I'm considering pediatric home health

caliotter3 · May 17, 2012

From your post, it sounds to me like you are very well experienced and should have no problem getting hired. I would suggest you start out doing extended care cases for awhile, at least until you get more experience with trach care. Then you might decide you would prefer to go to intermittent visits. Logistically, extended care is generally easier for the beginner. Routine care for stable patients. You will find the more complex work when you do visits. Try to find an agency that does both extended care and visits and then you can switch while remaining employed by the same employer, if you wish. HTH

ToughingItOut · May 17, 2012

Thank you the encouragement!! :)

KelRN215, BSN, RN · May 18, 2012

You sound like you have good experience. Patients with trachs/vents are more often private duty patients. I work for an agency that does private duty and skilled intermittent visits. Most of the private duty patients are trached and vented, or on TPN. I have yet to see a skilled patient with a trach. The majority of the patients I see are oncology patients who need home CVL care and/or lab draws. I also see otherwise healthy children who got some kind of infection and need several weeks of home IV antibiotics- the parents are expected to give the antibiotics but they need reinforcement with teaching and PICC line dressing/cap changes and sometimes lab draws. Teaching is a huge part of intermittent home care and one of the reasons I'm loving it.

ToughingItOut · May 18, 2012

Yeah, I was wondering where the parents fit in extended care! We send chronic trach babies home with private duty nurses at night (so they don't plug off, etc.) which is unfortunately the fate of most of our other trach babies sent home without home care. BUT, what do private duty nurses do during the daytime? Are parents usually there? I do really love to teach so that appeals to me. :) Not that I mind, but are there elements of babysitting and schoolwork involved? I'm just trying to wrap my head around what types of pts I would see in home health. The antibiotic therapy population is very unexpected...It makes perfect sense though. Tell me more! :)

KelRN215, BSN, RN · May 19, 2012

Not all private duty patients have around the clock care. In fact, that is quite uncommon. How many hours the patient has depends on a lot of things. In my state, case managers from the insurance companies or, more often, the state go out to assess the patient and make a detailed determination of how many hours they qualify for based on their needs. Patients with trachs still need to be suctioned during the day and many of them have G-tubes as well so they need to be fed during the day. There are also meds to administer and a lot of hands on care. The parents may have to work or may have other children to care for.

Skilled/intermittent patients are the typical "VNA" patients. You go in to do something specific (dressing changes, BP checks, teaching, etc) and then you leave and you go to your next patient. The IV antibiotic population fits in here. I admitted a patient today who is on IV antibiotics q 6 hr. I did the first dose with the mother and she is responsible for administering it. These parents get teaching prior to leaving the hospital on flushing the PICC line and administering the IV antibiotics. In pediatric, they come in these little balls that are set to infuse over a certain amount of time and all the family has to do is connect it and unclamp. I will see this patient twice/week for his PICC line dressing and cap changes and weekly lab draws. Other than that, his care is his mother's responsibility. It's unlikely that you'd be starting peripheral IVs working in pediatric home health- if a child needs IV therapy at home, they usually have some kind of long-term access. IV antibiotic patients usually have PICC lines and oncology patients have more permanent access like a port-a-cath or Broviac.

tothepointeLVN, LVN · May 19, 2012

Depending on how long the kids have been home will depend on how much input you have. Once they get to a certain point it's impossible to tell some of these mothers anything, mostly they will be bossing you round and telling you to do something just as you were about to do it anyways.

My mom's were always home paying enough attention to be annoying but not enough to nurture the emotional needs of the child. The going to school with your patient is fun is your interested in doing some teaching or physical therapy. I didn't like the fact that when I went to school with my patient that the teachers and physical therapy aids ignored him in favor of kids without nurses (i.e all the others) I was forced to do the teaching and the physical therapy myself ( this was preschool ) which made me wonder why the kid was in school since he lost his daily 1hr physio and occupational therapy when he moved into the school system. I tried to persuade the mom to use her nursing hours for the evening so she could go back to school like she wanted but a) she believed her child was so fragile to not trust the aids and school nurses to take care of him when in reality he was the healthiest kid there and b) I think she didn't want the nurse in the house in the evening since they had a lot of people living in the same apartment.

So yeah I got out of private duty. I had other patients but the above was the long term one. We would go to the ER at least once a month for nothing. You couldn't convince her. Once she lost her free hospital taxis that emotional validation seeking stopped. It's part skilled nursing part psychosocial issues. Economic issues compounds that.

ToughingItOut · May 19, 2012

Thanks guys! It sounds like I have a lot to learn, but it could work! :) It would be awesome to find a company interested in investing some time in training their nurses.