Private Duty for New Grads

OrganizedChaos, LVN · Oct 28, 2013

Home health is generally visits where you go & do visits in the home no longer than an hour. Whereas private duty is shifts from 8-12, or longer, in the home.

I hope the agency fulfills on their promise to give you all that training but generally they say all that just to get a body through the door. I know it would be nice to work something "easy" but working pediatrics in the home, their health status can change in an instant. Even if they say the patient is "stable" the patient could crash in an instant.

I commented about this topic in another thread. But I went to a PDN agency to get a job. It was me, an RN & a new grad LVN whose only clinical experience was in clinicals. I could tell she was nervous. We watched the required videos, tested over CPR, inserting a gtube & took a test. When we were checking off on the gtube she was fumbling around & she obviously didn't know what parts went where. If she was in the home alone & had to replace the gtube by herself it would be scary! I don't think they hired her.

I have done pedi PDN for almost 4 years. These agency will do & say whatever they want to get a body in there. But once you're there you need to be 150% comfortable in your skills because the kiddo's condition can change in a heart beat.

Why don't you work at a nursing home PRN and get comfortable in your skills? I know it might be high stress but nursing is stressful.

meanmaryjean, DNP, RN · Oct 28, 2013

I agree that PDN is no place for an inexperienced new grad. Because it ALL YOU. My current case is a vent-dependent infant. I am not only the nurse, but also the RT (neb treatments, suctioning, emergency troubleshooting the vent).

PERHAPS starting out with just a g-tube patient might work, but I would not accept anything more complex than that at first.

reginarn88 · Oct 28, 2013

Thanks for the response. The agency limits us to g-tube or seizure precaution kids the first few months. For several weeks there is several hours of in office training each week as well as mentoring with another nurse. In fact, they will not let us be alone with a client until the first six weeks of training is over.

ventmommy · Oct 28, 2013

That will be a very impressive agency if they stick to what they are saying. I know at the agency we used, the vent training is 6 hours and then they send the nurse out. We had a nurse that had never seen a pediatric trach except on a practice doll. She wasn't with us but for a few days because her assessment skills were poor and the last thing my son needed was someone that had poor assessment skills. I can teach about the vent, trach, g-tube, diagnosis or meds all day long but I don't know how to impart the "just knowing" of assessment skills.

JustBeachyNurse, LPN · Oct 28, 2013

In the one agency I work with seizure precautions are not considered 'basic care' because there is such a variety in peds. But seizure experience with adults is transferable. I think because many of our seizure children are also respiratory/aspiration precautions and skilled nursing judgement is needed for PRN suctioning & oxygen. Even someone with EMS skills/experience may not be able to have the experience & applied knowledge for chronic/complex care.

Stable GT feeders (continuous, intermittent or bolus) is 1st level basic care. New insertion of GT is not, neither is JT or NG/NJ feeds.

I hope your agency follows through with their promises. Be strong enough to insist on the full training/orientation program.

SDALPN · Oct 28, 2013

Its really much better to get experience in a facility first. Maybe you can find a peds facility that has trach/gt pts. Its a risk to your license, the pt, and your career. Also peds and adults are completely different. Agencies will tell you anything to get you in the door and I mean anything. Do you have a warm body and a license? Great! They will hire you! Insurances require a year of experience, so if your company lies about that and you are caught, you can be charged with ins fraud.

witty_online_moniker · Oct 28, 2013

I accepted a PDN job for pretty much the exact reasons you stated in your post. I'm about 5 weeks into it and there are only two patients that I'm comfortable taking on my own at this point because they are not as complex. I just did my first solo shifts for those patients last week, after a combination of in-office training, field training, and multiple shadow shifts with each patient. Even with all of that, I still had a few questions once I was on my own. In both cases, the nurses that trained me offered up their numbers as a resource and the case managers are readily available by phone or text. Also, my questions were more of the "Where does the family store this med/supply variety?" not "What do I do if my patient decannulates when she coughs?"

I am finding that although my agency offers "extensive" training, they will try to rush it so that they can get shifts covered. They tried to get me to agree to solo shifts earlier in the training process, but I refused them -- it is essential to have a backbone and not be afraid to turn down assignments that you aren't ready to tackle as a new grad. I am not comfortable taking a vent-dependent patient with my current level of training in a single-patient environment. My agency staffs a few group homes and I am willing to take more complex patients in those settings with adequate orientation and training. In those situations, there are multiple nurses working the same shifts and I would have a safety net available if needed. I've always had strong critical thinking skills and plenty of common sense, but the learning curve is steep. I've spent quite a bit of time with google and you-tube to reinforce some of the skills and procedures that I've been learning. It's not a great substitute for supervised, hands-on experience but it helps me feel a little more prepared for things that I might need to deal with during my shifts.

Honestly, this is not my ideal first nursing job for all of the reasons that other posters have mentioned. However, I know my limitations and I'm probably way more cautious than most people when it comes to the amount of risk I will assume as an inexperienced RN. My agency provides better than average training based on what I've read here and seen elsewhere and I'm not afraid to ask for more training than I probably need for my own peace of mind. I'd rather be over-prepared than under-prepared in this setting.

SDALPN · Oct 28, 2013

The problem is new grads think they are prepared with the "training" they get. What you don't know, will hurt you. But the agency will be quick to sign you off and have you sign to say you are comfortable. There are lots of things that come up that require experience. Plus there is nothing worse than a new grad giving bad advice to a parent that contradicts what the experienced nurses tell them. Then the parent loses trust in the nurses. And I've seen the parent follow bad advice (which seems great to the new grad) and then the pt is harmed. A simple case with a kid with seizures could escalate quickly into an emergency that you aren't ready to handle. If something happens to the pt, are you ready to answer to a judge "but your honor, I needed a job"?

reginarn88 · Oct 28, 2013

Can someone give me more information about insurances requiring a year of experience? I obviously don't want to be charged with fraud. I don't see how new grads can be hired so widely and publicly if this is actually true. Maybe only certain cases require this and they don't put the new grads on these cases.

Please don't attack me, but working with just one patient one on one and keeping my eyes on them seems safer than working at a nursing home with 30+ patients. My friend said she got 3 days of "training", then she was on her own, and as an RN, she was the charge nurse. I do realize that kids are fragile. In clinicials, I was the first one to notice that my patient's blood pressure was not stable, and my nurse was on her lunch break and seemed less than concerned, but nevertheless that patient got a saline bolus once the physician saw her.

Acute care is just not an option for me in the near future, but it may be next year. However, I can't wait a year to start working.

Is all private duty considered LVN level work, or is it divided between RN level and LVN level? From what I understand if they are "stable", then it is LVN level. Starting off I will try to not take any cases that have had a history of frequent hospital admissions.

SDALPN · Oct 28, 2013

Can someone give me more information about insurances requiring a year of experience? I obviously don't want to be charged with fraud. I don't see how new grads can be hired so widely and publicly if this is actually true. Maybe only certain cases require this and they don't put the new grads on these cases.
Please don't attack me, but working with just one patient one on one and keeping my eyes on them seems safer than working at a nursing home with 30+ patients. My friend said she got 3 days of "training", then she was on her own, and as an RN, she was the charge nurse. I do realize that kids are fragile. In clinicials, I was the first one to notice that my patient's blood pressure was not stable, and my nurse was on her lunch break and seemed less than concerned, but nevertheless that patient got a saline bolus once the physician saw her.
Acute care is just not an option for me in the near future, but it may be next year. However, I can't wait a year to start working.
Is all private duty considered LVN level work, or is it divided between RN level and LVN level? From what I understand if they are "stable", en it is LVN level. Starting off I will try to not take any cases that have had a history of frequent hospital admissions.

I'm on my phone, so I can't post the pdf file from the state with the requirement. PDN is for all nurses. However, very rarely there are RN only cases for cases that require services outside of the scope of practice for an LPN. Just because a pt is stable leaving the hospital, doesn't mean they are always stable. You must be able to handle a pt that becomes unstable in the home. It is more dangerous than a facility because you have no safety net if something goes wrong. In a facility, you have extra hands and experienced nurses when things go wrong...and if you are lucky a Dr may even be on site.

reginarn88 · Oct 28, 2013

That's true. Good point, thanks.