First emergency after 2 years in the field

[IndiKast]

Tonight I had my first emergency, and I didn't do as well as I'd hoped. But after two years out of school and almost no training with my permanent private care post on his vent, I'm not surprised. So I'd like to put this here just to warn you others out there that may fall into my hole.

I got out of school and needed a job, like most of us do these days. I bounced a bit from here and there because Texas just isn't very friendly to new workers in general, being a "right to work" state...aka right to fire with no reason at all...you sneezed in the wrong direction btw.... So finally I stumbled into a home health agency. Now, peds isn't big ball of string but like I said, I NEEDED the job.

The agency seemed supportive and helpful. I was given an orientation with every placement. I figured my nerves were simple anxiety based on my history and I would overcome it once I'd settled into the simple night position. These kids are chronic and fragile, but not unstable. And a night nurse doesn't have a difficult job typically.

Pay attention now: I got settled in my current position and when something did happen I wasn't ready for it. I now realize that my night duties have been so limited that jumping to my toes is almost impossible. Oh sure, CPR is managable. So is yelling for help. But I looked like such an idiot when it was a simple case of the vent hose being knocked loose and I didn't notice it.

:uhoh3:If I worked in a hospital (which LVNs don't do here locally) this would have happened 2 weeks into my job and I'd feel dumb and be over it. But 2 years?! I feel very unprepared and I'm not even sure if its my fault. I never even have a vent class. My patient's mother is an LVN who also happens to work with vent children. She sat down after the incident and taught me what she could. Made sure I was okay. I am. The patient is, despite a minute and a half of asphyxia.

So in summary, if you have to work slow nights to get by with only a single patient as your assignment. It may be a blessing and you might get your reading list knocked down a few pegs...but PLEASE, PLEASE, for the sake of your license, if you get a chance to help out on the occasional day shift or to bone up on your other skills with another illness, do so. I'm already planning on my next move.

Regards.

[ibmanda2000, LVN]

Hey there! I also am a pediatric home health night nurse in Texas with only 1.5 years with my license. One word of advice I would like to give you is to NOT stay with one kid! Move around. If your agency wants you to have a steady schedule, then ask for 2 shifts with one kid and 2 shifts with another. Any free time you have, train on new cases. Do NOT get confortable with a child and their schedule. Things can and will change at the drop of a hat!

Being a vent nurse also, I feel that we actually have quite a bit more knowledge in trachs and vents than a hospital nurse would. Remember: They have RTs.. we dont! As far as the hose getting knocked off and you not noticing right away why the alarm is sounding... RELAX! You are just getting initiated! How often are we told to check the hoses and yellow/white tubing if there is a leak??? and yet when it actually happens, we forget everything! You wont next time tho! I had an RN who is in school for Nurse Practitioner do the same thing and call me into the room panicking! It happens to us all at least once.

Just remember... never take a situation with our precious kiddos for granted. Ask questions. just because you may be alone in the hojme does not mean you do not have help at your disposal. I have become one of my companies top LVNs by asking too many questions! Dont assume anything and you'll be fine!

Good luck to you!

[nursel56]

That must have been a very frightening experience. I think you should post this in either the Home Health Forum or the Private Duty Nurse forum.

After orienting many nurses to vent cases, I've learned that there are other nurses who accept vent cases without actually knowing how the vents work, what alarm sounds signify, what steps to take when the alarm is persistent, (start with the most obvious, the tubing connections and work from there) what to do if there is a power failure, the vent malfunctions, the circuit falls apart, etc.

You need to know how to bag a patient if nothing else works, have a fully assembled circuit as a backup, and a backup vent if possible.

Every vent case should have an owner's manual and I always tell new nurses to read that backwards and forwards. I still read it after six years with the same vent.

We are there for when something goes wrong. The vents are incredibly reliable, but not infallible. Glad no permanent damage occurred!