New Grad RN: Home Health or Wait it Out??

[MBrickle]

Hi All,

I recently (last week) had my pinning and am now a graduate nurse, preparing to take the NCLEX. Like most other new grads, I'm formulating a methodical plan for job-seeking that consists of networking with anyone possible, attending job fairs, and applying for all jobs I find (I have lists of every hospital, nursing home, and rehab in about a hour and a half radius!)

My student loans run out at the end of this month and I am in need of any employment to get the bills paid. In addition, I am attempting to save up for my wedding so I feel the extra pressure of needing some sort of an income.

My question: through someone I networked with, I got offered a home health position for a little boy with very critical needs...he has a g-tube, trach, harrington rods and is suctioned as many as 150-600 times a day depending on his heath status. In addition, during times of sickness he is hooked up to a vent at night. Other than that he runs around, rides his bike and is home schooled during the day. The hours would be 7a-3pm 3x a week and the pay would be 25-30.00/hr. The mother feels confident that I could do the job, and also has other new grad RNs on staff (December grads.) I have been honest in saying that I would still seek other employment but would be willing to make a commitment to her to maintain a presence in his life since I know children get attached to caregivers (plus I need the money.) There are pro's and con's to the job...she also mentioned that one of her last caregivers left after two years after being hired into a pediatric ICU and working in an ICU is ultimately where I would like to wind up in nursing.

Do I take the job? Training is involved of course, along with days shadowing current nurses...I know the current nursing market is tough so I'd like to take something while I can get it, however, I don't want to cut back the hours I would be available to any other forms of employment that I seek (most likely a rehab or LTC facility...)

Does anyone have any opinions on this? I don't want to make a committment to a family (and a little boy) that I can't/don't intend to keep but I also don't want to shoot myself in the foot by decreasing my availability to other employers from 7 days a week to four...

Let me know what you think!!! I am interested in hearing others opinions.

Thanks!

[sbostonRN]

I would definitely take it, and seek out per diem or part time jobs to fill in the gap. The pay is good, the hours are good, and you seem to have a good relationship with the family already. As long as training is provided I think it's do-able. The market is very tough, but as soon as you have the first thing to put on your resume, it makes everything a lot easier. I have a few friends who started off in similar jobs and did great.

[NeoPediRN]

150-600 times??? Holy suctioning! I work in a NICU/PICU stepdown setting and I have never suctioned a trached kid anywhere near that many times! I did pedi homecare and found it to be monotonous, but that was after working in a hospital setting. I would've been too nervous to do homecare for such acute kids before I got the experience I have, especially fragile trached kids or kids with critical airways....sometimes doing homecare is like being a nurse in a mobile ICU setting. You have to know how to tweak that vent, or recognize when the patient is decompensating to the point where he needs vent support, being able to titrate settings in an emergent situation until you can talk to the doctor or get the kid to the hospital, recognizing early changes in status and being able to choose the right intervention (PRN neb? Chest PT? O2?), being able to stay calm and bag the kiddo through blue spells, performing an emergency trach change, so on so forth. A kiddo who needs his trach suctioned up to 600 times a day doesn't sound like a super stable patient for your very first job out of nursing school, but that could be few and far between.

Maybe you could shadow his nurse for a few hours to see if it's a good fit, as well as to see if it would be in your comfort zone. It IS good experience and a small step toward working in a PICU, but it can also be dangerous if you don't know trachs and vents inside and out. There's a lot of rationale that goes into respiratory nursing, and it can be difficult to gain the needed knowledge outside a hospital setting. Above all, remember it's YOUR license. Do whatever you need to in order to protect it. You worked hard for it! Good luck, let us know what you decide.

[PediLove2147, BSN, RN]

I was in the same position a year ago! I was nervous I would be limiting myself but it's been a year and I am no closer to finding a job in acute care. Thank god I took the job, I would be waiting tables right now otherwise.

Take it and continue to look.

[MBrickle]

Thanks for the input. Yes, my concern in my experience level and him having such critical needs but the mother seems confident I could do it as she learned and so have his grandparents. To clarify, he does not get deep suctioned. They just suction the length of the trach as he can mobilize his own secretions to some extent but if he works too hard he has a sensitive gag reflex and he will aspirate (which is their biggest concern for him.) He is only vented at night (on CPAP) when he is very, very ill to help supplement his breathing. The one advantage to the situation is that I received trach experience in two clinical settings, along with ventilator experience...it's not much but I would say its a bit more experience with that than the average grad. I'm shadowing his nurse next week to see what it's like...other than needing suction and tube feedings he can ride his bike, play basketball outside, etc. and rarely is vented unless very ill. I would plan to really read up on his vent and know how to access it in an emergency to provide him stabilization until emergency services can arrive, and he doesn't receive CPT b/c his bones are too fragile so the mother doesn't allow it...when he isn't sick he is only on two meds: a neb and an inhaler.

I would never do anything that I don't feel capable of, but I also see this as a means of paying my bills, getting experience as I look for another job to supplement my income, and getting my feet wet. The job would be similar day-in and day-out, and I think it would really help my assessment skills as I would become very familiar with the subtle changes and workings of one little boy, and really cement my assessment skills for the future....I'm still deciding but thanks for the input!

[mookyjoe, BSN, MSN, APRN, NP]

I'm a new RN and looking for a job, but the only jobs I have had interviews for have been LTC. The first one I had to decline b/c I felt with that with only one CNA and 10 sub-acute pts I could not function or provide safe care 5 days a week and this second interview left me flabberghasted after being interviewed by a LPN. But not only that I would be oriented by a CNA the DON assured me so I would know the ropes . Am I being snobby about not taking that job? I don't understand how I will understand my duties as a RN if a CNA is showing me how the computer works. I don't think this new RN grad is gonna get a job. I feel like giving up and just moving onto grad school for some mundane Master's degree.

[~newRN]

Hi MBrickle,

It sounds like great experience! Especially if you are interested in pediatric critical care. Good luck!!