I don't mean to be harsh but...
Why have YOU allowed your license to be put in jeopardy by accepting an assignment you knew you were not qualified for?
Any agency that states it will only pay for 2 hours of orientation, signs off a skill checklist for a nurse who has NOT documented they are proficient in vent and trach care and assigns a nurse to such a case is one to RUN FROM as they don't know the meaning of quality care and are liable for negligence.
BOTH the individual RN and agency would be at fault if an injury occured to this patient...and I'm sure the agency would be placing all the blame on the RN.
I don't buy the excuse that you can't afford to go on your own time to be oriented by another RN in the vent care and paperwork.
a. You shouldn't have too go on your own. Orientation is the EMPLOYERS responsibility.
b. Because you bought into their line that they only pay for two hours and YOU ACCEPTED the case anyway, responsibility shifted and now falls on YOU to make sure your qualified.
Since you stated you were desperate to escape hospital, you placed yourself in this postion and have three choices to PROTECT your license:
a. Orient with another RN on your own time until proficient along with reading all the website material we've posted here about vent care.
b. Call employer and inform them you need additional training and are not able to do any vent/trach cases unless training provided. Can employer contact patients vent DME company so RT can orient you (won't cost your employer anything.)
c. Leave this agency and find another one that will provide training.
If this company is the only one in your area doing private duty care and you feel there is no other home health agency to go with, then orienting on your own time to protect your license is much cheeper in the long run. The fact that med and treatment sheet in disaray (other thread that you edited) is another indication that this agency is flying by the seat of its pants. I'd inform the nursing supervisor of your concerns, in fact it's your responsibility to do so. If agency not receptive, then expect you will not receive any assignments.
My first homecare experience in 1985 was with a startup agency. Policies/forms were created as needed...as is oten the case especially with new regs coming out periodically. However, training WAS supplied by the owner who was a ICU RN and RT inserviced all new RN's without vent/trach care prior to our accepting a new vent patient case or assigning RN/LPN to established case. Quality care was stressed...mght have done something with phone guidance re new IV pump/med but better believe inoffice follow-up training occured before staff was placed in sitution again to protect agency and nurses from liability.
Only you can decide what to do in this situation. Wishing you a positive outcome.
Agencies that are associated with the VNA, Visiting Nurse Association --- original homecare association started in early 19th century, usually are the best ones to work for and foster high standards.
VNA locator: http://www.vnaa.org/vnaa/gen/html~home.aspx