Advice needed for PD LPN

[Oldfashion]

Tl;dr: Am a new grad LPN in pediatric HC 6 months. I wanted to leave the job, but before I was able to get another job, current family "fires me." Should I retrain while I job hunt, or leave now as the job is not a financial necessity. I also am in BSN program and am in a "tough" semester.

Background:

I started PDN six months ago, and have been with one pediatric patient for the entire time. The family I was with was generally very kind, but the family member always at home was a bit overbearing and had some anger issues, we had a slight personality mismatch.

I shot myself in the foot by going above and beyond in the beginning, and there came to be an expectation of doing a lot of work in the house. I was beginning to become burnt out, and had issues with the overbearing family member. In the end, we rarely chitchatted and it could be awkward for 12 hours!

It came to a head when the angry family member asked me to administer a treatment I was not comfortable with. I advised against it, he gave a rationale, and against my better judgement gave it. It doesn't work, and family member flips. We discuss it, they blame me, and I inform the office after the shift. The office feels I am not in the wrong and just say to not let it bother me.

However, the family request that I no longer come, and the office wants me to train with another family. They caught me just before the weekend, and I told them I'd get back to them.

In reality, I'd prefer to leave PDN field, as I'm uncomfortable with all the random requests that go against medical advice. This was not the first time, and I should've refused or request they perform the treatment as I had before.

Dilemma:

I am currently in a BSN program and had already wanted to quit, but felt I "needed" the experience. I am unsure if my dissatisfaction and being uncomfortable with parents requesting/demanding radical and often unsafe changes to medications and treatments is going to change with a new family.

Pro stay:

-I won't leave on a negative note. The family blamed me for the incident, though the office did not think it was one and required no report. They think the FM has issues, but who knows if this is lip service.

-Continued employment looks better during job hunt.

- Job pays well. We do not need it, but even one short shift a week provides over $600 extra a month.

-Shows I can tough it out. This is perhaps just my pride speaking.

con stay:

-I may go insane, as I felt stressed with all the changes and requests.

-I'm in a tough semester that several students often drop out of. This gives me less time, and I'll be training between exams and clinical days.

-This may impact my job search in a big way. Should I even put this job as a reference if I leave now on a sour note?

Pro quit

-I can focus on school. I personally know two who have flunked out of this semester, and one student who came back after being unable to complete the course the prior semester had to drop.

- I can focus on finding a job I do not feel uncomfortable with. I don't mind the hard work and lack of support, just the demands that jeopardize my license if an adverse outcome were to happen.

Con-quit: Everything in the pro-stay

My husband thinks I should quit, as he sees how unhappy I am there. But, I wanted to get some advice from some seasoned pros. My only big regret, other than quitting sooner once I was absolutely miserable in the job, was not coming to this board sooner and reading all the stories.

I'm mostly concerned how quitting will impact my future employment prospects. It seems like a lot of the seasoned home PDN's here have switched agencies and gone to other sectors of nursing. Did you stick it out till you got a new job, or quit and find something better?

Thanks in advance.

[mluvsgnc]

SDALPN-

Thanks for being cool and not getting offended- it's nice to have a mature conversation where opinions differ and it's ok.

Since this is my first case, I have nothing to compare it to. Perhaps I am lucky that the client has strong family support and is fairly stable; from what I've read it could certainly be a lot worse!

Airway management and pain management are the top priorities for my pt. Lately he's tried to decannulate several times, and I have the spare trach set ready, reviewing the process and steps to take in my mind. I hope it never happens, but feel I know what to do if it does. As for his pain (r/t TGN), we are still trying to figure out how to best manage it. He is non-verbal so it is challenging; however, I have figure out some massage techniques that bring some relief and comfort to him, which I employ, and have taught the family and his aide at school these techniques (I am also a licensed massage practitioner for 15 years).

I had 24 hours of training with the option for more if I desired, and the agency is good at setting boundaries (at least with the family I work for and from what I've heard from other nurses), so again, perhaps I lucked out (?). My initial issue was the generality of the statement that new grads shouldn't do or don't belong in PDN- perhaps the view could be changed to "new grads need adequate training and agency support if they are going to be successful in PDN." But this is true of any setting. Again, ok to agree to disagree. :)

Thank you to other posters for offering perspective. I took it personally at first, but I no longer do.

[JustBeachyNurse, LPN]

Be careful training school personnel/aides as this may not be consistent with agency policy or even school policy. Also ensure teaching massage is within your scope as you are working as a nurse not an LMT. It's likely ok to teach family but might be overstepping to teach school personnel. Protect yourself, it's clear you have good intentions.

[mluvsgnc]

Good advice- thank you.

[SDALPN]

Be careful training school personnel/aides as this may not be consistent with agency policy or even school policy. Also ensure teaching massage is within your scope as you are working as a nurse not an LMT. It's likely ok to teach family but might be overstepping to teach school personnel. Protect yourself it's clear you have good intentions.[/quote']

I was thinking the same thing. The agency hasn't insured themselves for you to do massage. If something were to happen (i know, I know...odds are slim), the agency would be in trouble and they would come after you. But, great skill to have!

[SDALPN]

SDALPN-

Thanks for being cool and not getting offended- it's nice to have a mature conversation where opinions differ and it's ok.

Since this is my first case, I have nothing to compare it to. Perhaps I am lucky that the client has strong family support and is fairly stable; from what I've read it could certainly be a lot worse!

Airway management and pain management are the top priorities for my pt. Lately he's tried to decannulate several times, and I have the spare trach set ready, reviewing the process and steps to take in my mind. I hope it never happens, but feel I know what to do if it does. As for his pain (r/t TGN), we are still trying to figure out how to best manage it. He is non-verbal so it is challenging; however, I have figure out some massage techniques that bring some relief and comfort to him, which I employ, and have taught the family and his aide at school these techniques (I am also a licensed massage practitioner for 15 years).

I had 24 hours of training with the option for more if I desired, and the agency is good at setting boundaries (at least with the family I work for and from what I've heard from other nurses), so again, perhaps I lucked out (?). My initial issue was the generality of the statement that new grads shouldn't do or don't belong in PDN- perhaps the view could be changed to "new grads need adequate training and agency support if they are going to be successful in PDN." But this is true of any setting. Again, ok to agree to disagree. :)

Thank you to other posters for offering perspective. I took it personally at first, but I no longer do.

I never mean harm to anyone, just saying it like it is. I don't want to see a new nurse lose a license when they mean well. And I don't want to see a child harmed by the well meaning nurse. Unfortunately, even many hours of training is no substitute for experience. I wish I could explain it better. Nobody thinks bad things will happen to them, but it does and you need to be able to handle it when it does. You may be one of the lucky ones or you may be a very talented/knowledgeable and street smart nurse that can handle any situation without experience. I happen to be the nurse that if something will go wrong, it will happen on my shift. I guess it's another reason why I think the way I do. I've had vents stop working, sxn stop working, kids crash, etc all on my shift due to no fault of anyone. I've had parents cause their child harm and leave me to deal with it. I've been at work when the swat team came in with tear gas/pepper spray and a vent/trach kid (they don't teach that in school). That experience has made me the nurse I am. But it gives me a different view of things too.

[mluvsgnc]

I agree 100% that training does not make up for experience (esp. since your training is only as good as the person who trained you!). You have been in some scary situations, which at the time sucked, but make you a better, more well-rounded nurse (as you know). Thanks for sharing some of your experiences, and for your perspective.

[Alex Egan, LPN, EMT-B]

I think if carefully done...with just the right person, new grads can be successful in PDN. It is a project, and commitment for both the nurse and the agency. However a lot of agencies are in business to be in business, and as many have stated, will often throw nurses wherever they need. New grads are very vulnerable to this because they don't know what they don't know. A word of advice to new grads remember experience is the toughest teacher, because it gives the test first and then the lesson. When your tested in a facility there are other nurses and supervisors to catch you. In PDN your working without a net a lot of the time.