LTC to Pediatric Home care

CloudySue · Aug 17, 2011

I followed the same path as you did, starting in LTC and then switching to HH Peds this past January. The major difference in a nutshell is... In LTC, "they" (admin) are constantly on your back to do the right thing. In HH, "they" (the family you work for) will be constantly on your back to do the wrong thing. Be prepared for families to want you to tailor your work to their style. This may include wanting you to do things under the table without your agency's knowledge, like alter time start/end, tweak med amounts/schedules, give tube feeds in their way (which may not be as sanitary), reuse items until they are scummy or falling apart (I'm at a place that we've been using the same pulse ox sensor since mid April). I have a A&O teen who is constantly begging me for a night off from her bipap. It's heartbreaking to not be able to let her feel like a "normal" teen and ditch it. Sometimes they'll want you to give a OTC med which isn't on the MAR, and it's 10pm on a Saturday night. You explain you don't have an order so cannot legally give it, and the doctor wouldn't appreciate a call this late for something so minor. So they do it themselves, disgusted with you that you can't just do such a simple thing. I mean, who's going to know? Is their attitude.

Such things go on and on. Be prepared to stand your ground. It's your license on the line.

NurseLoveJoy88, ASN, RN · Aug 17, 2011

I agree. I'm a month into peds HH and I already see how the family can want us to put our license on the line. I told this one parent who wanted me to alter time sheets that not only can I loose my lic. but her son can loose his benefits. She never asked me again to tweak anything.

You may also experience parents who like to do everything themselves... it makes me feel like a high paid baby sitter. One of my cases involves the parent who does all his AM care: meds,feeding, cpt vest, cough assist, suction and etc. The couple times I tried to take over the kid whined and complained" This isn't how mom does it" and mom jumps in.

Some cases you will realize its just not the right fit. One of my clients is a dread to work for. I'm looking to drop this case if I get offered another one. Peds HH is totally different from LTC. I have to admit that sometimes I miss LTC because the 8 hours fly buy. In peds HH time drags for me... I'm 22 with lots of energy and watching cartoons and playing with legos all day is not appealing. I didn't go to nursing school to be a nanny. I know peds hh is NOT my niche, but I'm hanging in there until I get can something else.

Good luck to you.

CloudySue · Aug 17, 2011

Nurse LoveJoy, excellent point. You really become a babysitter/nanny. It's very exhausting and frankly boring to sit with an MR ct for 8 hours and entertain him/her. You really are expected to sing, play, and otherwise interact w that client. Some people enjoy it but I don't, not for that long a stretch. When it is time to do something, the parent will jump in and do it before giving you a chance. So I would feel totally useless being there as a licensed nurse.

My aforementioned A&O teen is a quad with very little usage of her arms, so often she asks for my help with her hobbies. This weekend we sat and scrapbooked for hours. She provides all the materials and directs me on what to cut, where to paste, etc. Now I happen to enjoy doing that. Not everyone would.

This summer I accompanied a 6 year old to a day camp for two weeks. She was in a group of children from 5 to 13 years of age, including some big, rough boys. The camp was run by teenagers and college students who were lazy and clueless, and I never saw a grownup in charge of them. The activities were mostly designed for older kids. My client (and her twin) were so bored and off task, sometimes even getting whacked by balls or knocked over by the big kids. Repeatedly I asked counselors to take my client (who, along with her twin who didn't realize I wasn't there for her too, kept gravitating to me and sitting on my lap) and get her back on track, get them involved, give them something to do age appropriate. I had to explain to them that I'm only there in case of a health concern, and I'm not there to entertain her. Of course, they had no idea how to do that. I was sooo glad when that assignment was over.

However, these "gripes" of mine are still preferable to the gripes I had in LTC. Having one client is infinitely safer and I always leave my shift knowing I did the best I could, something I NEVER felt at the end of my shift in LTC. The good news is, if you do end up compromising for a family and fudging it, chances are no one will ever know. Agency offices, even the best ones, are too overwhelmed with their own work to micromanage cases. But never, EVER, completely trust your families, even if they say you are a member of their family and love you like crazy. They WILL throw you under the bus if it suits their needs and saves their own butts. Protect yourself first. Your license depends on it.

NurseLoveJoy88, ASN, RN · Aug 17, 2011

Nurse LoveJoy, excellent point. You really become a babysitter/nanny. It's very exhausting and frankly boring to sit with an MR ct for 8 hours and entertain him/her. You really are expected to sing, play, and otherwise interact w that client. Some people enjoy it but I don't, not for that long a stretch. When it is time to do something, the parent will jump in and do it before giving you a chance. So I would feel totally useless being there as a licensed nurse.
My aforementioned A&O teen is a quad with very little usage of her arms, so often she asks for my help with her hobbies. This weekend we sat and scrapbooked for hours. She provides all the materials and directs me on what to cut, where to paste, etc. Now I happen to enjoy doing that. Not everyone would.
This summer I accompanied a 6 year old to a day camp for two weeks. She was in a group of children from 5 to 13 years of age, including some big, rough boys. The camp was run by teenagers and college students who were lazy and clueless, and I never saw a grownup in charge of them. The activities were mostly designed for older kids. My client (and her twin) were so bored and off task, sometimes even getting whacked by balls or knocked over by the big kids. Repeatedly I asked counselors to take my client (who, along with her twin who didn't realize I wasn't there for her too, kept gravitating to me and sitting on my lap) and get her back on track, get them involved, give them something to do age appropriate. I had to explain to them that I'm only there in case of a health concern, and I'm not there to entertain her. Of course, they had no idea how to do that. I was sooo glad when that assignment was over.
However, these "gripes" of mine are still preferable to the gripes I had in LTC. Having one client is infinitely safer and I always leave my shift knowing I did the best I could, something I NEVER felt at the end of my shift in LTC. The good news is, if you do end up compromising for a family and fudging it, chances are no one will ever know. Agency offices, even the best ones, are too overwhelmed with their own work to micromanage cases. But never, EVER, completely trust your families, even if they say you are a member of their family and love you like crazy. They WILL throw you under the bus if it suits their needs and saves their own butts. Protect yourself first. Your license depends on it.

I agree that this is way safer and less stressful then LTC. I do feel good about that part. At the same time I need a challenge. I'm looking into more skilled clients. Sigh-

This is what I love about nursing. If you don't like something you can always try something new. I may go back to school nursing for a while... I loved that !

Isabelle49 · Aug 17, 2011

Brush up on per assessments. Ped patients are not little adults. Remember a ped patient crashes way faster than an adult, as their compensatory mechanisms are not mature.