and was told that if there were no bullets I had no choice but to suction without. No there was no night time delivery service to get some to me. A respiratory therapist friend of mine brought me some and when my morning relief arrived I was done.

New grads are not cut out to work on high acuity patients alone in my opinion. We need the sort of team that is to be found in a facility in order to care safely for our patients. With more orientation (and a better supply chain) it is possible, but my advise is if you can't get the training, get out of there while your license is still unblemished!!

Thanks guys. I spoke with my nurse manager today. I explained to her how I felt. I told her that I do not feel fit for this position and it is not her fault because she has to train others. Also told her that I definitely like HH and it is the place where I want to be but I need to be able to seek out assistance when needed. She completely understood. I feel horrible because I enjoy the actual nursing aspect that entails HH, but my health comes first, then my license.

Just FYI, catheters are boiled in home health, due to some insurance requirements for the pts; it does no good throwing out supplies and leaving the pt short of required supplies; best to know and contact the insurance company as well as the supply company to be clear as of what the pt is allotted under their insurance in terms of supplies.

Now, on to the other issues:

-what the owner does to his office staff is really non essential, as long as the owner is not making sexual passes at you.

-this is the MAIN issue to me: you need more training; understanding OASIS and CMS and insurance regulations are a HUGE part in HH; what the nurse manager explained to you is total BS; it's a total "sink or swim" mentality, and that alone is a red flag for you to either look for a position outside HH, or align yourself with a company that provides extensive training-there are plenty out there that do so.

Best wishes.

Hello Lady free,

I agree, non essential. But it's just a bit disconcerting when you're known to work for "that guy that slept with so and so". I know, I know, non essential… I am part of the company and I represent his name. His actions makes his agency look bad and that includes the staff.

Thank you for the FYI about catheters being boiled. I had no idea that this was common.

I bet that with more experience HH would be a good fit for me. There is another nurse that started around the same time as I did… I can see the difference in clinical decision making.

I applied to another HH and they called me back and said that because of my employment background they wanted to but they would not be able to hire me because of my lack of experience. In retrospect, it completely makes sense.

Thank you for your input.

Specializes in Hematology/Oncology.
Yes many items single use and sterile technique, (such as enteral feed bags , syringes , catheters and more) in a hospital or other facility are clean technique and reused in the home environment. Check with DME if need cleaning instructions ( some catheters will degrade with boiling, for example, so washing with boiling hot water (as opposed to putting in a pot and soaking/boiling) the item.

It freaks some nurses out when transitioning to the home environment when they find out that many items must be reused.

Yea. Trach cleaning with soap and water.

Specializes in Pediatrics, Emergency, Trauma.
Hello Lady free,

I agree, non essential. But it's just a bit disconcerting when you're known to work for "that guy that slept with so and so". I know, I know, non essential... I am part of the company and I represent his name. His actions makes his agency look bad and that includes the staff.

Sorry, but no, you represent your license and your practice; most people who are your clients would NOT know what the owners are doing, most want a competent nurse; THAT is what represents the agency. :yes:

Thank you for the FYI about catheters being boiled. I had no idea that this was common.

I bet that with more experience HH would be a good fit for me. There is another nurse that started around the same time as I did... I can see the difference in clinical decision making.

I applied to another HH and they called me back and said that because of my employment background they wanted to but they would not be able to hire me because of my lack of experience. In retrospect, it completely makes sense.

Thank you for your input.

Find another agency; start out in PDN and then work up to visits; I didn't do visits until I had several years under my belt. :yes:

Hello Lady free,

I agree, non essential. But it's just a bit disconcerting when you're known to work for "that guy that slept with so and so". I know, I know, non essential… I am part of the company and I represent his name. His actions makes his agency look bad and that includes the staff.

I understand both sides here but personally I feel similarly to the OP. I wouldn't want to work for some shady, underbelly company. In the OP's situation, I would feel like, although I wasn't directly involved in the owner's scandals, I was somehow condoning it by ignoring it and continuing to represent his company. Even companies acknowledge that their employees are a reflection of them....this is why they don't want to find out you were chain-smoking while drinking yourself to the point of falling off your bar stool or see your picture in the local paper after a DUI or police chase......all while wearing your hospital uniform. They may be a great company and you (generally speaking) may be a crappy person....it doesn't matter because the bar patrons and newspaper readers are going to associate that person's behavior with that hospital. It goes both ways.

Word (gossip) travels fast and it's really a lot smaller world than we realize. Everyone knows someone who knows someone. I would feel like my potential patients (if they were aware of the company/owner reputation) would have a bias against me from the beginning. I want to be proud of the company I work for. I don't want to have to mumble my place of employment when asked because I feel ashamed of being (even indirectly) a part of it. "You are who you hang with" is kind of the mentality.

Actually, the system I work for was in the major news at one time for (I'm trying to be very vague here) a situation that I know puts our patients on guard (based on comments read in the media). Although I personally was in no way, shape or form involved with the issue, or even know who was, the patients come in and are distrustful and on edge with all staff. They don't care who it is.....to them, we all represent the company and it's values. We aren't given the opportunity to reassure the patient that we aren't involved or that we hold ourselves to a higher standard, because bad-mouthing your employer is never condoned.

Although it takes years to build a good reputation, it can take just one incident to destroy it. The general public is much more eager and willing to voice their complaints than to give praise. Think about it....for every "good job" we get, we also get fifty gripes. People love to complain, spread it around and ignite others to do the same.

Specializes in Pediatrics, Emergency, Trauma.

We'll have to agree to disagree.

I found that MY character transcends where I work, and I'm sure I have worked for some dicey places, and if the public never had the brass to state how they felt about the place I worked, either a) I transcended the "reputation" of the company or b) they never had the backbone to say anything to me, which I don't take stock in people who do that. :no:

I also don't take stock in people who have a halo of negativity enough that they complain about anything and everything; they have a right to do so, and I still have my own integrity that is intact and intentions that are always for the best; I don't have to "prove" anything to anyone-my example has done enough for me; the "thank yous" are only an extension to the things I already do.

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