Private Duty for New Grads - page 2

by reginarn88 5,852 Views | 46 Comments

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 private duty position with an... Read More


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    Quote from reginarn88
    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.
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    That's true. Good point, thanks.
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    Don't be fooled by "history of frequent hospital admissions" as a basis for how stable a patient is. My son had only two admissions in 2.5 years, however, he was the most unstable patient our agency. I know another family that also used our agency, our hospital and our doctors. That little girl was in and out of the hospital every month but was considered "stable" in terms of home nursing care.

    We had both RNs and LPNs. Our private BCBS paid for RNs or LPNs but Medicaid picked up 6 hours per day and they only paid for LPNs so you can't really base a case on type of staffing. We had everything from new-grad LPNs to an MSN/RN working on a doctorate.
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    It sounds like you have a lot of great experience and advice, ventmommy.
    ventmommy likes this.
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    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.
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    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.
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    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).
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    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.
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    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.
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    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".


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