lpn in home care

joprasklpn · Nov 20, 2007

I work agency in peds with trach and vent kids and make 21.00-23.00 an hr depending on the case and how far I drive. Hope this helps you. I had zero peds experience. They trained me for a day and then I would orient to each case, but you need to have some skills first.

dusky1228 · Nov 20, 2007

I have worked homecare for peds for 16 years. Most (95 % or so) of my caseload is pediatric, the rest is prenatal, or the occasional adult I see due to someone's request, or because it's the family member of one of my pedi cases. I came in to the agency with years of experience, and my salary range has been $30-45 /hr. I also am an RN. In this area (NJ), LPN's aren't hired in most of the agencies around here because LPN's can't do assessments, so they can't do admissions. Because of this, most agencies would roather just hire RN's and not have to try to cover what the LPN can't do in this area. I worked with an LPN about 10 years ago when they still had LPN's, and she helped me with my pedi cases, and her salary range was about $ 18/hr then.

pagandeva2000, LPN · Nov 21, 2007

I worked for an agency with a pediatric case last year one day a week. I was paid $25 an hour, 10 hours for the day. Our agency has the RNs go to make an assessment, and they decide if the case can be managed by an LPN, RN or home health aide. I would make sure that I am oriented to the case, meaning that you should go while another nurse is there to see if you can handle the nuances of the case. Mine was a trach and I would do nebulizer treatments every 4-6 hours along with other meds.

I have to say, I am not that crazy about pediatric clients, but I took the case because it was close to home and was a great learning experience to trach and respiratory care. And, I was very good to the little girl and the family. What one has to be aware of is family dynamics with home cases, because whether you are an LPN or RN, you work independently and have to know how to intervene if there is an emergency. What made me leave my case was that during the summertime, the mother wanted me to escort them on shopping trips, birthday parties, movies and bowling trips. In my eye (and I discussed with with my agency and they agreed), this is a risk, because I was being taken out of my area of familiarity (meaning the nearest hospitals and pharmacies, no emergency equipment, etc...) and also, if something happened with another child, what was my responsibility towards that other one as well as my client. The mother had nursing care since birth for 20 hours a day, 7 days a week. She was used to having us as babysitters. And, once, she told me that "the regular nurse" used to also babysit the client's half sister (not the child of the mother), and I started thinking again; I am not responsible for this other child who was much older than my 3 year old patient. This older girl was known to sneak out of the house to see boyfriends and was sexually active at the age of 12. I felt that while this was a fantastic mother, she did comprehend the role of the nurse and the function.

Again, family dynamics is a very important thing to consider. I plan to do more home care in the future, once I get some more med-surg and ER experience, which I will be doing very shortly per diem. Personally, I found that in my area, LPNs were offered just as much opportunities in home care as RNs; we just had to report to them if there is a change in status; since our scope of practice is to deal with more stable patients with predictable outcomes (not always the case, though).

TheCommuter, BSN, RN · Nov 21, 2007

In my area, most peds home health LVNs don't have any actual peds experience. To be hired by a home health agency in my area, an LVN simply needs a minimum of 6 months of experience in either long term care or acute care. As long as you have prior bedside experience, most home health agencies are willing to train and orient you to their way of getting things done.

Last year, I was offered a part-time position that paid $25 per hour. The same agency offered a full-time position that paid $33,000 yearly with benefits, or $35,000 per year with no benefits.

Blackcat99 · Nov 21, 2007

Is it hard to find a full time LPN job in home care? When they have a trach and or vent do you have to suction them frequently? What do you usually have to do to care for these ped cases? Thanks;)

pagandeva2000, LPN · Nov 22, 2007

Is it hard to find a full time LPN job in home care? When they have a trach and or vent do you have to suction them frequently? What do you usually have to do to care for these ped cases? Thanks;)

I was not in the position to need full time work, but it seemed to be an opportunity for LPNs to do so in my area if they chose to. My pediatric patient had to be suctioned and receive a nebulizer treatment (albuterol and pulmicort) every 4-6 hours, however, if I would do it a bit more often if necessary. It varies what you have to do. A few weeks ago, my agency called and asked if I wanted to care for a 3 week old baby with cleft palate and for $30 an hour. I didn't accept it because I felt that the child just got home from the hospital, this was a heavy adjustment for the parents who I am sure were devastated and feeding is really an issue with them. I was not confident to take that one on right now.

The agency is supposed to tell you the diagnosis, treatments and medications the patient is on (adult or child). There was a care plan in the home with the MAR. You should familiarize yourself with the meds before you go, have the phone number of the agency's nurse, the patient's doctor, the pharmacy, and nearest hospital (the latter should be made available when you get to the home). Also, I was honest with my agency and they knew I didn't have a great deal of experience, yet, they were gentle with me for that time. Take time to read about the condition before you go, or have a book with you so that you can see if the condition is worsening. What I would do is see the case before you go WITH THE OTHER NURSE PRESENT, so that she can orient you to the daily activities and can give you hints about the family. I say be sure the other nurse is there, because if something happens, she is responsible to intervene.

Many times, it seemed to be more babysitting, but keep in mind that this is your client, and it can't be taken lightly. I used to take mine to the park, she would ride her bike in her yard, play movies, play with her with her toys, clean her up, kiss her wounds and sometimes, I used to sing to her. She loved that...I can't sing worth a lick. Keep the environment safe, microwave small meals for her. There should be documents provided to say what you did, a systems check, sign the MAR stating that you see the medications, etc.

One thing to keep in mind at the home; it is more casual there. Do not be surprized if the family asks you to administer something that is not on the MAR. My client had on her MAR to administer Tylenol if she had a fever over 101. The mother told me that she responds better to Motrin, and was about to leave the house. I told her that I can't go against the MAR and do what I want, so, she had her grandmother administer the Motrin. Of course, I documented this fact. A few months later, when I was a bit more comfortable with the mother, the child had a fever again. This time, I said to the mother (because no one else would be home) that I would only consider administering it if she understood that I would NOT document that I gave it, because it is not on the MAR and I also didn't see a medication bottle with her name on it and dosage. She agreed, I gave it, child was fine. But, I also knew that Motrin was not going to kill her.

You have to know who you are working with, know your skill level, because even as an LPN you are more autonomous there, and basically on your own. Be sure that you have all that you need, know where the medications and emergency equipment is. I noticed that they changed the client's room around every few weeks without telling me. I had to tell the family to leave what I need in a specific area, or leave a note on the refrigerator letting me know where things are, because otherwise, I feel like I am invading their space. I don't wish to be accused of anything being missing. Anyway, I know that I carried on and made this a long post. Good luck. And, do not take a case that you are uncomfortable with. It is YOUR license, your bread and butter and your conscience. Especially with kids.

pagandeva2000, LPN · Nov 22, 2007

Oh, and make sure that you check supplies and medications if you will be alone, and if you have to go to the pharmacy, make sure that the family leaves you money or an insurance card to pick up meds. Do not assume that they will pay you back. This didn't happen to me, but to a friend of mine. You are not a bank or a storage supply closet.

Blackcat99 · Nov 23, 2007

Thanks so very much pagandeva2000 for all the great information!!!! ;)I will definately take all of your good advice.:balloons:

caliotter3 · Nov 24, 2007

I can only add to what pagandeva said by saying that you must insist on getting a copy of the 485 to review prior to going to a case and getting the most orientation that can be provided. You should go over the 485 to look at all the different treatments that are ordered and meds to be given and other info. If there is a procedure that you haven't done before, then ask the nursing supervisor to assist you. Most of the time you will orient for anywhere for one to four (or more) hours with a nurse who is working the case. They are supposed to help you learn about the case so that you are able to go in and do a shift on your own. If the case seems beyond your capabilities, or there is something else that does not set right with you, then you can always tell the agency that the case is not a right fit for you.

And there are some agencies that will hire nurses right out of school even though one should have experience. If you start with an agency like this, it is even more important that you ask for and receive orientations that meet your learning needs. Good luck.

caliotter3 · Nov 24, 2007

I might add that what pagandeva did about administering the motrin without a doctor's order was not according to policy or protocol. When you find out that a family member is doing something different, medication wise, send a communication to the MD, or call the MDs office in the daytime, or leave a message to get a clarification of the order. Inform the doctor that the parents are administering motrin and ask for an order for motrin. You submit a supplemental doctor's order for the MD to write the order and sign it. Keep a suspense copy in the home chart. Once the order comes back signed, then you can add the med to the MAR and administer it legally. Always CYA. Never administer a med that is not ordered. You would be correct in asking the family member to administer the questionable med and documenting the fact.

Added thought: You can take a telephone order over the phone and write it on the supplemental MD order form and send it in for signature. A qucker way to go about it.

soobynurse · Nov 24, 2007

Do anyone knows the softare needed to do your skilled progress notes in your own laptop ? Do scan the agency progress note first and then fill it and print?? I need help finding the right software and where to purchase it.....:uhoh21: