New Grad PDN (Advice, please?)

LilBit81 · Aug 21, 2013

If your questioning the verbal order just call the dr to confirm it or ask the mom to call dr and you speak with the dr so you can hear the order. And with my agency the dr visits are mandatory but if we did go it would be ok & we would still get paid. And my train of thought on that is this, 1) you get to meet the team if drs that work with your patient, 2) you can hear first hand any med changes or further appointments, & 3) you could still help with the child and give the mom a break. Good luck!!!

LilBit81 · Aug 21, 2013

I meant the dr visits are not mandatory

SDALPN · Aug 22, 2013

I just started a new job as a pediatric private duty nurse right out of nursing school. So, I'm looking for advice (and maybe reassurance) for the veterans here.
There have been a few scheduling problems thus far. I was hired on without a clear schedule. (As a matter of fact, I called Monday to ask about when I'd get one and was informed that I was due to work since the family needed me ASAP! Yikes! Luckily, my shift started later in the day.) During orientation, they hadn't received a schedule from the family so it seemed a bit touch and go. However, I was assured it was a 40/hr a week job.
I got there at my scheduled time (as agreed between myself and patient's mother, based off of her work schedule) and turns out, the patient was at an appointment and didn't come home for another hour and a half. So, a short day. Since the patient's mother didn't work on Wednesday, I asked if I'd be needed. I was told that I wouldn't be (at which time I stupidly shared that I preferred that, since I had a family function I'd like to attend in the middle of the day) and assumed it would be my day off.
Next day (Tuesday), I was asked to accompany the patient and family to an all-day appointment at the local medical center. Another short day. I tried to call scheduling and they were out all day. Cue the major anxiety and sleepless night. However, I called my agency and asked about the effect my shortened hours (upon the time their insurance granted them and my job) and was assured that since the patient's schedule necessitated the short hours, it was fine.
Wednesday, I call scheduling and figure that from one to nine, Monday, Tuesday, Thursday, and Friday is what the optimal time would be to care for this child. They call the patient's family to confirm.
Cue the callback, in which I was informed I was expected to work Wednesdays as well, even though the mother doesn't work. I'd get this day off, since I discussed it with them family but in the future, I'd work M-F, 1-9. (It sounded like I was made to look like I asked for this day off, which I suppose is arguable.)
My question is this: do all new cases follow along like this? I feel I was thrown into the water and expected to dictate my hours based on need and what they were allowed. Is that normal? I have to admit that it sounds strange to me, but this is my first job and clinicals took place strictly within hospitals.
Another question: is it normal, in this field, to accompany the child to all of her out-of-home appointments? At the moment, she goes to these appointments with family members, but they expressed interest in my presence there.
I feel like I may look disorganized, and I don't want to present myself in this light. Or is it simply that I'm experiencing the same thing that other private duty nurses do?
Also: My patient has seizures that aren't controlled by medications. The family was instructed by the DR to increase the medication verbally, however the only script that I have has a lower dosage. How do I communicate this while charting?
Please help? I'm feeling overwhelmed. I really like this case, but I feel like a chicken with my head cut off.

First off being a new grad in PDN is a bad idea. Search the threads for previous discussions. Next, the scheduling is fairly typical and there is never a guarantee of hours. Anything can happen for you to lose hours. After that, yes you must be with the pt at all times including outings. You should clarify any questions about meds and dosage with the PCP. From the sounds of it, this may not be a good fit for you. Plus you really need experience before doing a job like this.

LadyFree28, BSN, LPN, RN · Aug 22, 2013

Hi MissEm!

I started out as a new grad PDN nurse many moons ago. I found it to help my decision making, assessment, and advocacy in my nursing practice; as well as being comfortable with family centered care. It can be daunting; however, with the right agency and orientation and staff education program, you can succeed in PDN home health.

I will try to answer your questions as best as I can.

My question is this: do all new cases follow along like this? I feel I was thrown into the water and expected to dictate my hours based on need and what they were allowed. Is that normal? I have to admit that it sounds strange to me, but this is my first job and clinicals took place strictly within hospitals.

No, this is NOT normal; I had a orientation and set schedule with all of my cases, regardless of the agencies that I worked. I would orient with the family, as well as nurse prior to working ANY case. If I was not meeting up with a nurse and the caregivers, I was not on the case. :no:

Another question: is it normal, in this field, to accompany the child to all of her out-of-home appointments? At the moment, she goes to these appointments with family members, but they expressed interest in my presence there.

Going to the patients' appointments help add to the POC that is involved with your client; so this is normal as well. It's beneficial to the provider to have a healthcare professional present to collaborate on the POC as well as provided additional teaching and support to the parents/caregivers when needed.

I had one case where I went to his scheduled appointments while the parents were at work; we took public transportation, so it is doable in an urban area (if they are stable and not vent-dependent; then they go with the parent and nurse).

I feel like I may look disorganized, and I don't want to present myself in this light. Or is it simply that I'm experiencing the same thing that other private duty nurses do?

That's the "newbie" jitters; you are in a situation that you have not experienced; it's a culture shock to go from education of floor nursing to PDN. This is where you can get creative; organize what you need to do during your hours there; hen you orient in a case, you usually get a feel on how care is provided to the kid, the POC and go from there. First thing you do is safety checks, especially if the have potential airway issues and other precautions. Next is your initial shift assessment, preparing meds or any other interventions needed on the POC. Document your interventions as well as changes, if any during the shift; appointments, any issues of appointments; as well as reporting off whether with caregiver or to another nurse.

Also: My patient has seizures that aren't controlled by medications. The family was instructed by the DR to increase the medication verbally, however the only script that I have has a lower dosage. How do I communicate this while charting?

This is going to depend on your agencies policy; any discrepancies in orders needs to be clarified by the provider; when I worked at one agency where there was a discrepancy in ranges for a specific therapy; I contacted the nurse who manages the case-as far as updating POC, visits and collaborates with you on any updates and changes. I always updated and clarified with providers and gave my case manager the heads up on discrepancies, issues, updates, when I have to call a provider. I also ask the provider to notify my agency. Some agencies have order forms that have to be sent back to the agency and then are forwarded to the provider. A good way to prevent this is to make sure when the provider is making the change for the dr to either have a print out or make sure the script is accurate while they are writing the prescription; speak up to make sure that the orders are clarified.

You also stated that you like the case; which is a good thing. Advocate for yourself in terms of clarifying hours (even though hours are being cut left and right from insurance companies); as well as policies. Never hesitate to call or visit the agency and make sure you are following protocol, when it comes to clarifying orders.

I hoped I made a few things clear; I worked home health PDN for the 7 out of 8 years in nursing. I loved the flexibility, and the creativeness that I can do for my clients. I do still moonlight in PDN, because it is a great way to hone your assessments, documentation, patient education, and communication. :yes:

MissEm · Aug 23, 2013

Thanks so much, you cleared a lot up for me! You weren't kidding about it being a culture shock! :)

MissEm · Nov 9, 2013

So, for anyone interested: this case has been going well for me. I really feel that my job is just as fulfilling as the rest of the RNs I graduated with!

The wee baby I watch is non vent, stable, and so sweet. Not to tell too much, but I'm there for basic nursing care as well as respite care and monitoring. I go to DR visits, therapy, and am usually in attendance for any other therapists coming to the home.

The only downside is that the patient's mom, while awesome, has a certain way of doing things around the house that I'm simply not used to. It's still easy to make a mistake with laundry or the feeding preferences as outlined by the mother for the wee baby, but I'm still learning and we're making it! I'm fully aware that Mom is the expert! Also, the house is creepy at night.

mluvsgnc · Nov 9, 2013

Thanks for the update, MissEm. LadyFree gave excellent advice, too. I am also a new grad in PDN (LPN- almost RN), and a having a very positive experience.... it CAN be done! It is fortunate that my patient is stable and has strong family support as well (even with a myriad of diagnoses). Glad you stuck with the case (it can be difficult to find a good family to fit in with!), and keep up the good work!

reginarn88 · Nov 10, 2013

I'm about to start orienting so it's good to see that other new grads are doing well.

LadyFree28, BSN, LPN, RN · Nov 10, 2013

So for anyone interested: this case has been going well for me. I really feel that my job is just as fulfilling as the rest of the RNs I graduated with! The wee baby I watch is non vent, stable, and so sweet. Not to tell too much, but I'm there for basic nursing care as well as respite care and monitoring. I go to DR visits, therapy, and am usually in attendance for any other therapists coming to the home. The only downside is that the patient's mom, while awesome, has a certain way of doing things around the house that I'm simply not used to. It's still easy to make a mistake with laundry or the feeding preferences as outlined by the mother for the wee baby, but I'm still learning and we're making it! I'm fully aware that Mom is the expert! Also, the house is creepy at night.[/quote']
Great!!!

Sheryleneglvn · Mar 30, 2014

I'm also a new grad staring at home health. I'm glad to see this thread for support. It seems like the general census is that most nurses are ruthless to newbie PDN nurses saying that they shouldn't do PDN as a new grad.But glad to see other new grads are makin. It through PDN

CloudySue · Mar 30, 2014

I wouldn't really call us bring "ruthless", I think we just get frustrated by the fact that new nurses come fresh out of school thinking they know enough to work alone, and don't seem to heed our warning. I mean, we kinda know what we're talking about. If anything should be called "ruthless" it would be the fickle finger of fate, ready to spring an emergency situation on a nurse who's never attended a code or recognized some other situation that warrants immediate intervention.

I spent a year in LTC and every day I was smacked left and right with new experiences and lessons that I never, ever could have imagined in nursing school. I was constantly asking questions to my colleagues and floor ADONs. The first year for a new nurse in a facility should be considered an extra year of nursing school.

Granted, a new nurse would probably be just fine working alone w a stable client and never have a problem. PDN clients are mostly stable. But I've had a few hair-raising, touch-and-go nights with kiddies who were already brittle and then got sick, and I was able to refer to lessons learned in LTC to care properly and intervene appropriately. I can count those scary nights on one hand, but they do happen. And honestly, you don't want to be the nurse on duty when a kid tanks, it's the scariest thing in the world, even w facility experience.