Private Duty for New Grads - page 2

1) First of all what is the difference between home health and private duty? My state BON advises against new grads working "home health"........HOWEVER.... 2) I have been offered a pediatric... Read More

  1. Visit  reginarn88 profile page
    1
    It sounds like you have a lot of great experience and advice, ventmommy.
    ventmommy likes this.
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  3. Visit  ventmommy profile page
    1
    Thank you. I have a lot of experience of caring for my vent-dependent son (he has since passed away) as well as many, many years of caring for other special needs children (adopted and foster care). There are so many very sad stories about children being permanently hurt by inexperienced nurses that I like to pop in and offer my opinion.

    Here's one for you....developmentally pretty close to target toddler, vented for BVCP. No vent stand in the home. Humidifier is usually on floor, vent on a low table. Humidifier was refilled overnight by new nurse who placed it on dresser next to the crib. Nurse left. Mother knocked over humidifier which caused her child to drown. Drown. Not almost drowning. Actual drowning. As in dead. I know the mom and one of the nurses. Tragic. An experienced nurse would have knelt on the floor to add water because she would have known that water above vent tubing is a recipe for disaster.

    There is another case (that I think I posted about previously) where the family kept the humidifier on the dresser and had an almost drowning. A new to the case nurse but experienced nurse was pulling up for her first shift. As she pulled up she heard screaming from inside the house. She ran in and saw that the mom had accidentally tipped the humidifier over and water was flooding the child's lungs. The mom had already disconnected the vent and turned the child over. The nurse started suctioning and did CPR. The child, which was neurologically intact before this episode, suffered permanent brain damage.
    prnqday likes this.
  4. Visit  prnqday profile page
    0
    Tread carefully. I used to do PDN and had a bad experience with a little boy with a trach. Thank God his mother was in the next room and was able to assists.
  5. Visit  mluvsgnc profile page
    0
    I am a recent (LPN- almost an RN) grad and have been working with a trach/GT 14 yo patient for about four months now, who is considered stable. He has CHARGE syndrome, uses a CPAP, is deaf, half blind, and in a wheelchair. I feel completely comfortable caring for him. I have changed his trach tube (with one parent assist), but not his GT. I believe I know what to do in an emergency trach change situation (supplies are kept in his room, as well as O2). I am actually training a new RN on his case tonight! So I guess it depends on, really, how comfortable one is with their skills and assessment levels. t this point, I know my patient's pain/distress signals (he is non-verbal), but I definitely had to learn those, which took time. A big plus in my situation is that there is strong family support, and there is at least one parent around for a lot of my shift (but I have been left alone with him for several hours before, which the family and I are both comfortable with).
  6. Visit  reginarn88 profile page
    1
    I am so sorry to hear about your son, ventmommy.

    Dear Lord, those are some terrifying stories. It is a lot of food for thought. My agency has promised me a minimum of 5 shifts of orienting with a vent client after learning about vents, which won't be for many months after I start. If my gut is saying no though, I won't take those patients.

    Jeez. I'm just stunned at the tragedy of those stories. I would not be able to live with myself if I was one of those nurses.
    Thanks for the positive spin though, mluvsgnc.
    ventmommy likes this.
  7. Visit  reginarn88 profile page
    0
    By the way, not saying experience doesn't matter, but those humidifier stories really strike me as a nurse who did not receive adequate training on how a vent works.
  8. Visit  realnursealso/LPN profile page
    0
    I just wanted to add that I work for a "Home Health Agency", the definition you all use is not correct. I do LPN shifts for my "Home Health Agency". Just because some of you do visits, there is no difference between what place we work. Home heath is home health. In my state the only difference between agencies is that some are licensed agencies, and some are certified agencies. Certified agencies are able to bill medicare/medicaid on their own. Licensed agenices get the largest portion of their income from certified agencies, due to the fact that they cannot bill medicare/medicaid on their own. Licensed agencies can bill insurance companies on their own, but most if not all of the peds cases are medicaid. A subcategory of home health is shift work. Also some certified, "Home Health Agencies", do not have LPN's on staff, or anyone who does hourly shifts, it is all farmed out to other "Home Health Agencies".
  9. Visit  SDALPN profile page
    0
    Quote from realnursealso/LPN
    I just wanted to add that I work for a "Home Health Agency", the definition you all use is not correct. I do LPN shifts for my "Home Health Agency". Just because some of you do visits, there is no difference between what place we work. Home heath is home health. In my state the only difference between agencies is that some are licensed agencies, and some are certified agencies. Certified agencies are able to bill medicare/medicaid on their own. Licensed agenices get the largest portion of their income from certified agencies, due to the fact that they cannot bill medicare/medicaid on their own. Licensed agencies can bill insurance companies on their own, but most if not all of the peds cases are medicaid. A subcategory of home health is shift work. Also some certified, "Home Health Agencies", do not have LPN's on staff, or anyone who does hourly shifts, it is all farmed out to other "Home Health Agencies".
    Medicare/medicaid calls it PDN. I guess they are wrong too.
  10. Visit  imintrouble profile page
    0
    With all due respect, new grads don't know what they don't know. In PDN there's only you and the client. Maybe there are parents who know what to do in any emergency, but basically it's all on the nurse's shoulders.
    Good luck. It sounds like your decision has already been made.
  11. Visit  realnursealso/LPN profile page
    0
    No, but on here you have a division between people doing shifts and nurses doing visits. We all work for home health agencies. In our state you can get your provider number and be able to bill medicaid on your own.
    Last edit by realnursealso/LPN on Oct 29, '13
  12. Visit  reginarn88 profile page
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    I'm certainly concerned by many of your comments. But here's a thought---most LVN's work in LTC's or clinics versus acute care hospitals, AT LEAST in my area. If you are an LVN and let's say you have experience, you're not a new grad--but it's in a LTC facility. You don't have pediatric, nor acute care experience. Does that mean you shouldn't work in PDN? I'm an RN, not an LVN---but I don't see how everyone who works in PDN has the "acute care" experience which is so necessary to be successful.
  13. Visit  reginarn88 profile page
    0
    My decision is not yet set in stone.
  14. Visit  reginarn88 profile page
    0
    To the person who sent me a private message, I appreciate your input. I don't have enough posts yet to reply to you.


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