Am I a bad nurse?

smartypants22, LVN · Jul 31, 2015

So I got a new patient a 4 year old little girl, who is non-mobile and has a trach and g-button. So far it's going good since the little girl hasn't gotten sick. She just sleeps most of the time which makes my job really easy. Family is ok. Mom is pregnant with her boyfriend's baby, I just don't like the boyfriend because he curses a lot, and even curses and yells at the 5 year old little boy who is the mom's, but not his (but the boy calls him daddy). I just try to ignore that though. They also have 2 cats that have fleas and I've gotten bit everywhere. Fortunately my patient has not gotten bit by the fleas since the nurses try to keep the cats away.

caliotter3 · Jul 31, 2015

I would attempt to address the flea problem as suggested in your other thread. If not able to assist in getting this problem resolved, I would leave this case if you can not tolerate the bites, not to mention the possibility of flea-borne illness. Hard to believe that the other nurses have not taken on the flea problem.

Adele_Michal7, ASN, RN · Jul 31, 2015

I would personally run as far you can from PDN. That's just me, though.

Adele_Michal7, ASN, RN · Jul 31, 2015

You could always throw a few flea collars on Tom and Jerry...

JustBeachyNurse, LPN · Jul 31, 2015

New grad with a trached toddler? Fleas? Are you really comfortable doing young child trach cases?

SDALPN · Jul 31, 2015

New grads don't belong in PDN. This is a bad situation.

CBlover, BSN, RN · Jul 31, 2015

I'm not familiar with contracts as you mentioned. What would happen if perhaps you absolutely could not keep this one year contract? What kind of punishment could you get? Honestly, as SDALPN said, this is not the place for a new grad and this is a bad situation. I've read many-a-case where home care was not handled clinically well and there were bad outcomes. Parents are very quick and understandably so, to jump on you in a heartbeat if the child's care has any lapse whatsoever. I would be afraid as a new grad with the little training it sounds you have had. Your in a sticky situation, but contract or not, you've got to maintain the safety of these pt's AND protect your license.

smartypants22, LVN · Aug 1, 2015

You all say that new grads should not be in PDN, but the parents of the child are not licensed themselves and yet, they are perfectly capable of taking care of their child on their own, especially when nursing isn't available for the child. You all act like new grads are incompetent. The agency wouldn't hire new grads if they couldn't handle it.

I guess I could break the contract, they just take money from orientation pay out of the last check. I don't want to leave until I have at least 6 months experience under my belt.

JustBeachyNurse, LPN · Aug 1, 2015

The agencies like this will hire any one willing & licensed not necessarily those who are competent. The fact that you were hired via phone interview does not equate to a new grad being able to "handle it". Technically a nurse working in home care/private duty in CA must have a year paid nursing experience before being considered.

My agency will only hire nurses with a year of paid, verifiable nursing experience unless a highly competent new grad with multiple recommendations who enters the 1500 hr precepted training program (approximately 9 months classroom, practical/simulation lab training, field observation & training. Minimum of 30 hours with a qualified preceptor working with a basic care client (gt possibly seizures possibly asthma variant) the can work independently with that single client after demonstration of clinical competency to a clinical RN manager. New grads must work at least 2 years before considered to be recommended to the trach-vent training program.

Based on your descriptions of your training & orientation I can pretty much guarantee the parents had significantly more training before their child was discharged from trach care, changes, emergency scenarios, troubleshooting, ventilator management, when to call 911, CPR, use of BVM with trach, proper suctioning, oxygenation, infection prevention , equipment care & maintenance and more.

You do not know what you don't know.

I have a patient with a new trach & vent. Mom was discussing the classes, inservices and return demonstration to care for her child's GT, trach & vent before the hospital could discharge her child. You cannot compare an inexperienced new grad with what seems to be less than sufficient training to parents who are experts in their child's care and condition. Parents notice inexperience and incompetence. Were you not pulled from cases by parents because they were not confident in your skills and care provided?

Children have died at the hands of an inexperienced new grad nurse overconfident in their skills while working in private duty nursing.

OrganizedChaos, LVN · Aug 1, 2015

You all say that new grads should not be in PDN, but the parents of the child are not licensed themselves and yet, they are perfectly capable of taking care of their child on their own, especially when nursing isn't available for the child. You all act like new grads are incompetent. The agency wouldn't hire new grads if they couldn't handle it.
I guess I could break the contract, they just take money from orientation pay out of the last check. I don't want to leave until I have at least 6 months experience under my belt.

No, new grads should not be in PDN. If you can't realize the difference between a parent who knows the ins & outs of the disease process their child has & been taught everything they need to know about the medications & machines that their child has been on for years. Versus a new grad that doesn't know all that much. Then you better keep your malpractice insurance up to date.

Because I have worked PDN & those parents have nothing better to do than learn about what is wrong with their child. Just because you are a nurse doesn't mean you know everything, you learned a small amount in nursing school. The parents will (in some cases) educate themselves fully on the who/what/where/why. Which is a lot more than what you know at this point & they definitely know how to use the machines better than you.

Murse9185 · Aug 1, 2015

Now idk what the parents side of the story of why they feel uncomfortable however from your side of the story I wouldn't say you were a bad nurse. A PDN job is not a good place to start out as a new nurse. I learned the hard way but now that's what I do and I love it. Confidence is key when dealing with pts parents. As a new nurse I had little confidence because I had very little experience as a nurse on my own after graduating. The contract thing though is rough. I'm blessed to not be under a contract such as the one you have. Hopefully all works out well for you!!:)

NagathaChristie · Aug 1, 2015

I am an experienced nurse. I started in PDN as a new grad. It was hard at first, but I learned a lot about direct care, doing great assessments and more.

I decided that to succeed with families I was going to need to do some CUSTOMER SERVICE. So I was very friendly. I acted like I TOTALLY agreed with their house rules; yeah some rules are really stupid. I told all of the parents, (when asked about my experience or when I could squeeze it into a conversation) "I know the doctors are trying to do the best for kids but one thing I have learned in nursing is that no one knows a child like their Mom/Dad" I will say that this comment has helped to make my job easier. The parent (usually a Mom) tends to be nicer, more lenient and friendlier. Additionally, I will ask the parents before I leave "Is there anything else that I can do with/for your child that will make your evening/night/day/weekend a little easier for you?" One Mom told me that she liked me from the start because the morning she met me (I was orienting) I said to her "I hope I didn't make noise coming in and wake you."

So yeah, we need to be good nurses, use your common sense, protect your patient and yourself and play the popularity / customer service game.

Read about therapeutic conversation. I use phrases like "that must be so hard for you" or "I can't imagine how difficult that must be for you." toward the parents. They seem to like that someone is sympathizing with them. Also, "If you ever notice that I forget to do something or you do not like the way I do something, please let me know. I am always open to suggestions, I know you have more experience at ______."

Also, I never give much personal info. I keep conversation/chit chat to shallow topics like crafts, food, pets etc...

Here is how I respond to certain topics:

Politics = "Oh, I do not follow that stuff, seems so confusing to me."

Religion = I always respect their beliefs. I try to avoid the topic. If they are Muslim or Jewish or another religion that I am not I will tread very carefully.

Mom/Dad complaining about work/love life/neighbor = "That has to be hard for you to deal with." or "That must be so difficult for you." etc.

Anything else = try not to give negative comments. Was a restaurant terrible? too bad, if they ask say "hmmm it seemed like they might have been having a bad day. I think I would need to try it again to give a true opinion" do not say "oh it was awful! blah blah blah" you want the family to associate you with good things, not negative.