inadequate RN :(

[GenSurgRNFA, BSN]

Ive been working with my agency for about 3 weeks and I know thats not long, and I just graduated from RN school in May. Im the only nurse in the home since im full time and the patient is approved for 40 hours a week. I was never "trained in" to the home, mom just teaches me how to do everything and my case manager is 2.5 hrs away. Granted I can call or text her anytime. But my patient just got an ear infection and I missed it, the last few days Ive taken her vitals and everything looked fine to me. We don't have anything instruments to assess her ears so I can't do that. Thats the other thing, the agency only gave me a stethoscope (i have my own anyway) for assessment? I bought a thermometer and the home had an oximeter.

Anyway, im just super bummed out because Im feeling sorely inadequate and like this is not the job for me right now. And when I talk to my case manager about it she just gives me some profession mumbo jumbo that doesn't really help at all. I just wanna know how other home health nurses feel about it.

[JustBeachyNurse, LPN]

It sounds like you are doing private duty nursing since you are doing shift work. It's not recommended for inexperienced new grads unless an extended orientation with skills lab training. You should not be trained by the parent, you should be demonstrating competency to a preceptor or clinical nurse supervisor. Parents can orient to the routine and care specifics.

You should not assess for ear infections therefore an otoscope is neither necessary or appropriate. (Aside from pain, fever, discharge, pulling at ears then you contact the patient's physician with your findings. The MD will decide whether your assessment is sufficient to call in an Rx or needs to see the patient in the office)

The home should have a thermometer or one provided by the agency. You provide your own stethoscope unless isolation issues then agency provides one. Agency provides gloves, PPE, hand sanitizer, soap, paperwork, care plan. DME supplies pulse oximiter, oxygen, BP cuff, nebulizer, diabetic testing supplies & sharps contained, nebulizer & respiratory care supplies, suction and any other items prescribed in the plan of care and signed by the physician and appropriate to the diagnosis that creates a need for skilled nursing.

You don't assess other than what is in the plan of care. I.E. You don't check pulse ox with a personal device ever. Only use home device provided by DME and should have oxygen, suction, nebulizer etc to provide treatment based on results. A child without a respiratory diagnosis will be T, P, R only

[iSurvivor]

Don't beat yourself up. If the patient wasn't exhibiting any s/s of an ear infection, how were you to make that discovery? This stuff happens ALL the time in home health. I've had patients walking and talking and the next day, code. You can be as vigilant as possible but unforeseen occurrences can and will happen in home health just as in a hospital setting. Best of luck!