My new job...

[McArdle]

I recently interviewed with a family for a private duty position. Without going into the specifics, I will say that the patient has Nooners syndrome, is on a vent, with a g-tube and trach. I will be getting paid directly from the state.

I just finished my very first shift and I was with a LPN that was showing me her routine. Im feeling a little overwhelmed to say the least. I have never been around any patients that needed the care that this patient does. My exp is as a CNA in a LTC facility on the Alzheimers unit. All of my residents were ambulatory and able to feed them selves..ect.

I watched the LPN give a nebulizer treatment, put medicine in the g-tube, check the vent and reposition tubing through out the night. She also had to suction the trach 5 times and once while she was suctioning, the patient got agitated and she had to "bag" him giving him O2 with the bag.

My "orientation" with the nurse will last for 2 shifts. Although the patients mother explained that she will oversee me after orientation untill she is confident that Im able to do everything.

I feel like Im not catching on fast enough. Is it reasonable for other people to know this stuff after an orientation of 2 shifts? Im just scared that Ill do something wrong or forget a step. I told the LPN I was with, that Im really surprised that the state says its okay for people other than actual nurses to be providing this care. The nurse told me that years ago..only RN's or LPN's could be hired for the posistion but now the state says that CNA's and even PA's (patient assistant's...who have never had any formal health care training) can do the job as long as they have the required 2 shift orientation and are able to demonstrate the skills back to the nurse.

I am thrilled to have this expierence as Im sure it will help me in nursing school a great deal, but I dont want the exp at the expense of the patient's health or safety. Iv'e only met the patient twice but I already really like him.

He is such a sweet boy with a very optimistic attitude.

Anyways, how long does it take before you get to feeling confident and comfortable with this level of patient care?

[kids]

From your post I'm assuming you are a CNA.

You really need to check with the Board of Nursing n your state to confirm that CNAs are permitted to do the activities this job entails.

Personally, I wouldn't take the word of another care provider or a family member in this type of situation.

I've seen way to many families misinform a CNA that they were allowed and expected to do cares that (in my state) require a licensed nurse.

I also would not assume that just because a state agency is willing to pay you for the care that they (the state agency) actually knows exactly what care is being given and the level of licensure/certification that is required for the care.

[valifay]

A CNA doing that type of care sounds fishy to me. If you are not allowed to do it in LTC, I wouldn't recommend doing it in private care. Be sure you have the family sign papers not holding you responsible for certain things, like death due to faulty equipment, etc. And make sure they sign something that says they are aware you are a CNA and not an LPN. Keep a copy of these things for yourself just in case. Here's another question for you, I'm sure you are psched about the job, but I have to ask...by doing the same work as the LPN, will you be getting the same pay? I wouldn't take the job if you are not getting paid the same for doing the exact same care. Be sure to check with your state before you start to make sure you are able to carry out the duties of the job...not just with the agency paying you. In some states CNA's can only do these duties with training and only perform them with direct supervision of a nurse.

[catlady, BSN, RN]

I hope you're not in my state. I'm pretty horrified that a state would allow--and pay for--a CNA to manage a ventilator and G-tube. Are you supposed to assess the patient's respiratory status, and know what to do when he goes into respiratory distress?

If this is the wave of the future--of course, I never thought I'd see the day when aides could pass meds, but now they can--I'm washed out to sea.

[weetziebat]

As a CNA, I'm sure you will give this patient the very best care you can. But it scares me to think of someone with CNA training caring for vents, trachs, G-tubes etc. You just simply do not have the education, training and experience to handle a patient like this if something should go amiss. Which can happen so easily.

This is not to put you down at all, but to me it is like asking an RN, fresh out of school, with no ACLS etc. to intubate a patient. S/he is not trained to do that.

Like others, I'd check with the State Board of Nursing to be sure you are allowed to do this level of care, especially when not supervised by a nurse. I'd also get me a contract, by the family, that states you will not be held liable in the event of machine malfunction or such. And, while I was at it, I'd get me some malpractice insurance as well.

For your own benefit, make sure this you are legally able to take on these responsibilities. And good luck!

[rninme]

Oh my, oh my!!! I'd call your state BON!! Please don't take offense....but I wouldn't want a CNA being the primary caretaker of a vent dependent patient. I was an RRT prior to becoming an RN....and there is alot of knowledge that is required to take proper care of a vent patient...and 2 8hour supervised shifts really isn't enough education to give safe and effective patient care.

[EricJRN, MSN, RN]

Does this patient actually have Noonan syndrome? It's an interesting condition. I think you're right though to be concerned about the difficulty you might have managing this patient's condition.

[TexasPediRN]

Just my 2 cents--

I'm assuming this patient's insurance is Medicaid, as here in Texas, Medicaid will pay for non-skilled caregivers to come and sit with patients.

Normally, with my patients (private duty pediatric nursing), most of our cases have Medicaid insurance. There is a certain program through Medicaid which will allow a person to get MDCP hours, or extra hours that the parents can then request a nurse for (paid at a lesser rate), or can even request a non-skilled attendant to come in for a 8 hour or so shift to take care of the patient as well as do household chores, etc. Since its cheaper to have a non-skilled attendant come in then a nurse, Medicaid pays.

Normally my families who use non-skilled attendants use either grandma, or a family member who is compentent in the patients care..

I'm thinking this is the case here. But I could be wrong, so correct me if I am but I really just wanted to add my 2 cents on that.

It does sound like a great job opportunity, but I do think you may benefit more if you were to get a job as a nurses aide in a hospital setting, where you could feel free to ask the nurses around you questions so that you become for confident in how to care for patients.

On a side note - I'm still nervous around ventilators, and I have had training sessions, numerous orientations, etc. Presently I will only take care of kiddos on CPAP 24/7 (utilizing the ventilator machine), and I wont take care of vent patients - not comfortable doing so just yet!!

Good luck in whatever you choose to do, but please just be careful.

-Meghan

[nightingale, RN]

From your post I'm assuming you are a CNA.

You really need to check with the Board of Nursing n your state to confirm that CNAs are permitted to do the activities this job entails.

Personally, I wouldn't take the word of another care provider or a family member in this type of situation.

I've seen way to many families misinform a CNA that they were allowed and expected to do cares that (in my state) require a licensed nurse.

I also would not assume that just because a state agency is willing to pay you for the care that they (the state agency) actually knows exactly what care is being given and the level of licensure/certification that is required for the care.

Big ditto, and the funding is coming from the state and they will automatically quality check... Huge liability.

Run like the wind AWAY from this assignment. Your own natural intelligence is telling you to question this, and for good reason.

[loridoo]

I agree with the last post. Run, Forrest, Run. I've been a nurse for just over a year. In that time I have had about 6-10 patients with trachs and my stomach stills knots up when I have a trach patient, not to mention the feeding tube and the ventilator. These are NOT CNA duties. By taking this position, you may put your future nursing license in jeopardy.

[catlady, BSN, RN]

I'm assuming this patient's insurance is Medicaid, as here in Texas, Medicaid will pay for non-skilled caregivers to come and sit with patients.

Normally, with my patients (private duty pediatric nursing), most of our cases have Medicaid insurance. There is a certain program through Medicaid which will allow a person to get MDCP hours, or extra hours that the parents can then request a nurse for (paid at a lesser rate), or can even request a non-skilled attendant to come in for a 8 hour or so shift to take care of the patient as well as do household chores, etc. Since its cheaper to have a non-skilled attendant come in then a nurse, Medicaid pays.

Normally my families who use non-skilled attendants use either grandma, or a family member who is compentent in the patients care..

I'm thinking this is the case here. But I could be wrong, so correct me if I am but I really just wanted to add my 2 cents on that.

It does sound like a great job opportunity, but I do think you may benefit more if you were to get a job as a nurses aide in a hospital setting, where you could feel free to ask the nurses around you questions so that you become for confident in how to care for patients.

On a side note - I'm still nervous around ventilators, and I have had training sessions, numerous orientations, etc. Presently I will only take care of kiddos on CPAP 24/7 (utilizing the ventilator machine), and I wont take care of vent patients - not comfortable doing so just yet!!

There is a huge difference between working as an attendant and being asked to manage a ventilator and G-tube. If you are nervous as an RN with those tasks, imagine trying to do something for which you are neither trained nor licensed. It might be a great job opportunity for you, but not for a CNA. Asking nurses questions isn't going to make her competent or licensed.

[RNin'08]

Wow. That's a lot more than any CNA around here would be allowed to do. I'd be scared to death to attempt a job like that. With the 8 weeks of accelerated training I had to become a CNA I can truly say that is one assignment I'd be running from as fast as possible! (even with the almost 2 years experience I now have). It does sound like an incredible learning opportunity but it also has the potential to be a very dangerous situation for both you and the patient.

I agree with the others that have suggested contacting your state Board of Nursing. Cover yourself before you potentially endanger your future ability to hold a nursing license.