Meeting 1st Client - NERVOUS

middleagednurse · Apr 16, 2015

Read up on anything you're not familiar with, such as the client's diagnosis and any treatments or meds. I assume you will get an orientation. Tell agency you want an entire days orientation. Also, talk to the parents. Most ped client parents are extremely knowledgeable about their childs care, and they will be happy to share their knowledge with you. Basically just follow the care plan and remember if worse comes to worse you can always call 911.

SDALPN · Apr 22, 2015

Private duty isn't for new grads. Read previous posts for more info on this. Some will agree and some won't. But the more experienced nurses who have seen it all will tell you, you need everyone. Agencies just want warm bodies with a license. A few agencies don't even care if you have a warm body! If you mess up, they will throw you under the bus. They will stay in business and hire the next new nurse so they can pay less and make more. Meanwhile, you are trying to make ends meet without a license. In my state, they require a year of experience to do private duty. They require 5 years to be a supervisor in PDN.

LadyFree28, BSN, LPN, RN · Apr 22, 2015

When I was a new grad LPN, I utilized my resources by having a thorough orientation-having the opportunity to understand a POC as well as starting out will low acuity patients, then attended classes and had competencies verified before I got high acuity patients.

You state you have some post acute experience; some of those skills are transferrable when it comes To home health; you have a grasp of assessment skills, and can communicate with families; as well as perform medication administration.

I have been in your shoes; advocate for yourself-make sure you are comfortable taking the case; that's the purpose of meeting the families and finding out whether the case would be a fit for you, and make sure you understand policy and procedure in order to do the proper way of managing patients.

I will also suggest finding out as much information related to your client's condition; self-study is the name of the game once you are a licensed nurse; it will give you a general idea on your client's presentation, as well as ideas for interventions that families may not have even began to think about.

Best wishes.

CloudySue · Apr 22, 2015

Even w a year's experience in a facility, I still felt woefully unprepared at first in private duty. I started w an agency that gave me their client w the highest acuity because they couldn't keep him staffed and I didn't know any better. He was a trach/vent w a tricky JT that couldn't have its balloon inflated, not to mention a mystery dx and about 12 different meds. I worked w him for about 6 Saturday nights before I finally realized I had no business being w a T/V client alone. I was staying an upaid extra hour every Sunday morning w the oncoming nurse to be trained by her. When I asked my agency for more formal training, they had nothing for me. I quit. Then I went to another agency (rhymes with Day-ada) that was awesome w its training program, both in the lab and the field. They wouldn't even put me with a T/V client until I had been w them a year, and even then I had an extensive book and clinical training program. So my point is, if you are going to work in private duty, be absolutely sure you have the support and the training from your clinical manager and the office people. Don't take any client that you are not comfortable with.

Also, don't lean on the parents too, too much, often parents cut corners and do things in a way that those with a license to protect should avoid imitating. When you start in a facility, you gain good habits in your practice. I always say that in a facility, those managing you insist on you doing things exactly to the letter. When you work in the home setting, parents often insist that you to fudge things. It's quite ironic.

caliotter3 · Apr 22, 2015

If you honestly believe the case is a little too deep for you at this time, then speak up to your staffing coordinator or clinical supervisor and pass up this case for one that is a little more basic. Cut your teeth on an easier case and work your way into a case that is involved and complex. They can't fault you for that. Or, you can go to meet the parents, and speak with them. You can get a feel for whether or not you want to try, or if you should pass it up. No harm done.

LadyFree28, BSN, LPN, RN · Apr 22, 2015

I went to another agency (rhymes with Day-ada) that was awesome w its training program, both in the lab and the field. They wouldn't even put me with a T/V client until I had been w them a year, and even then I had an extensive book and clinical training program. So my point is, if you are going to work in private duty, be absolutely sure you have the support and the training from your clinical manager and the office people. Don't take any client that you are not comfortable with.
Also, don't lean on the parents too, too much, often parents cut corners and do things in a way that those with a license to protect should avoid imitating. When you start in a facility, you gain good habits in your practice. I always say that in a facility, those managing you insist on you doing things exactly to the letter. When you work in the home setting, parents often insist that you to fudge things. It's quite ironic.

THIS is so important!! :yes:

Advocate advocate advocate; make sure your company is supportive to making sure your are competent and comfortable enough to take a case-start out with low acuity and go from there.

Baileynewf · Apr 23, 2015

Thank you all for your replies! This is excellent advise. I will definitely not be taking any clients that I feel are above my skill level. The only T/V training we received was a video and practicing a little on a doll! They wanted to put me with a 4 month old that was S/P tracheostomy and I said NO WAY!!

JustBeachyNurse, LPN · Apr 23, 2015

Thank you all for your replies! This is excellent advise. I will definitely not be taking any clients that I feel are above my skill level. The only T/V training we received was a video and practicing a little on a doll! They wanted to put me with a 4 month old that was S/P tracheostomy and I said NO WAY!!

Omg an agency in my area did that to a new grad who didn't know what they did not know with tragic effects, as in the child died. You must have hands on training and field preceptorship and should NOT be doing high tech cases for at least a year after doing basic cases. IMHO run from the agency. Start looking for other work now! My one agency doesn't even start new grads with infants. They keep new grads with school aged or teens with basic needs Respiratory meds/oxygen, GT/GB feeds & care, working up to seizure precautions with VP shunt and VNS.

SDALPN · Apr 23, 2015

Thank you all for your replies! This is excellent advise. I will definitely not be taking any clients that I feel are above my skill level. The only T/V training we received was a video and practicing a little on a doll! They wanted to put me with a 4 month old that was S/P tracheostomy and I said NO WAY!!

As a new grad, pretty much all cases are above your skill level. Anything can happen at any moment. Not only that, how do you know about supplies/ordering/quantities allowed/equip maintenance/etc.? If you mess that up, it can't be fixed until the next set of supplies comes in. Do you know what medicare/medicaid requires in documentation? Even if you have the most basic case...if something goes wrong, you have no safety net. The parents and agency will throw you under the bus. Even other nurses will burn you to save themselves. Without experience, you are asking for trouble. It's hard to see it now, but look back in a few years (if you still have a license) and you'll see why.

JustBeachyNurse, LPN · Apr 23, 2015

Editing to add in both of my agencies new grads must complete residencies...minimum of 3 sometimes 6 months where they work with an experienced preceptor full shifts. They have classroom time and simulation lab time with the nurse educator for approximately 2-4 weeks before they go out in the field for observation then hands on skills with the experienced preceptor. They don't go near high tech cases for a minimum of 12-18 months. To be considered they must have a letter of reference/recommendation from a pediatric lecture or clinical instructor.

This is rare for agencies but it promotes safe practice on behalf of the nurse and the agency. The pay is lower as the agency is not reimbursed for the new grad resident's care but once preceptorship is successfully completed the rate goes up to the base rate for nurses.

But SDALPN is right even basic care in pediatrics is not simple care. It's not high paid respite babysitting. My assessment and documentation is just as thorough for the ambulatory kiddo with a seizure disorder severe enough to require 1:1 PDN as it is for my most complex, high skilled trach-vent case.

Baileynewf · Apr 23, 2015

I accepted a position with a clinic at a hospital today. I feel MUCH more comfortable with that! The pay is higher and I will be able to get some great experience. Thank you for your honest comments. It helped a lot!