Thrown in cold on a vent case - your thoughts?

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Specializes in Pediatric Private Duty; Camp Nursing.

I'm an LPN who graduated in August 09, in my 40's, after a mid-life career change. I went from working one year in LTC care to home health care about three months ago. I signed on with a smaller agency and got an overnight part-time job taking care of a 20-year-old man with a cerebral degradation anomoly that doctors have been baffled by. His brain shows a constant state of seizure although he lays mostly still. He's 100% dependent for care and non-communicative. He appears alert but shows no sign of any awareness of anything. He has a trach (which I'm ok with), and at night he is to be put on a vent when he is asleep. He's by no means dependent on the vent, but he has had incidents in the past where his BP or O2 has tanked, especially when he's ill, which is several times a year.

The agency asked me if I had trach/vent experience. My response was that I had some experience in nursing school, and did trach care at my LTC. They thought I'd be good with this case and offered it to me, and I asked if they had any sort of classroom training or certification. Their response, "Oh, the nurse there will tell you everything you need to know when you orient." Next thing I knew I was training with this young man. The nurse was nice and caring, and genuinely was interested in my success, but as I learned over the last several months, it's impossible to learn to care for a vent pt in one three-hour orientation.

I took the job because I didn't know what I didn't know. I work with this man 1-2 times a week, for about 10 weeks now. At first I'm thinking, "piece of cake!" but after several "common" scenarios that I did not see coming, nor had any idea to remedy the situations, I have come to realize that I have absolutely NO business being with a patient on a vent. The family is always home, upstairs sleeping, so I do have a safety net if something were to go wrong. But it should not come to that. When the morning nurse comes in, I spend an extra hour asking questions on his care. (He's got other issues besides the vent, it's not all about that.) The other nurses have been with him since was a little boy, and understand all his nuances. They all think I've been doing a great job so far, but also know that I am undertrained, and furious with the agency for putting me in this situation. It's happened before but they feel I'm the best candidate they've sent in a long time. They think if I keep it up I will eventually be fine, but what if something happens to him in the meantime?

I just signed up with another agency, a national chain, and they were horrified to hear that I was thrown to a vent case in like this. They don't even allow their nurses to TRAIN for vent until they've been with them for at least a year, and then it's extensive book study and practical training. My question is, is this agency taking advantage of me and risking my license by throwing me in cold like this, or is this pretty much a common real-world way of learning the vent? Any other thoughts would be helpful. I am an inch away from calling the agency and cancelling all my future dates with this pt. Thank you!!!

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Specializes in chemical dependency detox/psych.

I was put cold into a similar situation. I worked one shift--the scariest night of my life, and quit the agency the next morning. Never, ever again. I refuse to risk my license or the health and safety of a patient like that. It's shameful what these agencies will try to pull.

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There have been cases where nurses have been assigned to at home vents without previous training. Needless to say there have been bad results. What are you struggling with? Why do you think you cant handle the patient?

"At first I'm thinking, "piece of cake!" but after several "common" scenarios that I did not see coming, nor had any idea to remedy the situations, I have come to realize that I have absolutely NO business being with a patient on a vent. "

What were these common scenarios? I'd try to get more training from either agency you work for. Let them know how you feel and where you need help. This looks better than just quiting and they can always reassign you if they feel like your not able to handle the patient after teaching you more. Or if YOU still feel uncomfortable.

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Specializes in Critical Care.

I'm curious as to what kind of problems you have run into as well. I'm sure they have taught you the common causes and therefore fixes to low pressure or high pressure alarms. Vents and vent settings can get complicated, but since he is not vent dependant, I'm guessing he is on pressure support or some other common vent setting. If he is your only vent patient, then his one vent setting shouldn't be too hard to teach to you.

And if you ever run into a serious problem and can't fix it quick enough, you can always ventilate him yourself. Then again, if he isn't vent dependant, you shouldn't even need to bag him if the vent stops working right?

I would still want some further education before they added you to another vent case though.

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Specializes in Pediatric Private Duty; Camp Nursing.

A lot of the "scenarios" just have to do with tendencies the boy has while on the vent, and discovering them the hard way, without being forewarned and told what to do about it. For example, when he sleeps very deeply, and rarely, his bpm goes way down. His vent is set to 8bpm. At one point he was down to 15, 12, 9... and I was starting to get very nervous. Then 8 for a few "what the heck is wrong" moments, when the vent took over. His O2 stayed WNL, but it was scary for me, bc I had no idea this happens with him sometimes. Then it went back up again, leaving me a bit shaken. In the morning, I mentioned it to the oncoming nurse, who showed me that he has an order that his vent can be adjusted to 12 bpm. So that was one thing.

Another is when the Low Pressure alarm goes off and I cannot figure out why. I am supposed to shake the condensation out of the tubes, but at first I was scared to death to take anything apart. But one night I just could not figure out why it kept happening. Turns out, the morning nurse said, "Well, if you had him readjusted on his side, he needs a bit more air in his trach cuff. He's grown recently." And that was it. No biggie, but it would have been nice to know.

And I have NO idea what the numbers really indicate. I know what each means individually, but just yesterday the oncoming nurse took the time to explain their correlation with each other and what it means if this is up, this should be down, etc. I can understand this of course, but shouldn't I have been educated on this BEFORE working this case? Not over two months into the job? Which makes me nervous... what ELSE don't I know?

Then there was the morning when, 10 minutes before the morning nurse came on (perfect timing, thank God) he awoke from a peaceful sleep with a shake, and his O2 just started dropping down to 94-93 (I know this is WNL but he's usually 97-99) and HR climbed to 120. Turns out this was not vent-related at all, but at the time I didn't know. It was one of his quirky nuances, and he needed saline drops in his nares and throat to loosen secretions and suctioning. This was sort of a no-brainer answer, but it came on so suddenly it was alarming to me. I mean it was boom! Just like that!

So some of my apprehension isn't from the vent, per se, but scenarios that happen that are just part of his very quirky repitoire of things that happen with him. But I do feel that I have no business working with a vent until I have some formal education and practical training with a preceptor. This is NOT the type of thing I should learn along the way. By the way, my agency thinks that 3 hours of orientation was enough for his case. (He's got LOTS of issues. ) Thanks for listening!

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What you are describing is common, particularly with a certain nationwide home health company. If the other nurses say you are coming along, then I would listen to what they say and stick with it. You will never get vent experience until you get vent experience.

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I would ask a coworker and express your concerns to them. If they think you are doing alright then I wouldn't worry. It sounds like your just nervous with a new patient who has tendencies and equipment your not familiar with. And remember to assess your patient. If he was breathing at 8bpm and Sats were fine and he wasn't turning blue/looked any different then whats the harm in him breathing so slowly. Also you could have woken him up.

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Specializes in pulm/cardiology pcu, surgical onc.

Not everyone is cut out to work and can handle stress well with sometimes unstable pts on vents. Have you wrote everything down when you get questions answered so you have something to reference? Have you tried studying up on vents and the different types of settings and what your client is on?

Sometimes in the world of nursing you must search for the cause and problem solve for the solution. It's not always clear cut and once you get to know your client it makes it easier. Only you will know if you want to keep on with this challenge or find something easier, everyone has there own preferences and neither is wrong. It sounds like a wonderful learning opportunity if you were to give it a chance.

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Specializes in Pediatric Private Duty; Camp Nursing.

I called my agency and spoke to the DON, who wasn't very helpful. She was rattling off basic stuff about high pressure alarms, low pressure alarms... duh! I got that part. I cut her off and told her it's the odd things that have been happening, that I have to find out from the day nurse in the morning how I deal with THIS pt when they happen. I told her that until I can have some more formal training, I would like to have my future shifts taken away from me. She's going to call the medical equipment co. to see if she knows of any classes or training materials. She told me she went to a training course once and left confused. I've had it with this co. who threw me off the deep end right off the bat. I've been orientating w another agency, one with a nationally great reputation, and am going this afternoon to get some orientations for new cases. I already have one orientation tonight. I am sure if I stuck this vent case out, I would learn and eventually have a good laugh at my lack of confidence, but this young man is a human being, not a guinea pig, and I will not risk his life, however remote the risk, so I can learn.

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Specializes in LTC.

A skill that you aren't trained for or accustomed to is one you should stay away from until it is clear you have the training needed to be comfortable.

It doesn't matter how strong your skills are, if its one you don't have much/any backround in you are in a position of not being capable of performing it with any type of professionalism.

Nothing is more annoying than the general, dangerous way of thinking 'you are a capable nurse with what you know so what you don't know is easy too'.

I'd not risk my license or sanity on what I don't know just because I do know something about something else. No matter how good of a nurse they tell you you are. Flattery won't save your behind, or your license.

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