Anyone working Pediatric Home Care?

SDALPN · Jan 11, 2014

Bad idea. New grads don't belong in private duty. Parents are not "back up" as part of the reason we are there is to teach the parents and continue educating them. There are plenty of threads on why new grads don't belong in private duty.

I had a toddler plug yesterday due to a parent failing to bring suction and emergency equipment to school with the child...would you know what that sounds like, would you know how to recognize it, would you know what to do? If I had not responded appropriately and recognized the problem, the toddler wouldn't have survived. And there was no "back up", I was the only nurse. Nobody else in the building was trained. That's why I say new grads shouldn't be in private duty. Also it's medicare/medicaid fraud to do private duty until you have a year of experience as they require a year of experience minimum. Even they get the dangers of a new nurse in this job.

smartnurse1982 · Jan 11, 2014

I don't understand why a new grad can't work in private duty.

The nursing homes in this area are 200x worse than private duty,yet new grads can work in ltc.

I was placed by myself on a ltc floor as a new grad Lpn with 40? patients with trach,gtubes,and other.

My first pdn case was a trach and gtube.

The advice I would give you is start working with basic cases,like kids with gtubes.

Take all the classes offered on trachs and vents. See if the agency let's you shadow another nurse that works with trachs and vents for a few weeks.

smartnurse1982 · Jan 11, 2014

Wow,I wasn't aware the agencies I work for commit fraud,because we have been getting lots of new grad lpn's and Rn's.

SDALPN · Jan 11, 2014

I don't understand why a new grad can't work in private duty.
The nursing homes in this area are 200x worse than private duty,yet new grads can work in ltc.
I was placed by myself on a ltc floor as a new grad Lpn with 40? patients with trach,gtubes,and other.
My first pdn case was a trach and gtube.
The advice I would give you is start working with basic cases,like kids with gtubes.
Take all the classes offered on trachs and vents. See if the agency let's you shadow another nurse that works with trachs and vents for a few weeks.

In a nursing home you have a safety net of nurses and an RN on site as well. You don't have that luxury in the home. And yes, those agencies are breaking the law. Some agencies do it here and make sure they don't share the new grad files if they're audited. The nurse is still responsible for knowing this and for not accepting the assignment. The OP can read the other threads and see the many reasons from many different nurses for why it's a bad idea.

mluvsgnc · Jan 11, 2014

Hi Baubo516-

I am a new grad (LPN, almost RN) in pediatric PDN (I've been in the home about 6 months), and it is working out really well for me. My pt. has a GT and trach (no vent), and I was able to shadow a nurse for three 8 hour shifts prior to starting solo, as well as take a trach training course through the company. My pt. has many issues and a myriad of diagnoses, but is actually pretty stable. The family is really involved and supportive, too.

One of the biggest challenges is fitting into the family dynamic and having good boundaries. The family I work for is considered "difficult" and has gone through many nurses, but I have proven that I am competent and that I have their child's best interest at heart. I'm not afraid to ask questions, and I take on additional duties (ordering supplies, stocking them, calling providers, etc.) that I know they appreciate. I am the first nurse they've ever had (the pt. is early teens!) that has requested to help change his GT, change his trach ties, change his trach tube, communicate with the physical therapists, etc.... the mom or dad had been doing those tasks themselves this whole time!

So it can be done. Know the family preferences. Know what you don't know and learn it. This is my first job as a nurse, so I don't have anything to compare it to. Also, I like the flexibility of my schedule (allows me to continue with school), so that is another plus. I told the company upon getting hired that I could only work x number of hours and they agreed.

Sometimes a downside is spending so much time with the family, but that is just part of in home nursing.

Feel free to ask me any other questions!

SDALPN · Jan 11, 2014

The problem is new grads don't have the experience to know how little experience they have and the danger involved. While most days are "easy", it gives a false sense of security. Then something happens and you aren't prepared or trained for it. The agency will convince you that you are fine to work because they just want a warm body with a license. They aren't looking out for you! Ask some NICU/PICU nurses that have worked in the hospital after a new nurse has made a huge mistake. It happens all the time! You can mean well, but that won't save the patient when things go bad.

Baubo516, RN · Jan 11, 2014

SDALPN - I appreciate your concerns and your perspective. I will talk to my nursing instructors and some of my RN coworkers who work home health to find out about the law in my state. Of course, I can also check with the BON. As a second-career nursing student who is 40 years old, I am comfortable admitting when I don't know something and when I need help. I am not expecting ANY nursing job to be easy - just looking for an LPN job that can be flexible with hours, as I am still in school.

Out of curiosity - what do you think is the most appropriate job for a new grad LPN?

Baubo516, RN · Jan 11, 2014

smartnurse1982 -

Thanks for your advice! The home care manager I spoke with told me there are two cases in my town, and one in a nearby town. We did not get into specifics about what type of care the kids require, as she basically told me to call her after I pass my boards. :) I have registered but have not tested yet.

So, hopefully the cases that are nearby will be uncomplicated... The manager also told me that I would receive training from the nurses who have been caring for the children. I will make sure to seek out all of the learning opportunities I can. I know there is no substitute for experience, but I definitely like to have as much information as I can before I do anything.

My experience working in LTC as an aide was a negative one because of the "culture shock" I experienced dealing with rude coworkers. I used to be a middle school teacher, so I was used to dealing with rude kids and weird families, but I never had to deal with disrespect from coworkers. The teachers and principals I have worked with have always been kind and treated each other with respect. So, I am not interested in a LTC LPN job. I love the geriatric population, but was also frustrated with the staffing levels at the LTC where I worked. I have applied at only one LTC facility, but it is privately owned and run. It is the retirement home for an order of Catholic Sisters. I did a clinical there, and no one appeared stressed out. The staff treated each other and the residents well, and there were lots of activities for the residents. I guess this is a little bit off topic, but just felt like sharing! The thought of being in charge of 40 residents as a new grad is a little daunting for me.

Thanks for your reply and I will keep you posted!

Baubo516, RN · Jan 11, 2014

mluvsgnc -

Thanks for your reply! I do anticipate that dealing so closely with the family of the patient could be one of the most challenging aspects of a pediatric home care job. But I think I have a good sense of professional boundaries - I realize that I will be paid to be there to care for their child and to help them out as I can. In the hospital I have been pretty successful dealing with "difficult" patients and families, because I simply don't take anything they do personally. (Well, I guess it is not "simple," but it is the attitude I take.) Part of my goal of professionalism is to provide the best care I can, and sometimes that means "handling" the patient and family. I was a middle school teacher for 7 years (and K-8 teacher for 2.5 other years), and so I have had lots of experience dealing with different personalities of children and families, and MANY different family dynamics. I'm sure it will be a little more difficult when I am one on one with the family, but at the same time, it will be one family at a time, not the families of all 400 kids in the school! I am hopeful that some of my past experience will help in this area.

It sounds like your willingness to help has been appreciated by the family and has helped to build a positive rapport with them. I like to work hard and I don't like leaving things undone - if I use the last supply, I call and get it restocked; if a trash can is full, I empty it. Sounds like this will be helpful if I get the home care position.

Thanks so much for sharing your experiences and your perspective. I am hopeful that this might be a good fit for me. I will keep you posted!

smartnurse1982 · Jan 11, 2014

When I worked agency,the best ltc facilities to work for were religious based,esp the Catholic and Jewish based Ltc facilities.

CloudySue · Jan 11, 2014

Wow,I wasn't aware the agencies I work for commit fraud,because we have been getting lots of new grad lpn's and Rn's.

These cases might have another source of payment rather than Medicare/Medicaid. That's a requirement that's specifically theirs. Private pay and some insurance co's might allow a new grad. Unless you know the source of payment, it's unfair to assume anyone's committing fraud.

I haven't read through all the posts and OP's responses, but I remember a time when I thought I knew about trachs and vents because I had it in nursing school. I did have over a year experience before starting in PDN, and I received a trach/vent case for my very first PDN assignment. I was brave and bold and confident. The nurse who "trained" me could not even tell me what PEEP and PIP stood for, let alone articulate what they meant. This did not even raise a red flag for me, but it should have. I didn't even know what I didn't know. It took me about 6 shifts to realize that I had NO business being on that case. Once I realized there was way more to vents than I bargained for, I got myself off that case and asked the agency for more, formal training before I went back. They had nothing to offer.

Fortunately the next agency I worked for would not even ALLOW me to work a vent case until I had been with them for a year. Then they gave me a whole self-study course with books and videos. Then I needed to demonstrate skills in their lab, THEN I needed (I think, could have been more) about 18 orientation hours with an established vent nurse. And even now I'm not 100% confident because I have not experienced a real emergency situation yet. I cringe when I think about how arrogant I was, that just because I did it in nursing school, that I was ready.