How much orientation should I expect to receive in private duty nursing?

mluvsgnc · Jun 26, 2014

I went into PDN as a new LPN (but almost RN) grad, on a ped pt. with a trach, GT, who is also deaf, half blind and non-verbal. "Stable," but a lot going on. I trained three 8 hour shifts, with the option to do more if I thought I needed it. I am coming up on the one year mark for this, my first nursing job, and feel it has been a successful journey. There is still so, so much to learn in nursing, and for me I think I will find my "niche" outside of PDN, but it has been good learning and I am thankful for the experience. Here are some of my thoughts and experiences:

Regarding roles, there is no difference between what I do as an LPN and what an RN does. I actually train new nurses on the case, complete audits, have done a recert, etc.... So I think a lot depends on how much the agency supports you for training (in addition to shadowing a nurse 3x during pt. care, I took an 8 hour trach class). I have not worked with a vented patient, which ups the ante quite a bit, I believe.

I have worked part time as a PDN nurse, which has allowed me to finish the RN portion of my schooling (as of Monday- yay!), so it can accommodate a flexible schedule if needed (like furthering education).

It is super important to set and maintain boundaries with the family. This is one of the biggest challenges, I think. After all, you are in someone else's home for 8-12 hours at a time (!). You have to be somewhat involved, but there is a fine line.... Also, put yourself in the family's place. I try to do that when the mom is rude, or taking frustrations out on the nurse- I get it as much as I can get it- I see what life is like with a child who is technology dependent, with cognitive and sensory deficits and so on. OMG. How hard! So know when to stand up for yourself and when to let it roll off your back. Thick skin comes in handy in PDN

Know emergency routines. My patient decannulated one time (heard the trach hit the floor on the baby monitor). I go in, open a trach set (while calling to pt.'s mom across hall), she comes in while I'm putting a new one in. She does up the ties (but I have done this dozens of times when changing the ties after a bath), and pt. is stable with no sign of respiratory distress. A form is then filled out and sent to the office. Point being, I had reviewed that procedure many times in my head, as I know the pt.'s prone to pulling out his trach, so I felt prepared. Same goes for knowing how to set up the ambu bag to the O2 tank, how to perform CPR on a trached patient, how to work CPAP, pressure monitor, etc. even though those are "NOC nursing tasks."

I am of the opinion that PDN can be done successfully as a new grad, but it is important to have a good agency (they do exist), feel properly trained for your case, and have good interpersonal and communication skills. I am lucky to have a family who gives strong support to the pt., and my experience is super limited, but from what I've read, there are a lot of bad situations out there.

nekozuki, LPN · Jun 30, 2014

Welp, my opinion is gonna be unpopular, but here it is, OP.

I think the decision to go PDN definitely depends on the individual, the vibe/support they get from the agency, and fanatical drive to defend their license (which, thankfully, pretty much goes hand in hand with protecting the patient). I went right into pediatric PDN as a new grad, and was working with infants on vents within a month (my company requires two vent classes taught by an RT where we must demonstrate our competency). The orientation was only 48 hours, and if you weren't proactive, you could very well spend that time standing around doing nothing. There is no one around to hold your hand, so it's a "sink or swim" environment. If I felt a case was too complex for me, I refused it. If I needed extra training/orientation, I asked for it. Now, a year and a half in, I pretty much work exclusively with preemies fresh out of NICU (who can and do desat on a dime) and while I am learning new things every day, I feel confident in my abilities.

Can a new grad do PDN and do it well? Absolutely. But you've got to be smart enough to recognize what you can and can't do, and assertive enough to remedy the situation so that patient safety is never, ever jeopardized.

Maybe it's just my area, but my agency has "entry-level" cases with really stable older kids and parents who happily take on new grads and help orient them to new cases.

rnrg · Jun 30, 2014

Im in the same boat as the ^ poster :-) all good advice.

systoly · Jul 1, 2014

you think they'd throw a new grad into cases that would risk my license and the company's reputation? i'm getting so many mixed messages... i posted in the general nursing discussion about private duty nursing and ppl said to go for it as long as i get proper training... which is why i'm asking here about what "proper training" should look like. meh, so confusing... and a bit discouraging

You are not getting mixed messages

the messages you are getting from general forum differ from the messages

you are getting from the experts

that's not hard to sort out, is it?

in my area, there is no agency that would give you even a fraction

of the orientation necessary to safely handle a case like the one in question

some of the agencies give you some orientation and then have you fill

out a competency sheet - if you check off on trach/vent - tag, you're it

realnursealso/LPN, LPN · Jul 8, 2014

Some things you need to know immediately doing complex private duty peds cases : the vent alarms- high pressure, what does that mean? Low pressure- what do you need to check for asap, remember the answers to these 2 questions are a matter of life or death to your patient. Or, your little patient is not on a vent, but has a compromised respiratory system and is being monitored with a pulse ox. They are breathing, but their sats are dropping, why? What would you look for, what would you do? Remember these little ones can go south very easily, it's all up to you. You are there all alone, somehow your little pts. trach ties get way to loose and their trach pops out, will you have your wits to calmly replace the trach so they can breathe? All of the above things have happened to me through the years, it has to be immediate and instantaneous what to do in all of these cases. On your own, no one to help you, you just have to do it. So you decide, can you do it as a new grad? No maybes, no I think so, just action, now!

Adele_Michal7, ASN, RN · Jul 9, 2014

Yeah I would be very leery of this. I've had 4 years experience in PDN and in those years I've had some emergency situations where I wouldn't have wanted to be without training. Shame on the agency

firefly101 · Jul 19, 2014

So just to give an update:

The private duty agency that I mentioned was really strange ... They kept saying that they wanted to hire me but it was impossible to schedule an in-person interview, and it was difficult for me to get my questions answered. Also my info in their emails were wrong (such as my availability.. my name's spelling...ect). Everything was so disorganized. Not impressed.

I'm talking to another agency that specializes in pediatric home care. My training would be limited to 1 or 2 shifts, but my case would be very basic, such as a cognitively delayed child that requires medication administration. They do not allow new grads on trach/vents/complex cases. As I get more experience I can be trained on more cases so that I can cover shifts when needed.

I'm excited that I will soon start working. I KNOW that the pay is going to be pretty low, but I'm not sure how low... my friends who did manage to obtain hospital positions in MN twin cities are starting around $30/hr + differentials... Anyone have an idea of what I can expect in private duty nursing in the same area?

brillohead, ADN, RN · Jul 19, 2014

In my area of SW Michigan, hospitals start around $26-$27, and pediatric PDN (through Medicaid) is $21-$22 for RNs (the LPN rate is lower, but I don't know how low b/c I'm an RN).

It's all tied to what the insurance reimbursement rates are in your state. For example, Michigan has unlimited medical coverage related to vehicle accidents as part of the mandatory No-Fault insurance rules here, so PDN work that is related to auto accidents pays more like $30 because it's car insurance rates instead of Medicaid rates.