Advice on how to keep skills fresh?

[hezasan]

Hi, I have recently started a position nursing for an infant with trach/vent/gtube. I really enjoy it, the kiddo and family are great and the agency, while a little disorganized, is always willing to help me take care of things that come up.

I am wondering what others might suggest on keeping up with the variety of nursing skills that I learned in nursing school -- I graduated (second career!) about six months ago. I love providing lots of patient and family-centered care, but the family wants to do most of the work with the trach, vent, and g-tubes, changing the tubes and other regular maintenance. Even bathing, weighing, and other care they prefer to do. I feel I understand their perspective on this and have no issue with the fact that that is the way that they want to do it, however, as a new nurse I would really appreciate the ability to keep practicing those skills in case I do actually need to use them -- with this kid or another!

For now, the agency wants me working full-time with this child, and they actually have very few nursing cases (most are caregiving) so there is not a lot of ability to jump to different cases. I keep offering to do these things or participate in them more, but the family politely declines (as with the other nurses).

Do any of you find ways outside of work to keep in practice with these skills -- such as volunteer work, or anything else you can think of? I would love some ideas! Thank you so much!

[SDALPN]

6 months really isn't enough experience to be doing pdn. This topic has been brought up on here a few times. As for skills, you can float to gain skills or keep them up. Or you could take a job at a facility. There are just too many things that can go wrong while you are by yourself without experience. In NC, medicare/aid requires that nurses have at least a year of experience. If you don't have that experience and you get caught, they can charge you with fraud. Also, the parents may be reacting like that because they don't want you "practicing" on their child. I've seen many parents do that. Infants can change and go downhill so fast. A good agency will have you get comfortable with trach patients that are older and more stable before doing an infant trach case. They also have you do a basic infant case before working with an infant with a trach. After doing this job for years, I still request to float to keep my skills up. Good luck.

[hezasan]

I really appreciate your concerns. Thank you for sharing that and I agree with you.

[CloudySue]

I have a feeling this family will pass off more work to you as they get to know you better and you become more proficient. I follow a parents w trached kids board on FB and they overwhelmingly are very nervous for a while w new nurses. Once you are part of their family, so to speak, they'll trust you to do more. I work w a mom who doesn't let the nurses do anything more complex than suction... but after a year of being w her and I knew they liked and trusted me, I told her I was concerned that I haven't had recent practice changing trachs. So she's going to let me do one soon. Trust reeealllly has to be earned in homecare.

[smartnurse1982]

I disagree about the skills being complex.

From what other nurses tell me,the skills we have are basic.

vents,trachs,gt,ngt,jt,tpn.......thats all thought of as basic.

.

At leas thats what they tell me

This why i think i have trouble getting hired by nursing homes.

Another reason they tell me is because we dont have time management experience.

[SDALPN]

I disagree about the skills being complex.

From what other nurses tell me,the skills we have are basic.

vents,trachs,gt,ngt,jt,tpn.......thats all thought of as basic.

.

At leas thats what they tell me

This why i think i have trouble getting hired by nursing homes.

Another reason they tell me is because we dont have time management experience.

Trach and vent skills are more complex. But rarely used in facilities because respiratory therapists usually do those tasks. TPN is certainly not a basic skill. GT skills are simple and some states allow CNAs to work with GTs. It's mostly time management skills if you aren't getting hired in a nursing home. It also could be that nursing homes are mostly geriatrics and PDN can be pediatrics or adults. Both are different skill sets.

I could run circles around facility nurses with no vent or trach experience just as they could beat my time at a med pass.

Either way, being alone with a trach or vent without experience is asking for trouble.

[hezasan]

In my four months of experience in this position, I'd say the vents, trachs, and G-tubes, while complex, become routine very easily...at least as long as everything stays routine, which of course is no guarantee. The hard part is doing all of the "noticing" essentially by yourself. Even though I have had resources available by phone, as well as whatever websites I could manage to get to work on my phone, there is nothing like a pair of eyes and pair of hands to confirm or set you straight when you see something that's just not quite "right". I think that's true for nursing at any career stage, but it's most especially true when you're new. That is where a wide variety of experiences with different patients, as in the hospital setting, would come in really handy. Lucky for me, starting next month, that is exactly the kind of experience I will be getting Though I would say I don't really recommend the home setting as a job for new nurses, at the same time, I had bills to pay and I'm grateful for the opportunity this company gave to me. Sometimes you have to do what you have to do until the "best" situation finally presents itself. What kept me safe in this situation was CONTINUALLY asking questions of everyone, not being afraid to call the doc even if I might have looked silly (and usually they validated my concerns), and not taking "it's fine" for an answer