New to PDN

[Gooselady, BSN, RN]

I've been an RN for 23 years (gawd), remote HH experience as a new grad and then psychiatry for many years. The last six I've done medical oncology in a hospital, my first hospital job. Surprised I made it that long . . . can't knock the experience I got though.

I am no starry eyed savior nurse going into PDN. At this point, PDN is just another kind of nursing job that I hope to do in one way or another until I retire. What I look forward to in private duty is almost the same as what I dread about going into it, which sounds about right.

The clientele are mostly peds, which I have no experience in except in nursing school. I have adult children and little grandkids. Over the years I followed all these blogs by parents about bringing their preemies or very sick babies home, just very intrigued and concerned but in an armchair kind of way. I never considered doing peds nursing, but now that private duty is on the horizon I am really getting excited about it.

Supposedly we have training opportunities through the company. Ha, I'll believe it when I see it. Well, it's a start. The only thing I haven't done at all is manage a vent dependent patient. As for trach, GT, JGT, NG, central lines and acute med/surg and palliative care stuff, I got that (with adults). Doing it with kids isn't just doing it with smaller bits and smaller patients.

So as experienced PDNs, please give me your opinions and/or experience to point me toward good educational materials, tutorials AND whatever hands-on you would recommend or do yourself if you had to do it over.

I may eat my words but I trust my personal boundaries and de-escalation skillz , what not to do, where not to go in terms of relationships with patients and family. Sure I'll make mistakes and learn the ropes like the next person, but this is not what I am most concerned about. I can almost taste the words LOL.

Thanks in advance!! And yes I have pet geese :)

[conscientiousnurse]

I did PD in the past. You could look up more info on ventilator care (alarms, etc.), and videos on any other skills your clients have that you're not that comfortable with. Maybe review basics on peds, like vital signs, normal development. Also, a peds textbook should tell you the physiological differences between kids and adults. For instance, sometimes young kids don't have as much reserve and can go downhill faster. As far as being a specialty you can do till retirement, just keep your eyes wide open on the following.: Many of your clients will be total care, and will be growing heavier with time. You will be the one turning and transferring them. Sure, they might get a Hoyer lift at some point, but some clients can still be wearing on your back. Even night shift often has to turn during the night, and/or transfer client to or from bed. Also, it can sometimes be difficult to have a stable amount of work. If clients go to the hospital or move out of your area, you won't get to work for that client while they're not at home, and it can take time to find you another one. The families also can sometimes be difficult, but it sounds like you know how to handle that. If it weren't for those problems, a lot more nurses would enjoy this field as a "till retirement" job. But just in case your back can't handle it with time, I'd try to keep my skills up for another area of nursing for the future.

[tnmarie]

I've done PDN for almost 5 years and I am returning to it after a break to get one year's recent facility experience.

I have an EXCELLENT assessment tool that I took with me everywhere for peds pts. I'll have to track it down and post it for you if I can find it again.

FYI, I swore I'd never do peds, but my second patient out of school was a peds patient. I ended up staying for two years each with my two primary peds patients so don't worry about the peds aspect (oh and I have no kids!). I absolutely adored my "little munchkins" though :-)

Here are some tips:

1. Make up a bag. As you work, you will see what you need. This bag is in addition to your daily work bag; I leave mine in my car. I carry a change of scrubs, hand soap, gloves, baby wipes, extra blank copies of all required documents (N.N., supp orders, time cards ect). Yes, you inform your company when you need supplies, but what are you going to do doing your shift? That is why I bring backup stuff so I KNOW that I will always have what I need regardless of how long it takes supplies to be restocked. Some companies make you go to the office for supplies if you are out.

2. Never give your personal phone number to the pts. I never did but I've seen nurses do it. You MUST set boundaries or you could find yourself in some real trouble. This is pretty highly stressed in orientation and you will hear horror stories. You sound like you will be just fine with that though!

3. Never accept anything from the family or pt. Seriously. Not even a coke. Decline diplomatically, of course. "Oh thank you so much, but I brought my own".

4. The family is in general an excellent resource. Most have been caring for their ill child for years and are very knowledgeable.

As for your skills, you should have an education coordinator. Find out who that person is and they can train you/refresh you on everything. Ours will even come out and guide us through any procedures if we need it. Youtube also has tons of videos of various procedures as well.

Good luck and feel free to ask more specific questions. I'll try to find that peds tool. I hope I do becuase I really need it agint too :-)

[tnmarie]

Found it:

Also for vents, you can find most vent instruction manuals and even some videos on the interweb once you know the company and model number.

[Gooselady, BSN, RN]

THANKS!!! I felt bad starting this thread because I know this stuff is covered 'elsewhere' in hundreds of iteratons. I did spend a couple of days just reading back through old threads to see what comes up the most for PDNs, and professional boundaries comes up over and over (as do what happens when you aren't vigilant about them ).

The bag o' goodies to keep in the car is exactly what I was hoping to hear! I will definitely get a bag together, that was very helpful advice. I also copy/pasted the Pediatric Assessment to wordpad so I can print it out for my clipboard.

I have been cruising Youtube and found excellent refresher type material on ventilation mechanics, trach trouble shooting and the like. The company is JCAHO certified so I trust their education opportunities more than I don't. It's what doesn't occur to you that worries me, what a shock I know. I hope they will allow me to shadow other nurses even just to drop in and get familiar with a particular kind of vent or braces or whatever.

In my remote HH experience, I drew blood for labs. Is there a reasonably common need to start a peripheral IV in PDN? I imagine there could be. I don't remember them saying they had an IV team, nor was I asked how well I could start IVs on a pudgy baby hand/arm.

Thanks again for your responses :)

[nursel56]

Welcome to PDN, Gooselady! First I will share what I would call the "gold mine" of allnurses links and information on all things peds trach and vent that have helped lots of us for years and have been updated as well. It is actually in Home Health but if you haven't seen it yet I recommend it highly.

Pediatric Vent and Trach Info

To answer the IV question. In my personal experience I have not been required to do that, but my number of clients is too small to generalize about what you may experience.

I think your prior experience and especially your "people skills" will serve you well and the above tips are really good. The thing that most struck me after years in different areas of nursing when I started PDN was just how unique each private duty case is from the next one even though age and diagnosis may me similar.

Just a few tips here-- and apologies if you've seen them already. The biggest difference in PDN compared to other specialties to me was that the family is an ever-present part of care and in a sense are clients as well. This can mean that lots of patient education may be called for (recent first discharge home with boxes of supplies everywhere, etc) , or perhaps their child has been home with PDN help for years and has routines set in stone. Flexibility is a must!

You may find that co-nurses or PCGs will want to rush through orientation. I wouldn't budge on a thorough orientation no matter what. It really helps if you can get a copy of the Plan of Care (485) ahead of time with identifying info removed if you haven't formally accepted the case. That is your blueprint. It will usually tell you what type of vent or other equipment the client has. I would then find the manual online to familiarize yourself with it's particular settings and alarms, etc.

Hoping others will jump in as well with their tips. For a really informative take on what it's like to be on the other side (as a parent of a special needs child) check out posts from ventmommy. We're always here to help as needed. Best wishes!

[Tenebrae, BSN, RN]

Sorry showing my ignorance, what is PDN? Realise its something to do with paediatric patients but yea

[nursel56]

Tenebrae-- that's Private Duty Nursing - either children or adults.

[tnmarie]

In my remote HH experience, I drew blood for labs. Is there a reasonably common need to start a peripheral IV in PDN? I imagine there could be. I don't remember them saying they had an IV team, nor was I asked how well I could start IVs on a pudgy baby hand/arm.

In my experience, the majority of PDN patients that require IV fluids or frequent blood draws have PICCs , CVCs, or other more permanent forms of IV access. I don't think starting IVs is a very common procedure in PDN. Curious to hear others' experiences on this one too.

[SDALPN]

Maybe it has to do with scope of practice by state. But we do IVs and blood draws on patients in the home. Sometimes they have a central line. But sometimes we have IV meds. Depends on the patients needs.

[Gooselady, BSN, RN]

Nursel56; thank you, thank you . . . that's exactly what I was hoping for, the links and your words telling me that it was very helpful for you. I appreciate the patience with my questions very much. I have reasonable experience with trachs (including humidity), just not ventilated patients. I 'know' FiO2, PEEP, tidal volume . . . but it's a different part of the brain to apply in real time. I didn't know you could put a vent in CPAP mode, for instance.

I am waiting for my background clearance and references to get done, and I'll accept the job. I have fairly low expectations as far as making money, what shifts or types of days/holidays I work. Not out of desperation, I sincerely don't mind and my life allows for flexibility. My last job (before my right knee blew out) had 24/7 visiting hours. Families were accommodated generously, and I was surprised at the nurses who didn't like that. Naturally I had to cope with angry, even vicious family members, and my old psych skills were a godsend. I 'know' the helicopter family member, so anxious I swear they are conveniently deaf AND hear what NOBODY said, but they don't bother me, I see their anxiety and don't take it personally. Not that I let people walk all over me either.

I appreciate hearing how different every 'case' will be in PDN, that makes sense. The common denominator will be me, so finding out how to prepare and support myself is at the top of the list. A lot of that will be 'self advocation' so my orientation is adequate and protects the patient (as well as my license).

TNMarie and SDALPN, I have started a list of questions for my orientation and the IV is one of them. I am familiar with all the central lines from working oncology, enteral feeding, TPN, yadda yadda. I'll just have to wait and see.

In the hospital, we had a certain IV pump, certain beds, certain feeding pumps, and so forth. It sounds like in PDN a challenge will be learning the different sorts of vents, pumps, and gizmos that go along with them. I can always call the company that provides them too.

What I look forward to (in a slightly perverse way ) is how patient/family led PDN appears to be. I was never the nurse who blew into the room and imposed my Nursely Self and Interventions on the patient unless the patient family were clueless. I feel OK speaking up when erm, there is a need for re-education, without the family and patient feeling too insulted. I learned so much from the patients caregivers. Just personality-wise, I think PDN and me will make a decent fit.

[brillohead, ADN, RN]

My car-bag (mine is actually a plastic tote with a lid that I keep in the trunk) also includes non-perishable food items, a cheap stethoscope, and some extra pens (in addition to change of clothing, etc.).

Sometimes stuff hits the fan and your regular supplies aren't available to you -- having bare necessities backed up in your trunk can be a shiftsaver!