HH for 6+ months... still not checked off on skills

[peachnurse22]

I was hired as a PRN home health nurse around May 2016 - the agency was going through a significant restructuring at the time (a significant number of the RN/LPNs on staff were fired or contract staff that were asked not to return) anyway, my point is that from the top down the entire office was starting from scratch. When I was hired a brand new ED, Clinical Supervisor, and multiple nurses were hired at the same time. Because I was PRN I was not given priority for orientation. I had 2 days with an LPN and 2 days with an RN - I received no training really on SOC guidelines.

I'm still at the company and the nurses I was hired with left months ago. At this time there are multiple clinical skills I never was checked off on, including peripheral blood draws, PICC line dressing changes, IVs, etc. The only clinical skills I was checked off on were foley cath changes and wound vacs (which really was an LPN doing the wound vac and just signing a sheet for me)

So is this normal to go this long (6+ months) without completing part of my orientation? I brought this up multiple times to the point where I realize they don't care so I just let it go. I don't get visits for things I haven't been checked off on, but I'd like to move on to another company, but at this point I feel it would look strange to ask for an extra orientation at a new company for someone who has been in home care already??

My background is 1 year of med-surg nursing, 1 year of psych nursing and 1 year of med-tele and rehab nursing part-time last year as I had to bump my work hours for family issues.

Any advice? Is this normal? Should I ask for a longer orientation or go ahead with another company and be upfront with them?

Thanks for any advice!

[oceanblue52]

I was a new grad nurse and they never bothered to check me off on skills...I left that agency after 5 months because of too many other problems. Seems systemic with poor agencies; if you read this forum you will find that some agencies actually provide PROPER training. Good heavens, I have no clue how you would do a SOC without any guidance. Anyway, one thing to consider is that checkoffs are often contingent on having the right patient populations. If the agency doesn't have patients with IV infusions or wound vacs how can you be checked off? Doing skills on a dummy is just not the same. I think this is a legit reason you could bring to a new agency.

[Double-Helix, BSN, RN]

Your nursing license is what constitutes you as qualified to perform all of those skills. While proving that you have demonstrated competency in those skills may be a Joint Commission requirement for the agency (I'm not familiar with regulations for HHAs), I would caution you that the onus for making sure you are knowledgable and performing these skills correctly is on you. If there were litigation brought against you, saying that the agency never trained me” would not get you anywhere. I think you're absolutely right that the agency has done you a disservice by not adequately training you and clearly they don't seem to mind. But it is still vital that you learn how to perform these skills according to your state's nurse practice act AND your agency's policies and procedures.

[Libby1987]

Agree about being contingent on having irregular opportunities depending on patient census. Will add that every agency must be heavily focused on disease management and avoiding hospitalization, with this skills being easily taught tasks, they're probably not on the front burner for an agency going through a restructuring.

I would tell them that I have reviewed all of the policies, viewed multiple sanctioned videos and was prepared to be checked off in the office. (Our nurses have to have 3 successful venipunctures in the office before 1st attempt on patients. Also demonstrated sterile technique and things such as SASH) And then you would like the first convenient opportunity to be checked off in the field so that you can be more versatile to them.

Also have to add, we don't hire prn staff without prior HH experience, too difficult to complete orientation with limited hours. Perhaps if you offered to work FT for a short duration to increase the opportunities that could work?

[caliotter3]

I have encountered this often. The checklist is just a formality that is often just marked down the line and placed into the folder, never to be seen by the new hire again. I would not mention it again, unless you see a good opportunity to get the checks done. Tell a new employer the truth. They won't be surprised.