New grad s/p two days

Nurses LPN/LVN

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I graduated in May with my lpn, passed NCLEX and got a job as a pediatric homehealth LPN. I got no training, didn't follow any nurses/shadow, took a 40? med math test and got a binder about various health conditions, working vents, suction and charting. After two days heres where i stand...I am the nurse, hear me roar!

Two days later, many firsts, lots of new information, skills and just the beginning of my o crap moments. I first day ever as a home health pediatric LPN, my nursing director meets me at the house, introduces me to the kid and parents. Hands me a binder with plan of care, and random instructions and information...then leaves. After she leaves, the parent asks if I mind if she goes out for breakfast....sure? O btw he will need his meds within the next hours, they are in the drawer and fridge. Bye! Here I am a new grad nurse, 2 semesters of college, 22 individual days of shadowing a nurse in the hospital, all alone with a child who has an artificial airway, feeds from a hole in his stomach and too little to communicate anything to me. I got this right? Wait how do I give meds through a gtube, I watched a video on this in class about 9 months ago, and did it ONCE in the hospital setting. Do I mix them all up, can I do that? Will they interact with anything? Am I going to kill the kid?? Ok I looked up a few things, I got this. Meds are ready,just gotta connect the tubing to the gtube. I can't get it to stay, im goingto pull the tube out. I really can't get the tube to connect, the kid is thrashing around,wants to get down, has his blankie in the way of my vision ahhh I need help. Google somemore...alright I got it. Finished the messy task, spilled the water, but hey he got his meds right? I am so proud and excited. I just gave my first medication administration by my self, no teacher over me, no nurse watching me, I just did it!! The first of firsts. After playing and messing with the kid, its time for trach tie changing. Well I've been around trachs in the hospital and have helped changed countless trachs and trach ties. I've suctioned ONCE before in my entire life, I got this. Well wait, Im used to in the hospital there are two people always incase we need to bag the kiddo or anything happens to the airway. Your telling me I have to do this ALONE, BY MYSELF, for the second time ever, an hour away from any hospital, and good20 minutes away from civilization. I have to mess with this kids airway ALONE? Time goes by, Im very slow, the kid is fantastically patient for me, I only pinch him once, super nervous, but gosh dang it I GOT IT. Another first..my first trach care alone. First day goes great otherwise.

Second day has more firsts than the first day. Second day family asks me for "advice" The last five years as a tech I've been asked a lot of questions, I answer them the best of my ability but I ALWAYS finish with ( in the acute care I can say this) " but be sure to talk to your nurse or doctor about it". I almost say those words today to my patients family, then I remember I AM THE NURSE. Now its no longer advice, but its PATIENT EDUCATION and its my OBLIGATION as a NURSE. Alright, get through medication administration again , piece of cake this time. Well I notice my kid has a bit of secretions, working a little hard to breathe. Hey I can problem solve, this is easy...lets just hook him up to the pulse ox, double check hes fine. WRONG...his stats are dangerously low. WTH, *** do I do. Quick call respiratory, grab the nurse and stand by to help as needed ( that's what I've done the last five years of my life) NOPE..megan you are the nurse, you are the respiratory therapist in this position . I have to act, and I have to act fast.Ok I make sure my ambu bag and vent is near by and okay..but I don't want to use them as ive never EVER initiated vent use. Problem solve and QUICK...oxygen and breathing treatment...( my phone is next to me incase I give up and call 911 and introduce myself as a new grad nurse) After breathing treatment stats go up..but not much, quick suction....alright stats go right back down . More oxygen and some puffs. Alright stats are up...I saved him, he didn't die....I got this. Yet the entire time this is going on the kid is looking at me "screaming" for help, choking on secretions, I want to call the mom and 911, I need backup I have no idea what im doing. Deff doubting myself. " O **** this is me, I have to do something NOW" went through my mind a few times during that episode. After all was situated I even thought.." I don't want to be a nurse, its just too stressful, peoples LIVES directly are in my hands" After it was all done I really just wanted to cry, it was a scary first, a stressful first, but with the fabulous education I received I was able to handle the situation. Here I think..I am the nurse hear me roar. The other first I had was with feeding rates. Again more doubt. I am grateful for nurse friends I can call for advice in times of struggle. Order was for one amount at one rate. Patients having feeding intolerance and mom request I change the rate. BUT WAIT..am I allowed? Will I LOSE my nursing license..Am I GOING AGAISNT DOCTORS ORDERS. Nope! I am THE NURSE, I can assess the situation and my kid will be getting the ORDERED AMOUNT. At a SLOWER rate..in the PATIENTS BEST INTERST. I WILL DOCUMENT reason for CHANGE, and be JUST FINE. Again, I AM THE NURSE , and my judgment is needed to ensure the patient will be okay. Five years of being a tech in the hospitals has given me incredible learning experience, I've seen it all, helped with it all, and heard it all. But I have always worked under the nurse and doctor, they have always been a resource for me. They have always covered my butt. Now this new range of responsibilities, obligations and requirements is overwhelming. In the home health setting I am everything I have. I know I am skilled and competent, I need to stop doubting myself, I need to trust my instinct. I am a skilled damn good nurse, and I know I will have many more first, and many more o **** moments, but I will get through them successfully and learn ongoing. I got this ( fake it till you make it right?? ) My one goal will be not to kill anyone...all new grads have that common goal right?

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Specializes in Pediatrics, Emergency, Trauma.

I don't know where to start... :eek:

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Specializes in Emergency.

Take this with all relevant contexts: "RUN...."

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Specializes in corrections and LTC.

Get out of that situation before you lose your license, which means now.

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I'm glad you posted this. You need to know the lack of training you received isn't ok. Yes you did fine in this situation, but the next you might not be able to turn things around. They should have sent you to be vent/trach trained somewhere or at least should have done it at the homecare agency itself. There is no excuse for them putting that child and your license in danger. Again it isn't your fault, it's theirs. They know they have an excited new grad eager for experience and are cashing in on it. I had a homecare agency do something similar to me as a newer grad and I was too dumb to realize it until someone else pointed it out to me. We are that voice telling you that you are not in a safe situation. Tell them to train you right or find another company that will. Best of luck with your career.

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Specializes in Hyperbaric Medicine and Wound Care.

I disagree with the posters who would suggest the you run from this challenging case. As I read it I was nodding "yes" to myself remembering the time that it actually hit home that "I was THE nurse". Mine was a geriatric patient on a vent with weeping bilat LE diabetic wounds. My first shift I probably sweated off 10 lbs. of body mass. The second shift at least 5 lbs. By the third shift, and beyond, I knew what to do. And, more importantly, when to recognize when I was truly out of my league, and out of my scope of practice. In today's nursing, what you describe is a standard Home Health assignment. Parents have been living with the challenges for X amount of months and are used to it. Your fellow agency nurses are used to it as well, and have forgotten what it feels like to be newly minted, and thus, didn't take your fear and lack of experience in to account when assigning you the pt. But, YOU DID IT! You knew enough to pulse ox the pt, and to suction (even if that went so-so your first go around). Pretty soon you'll be sucking mucous like a champ! (finger on, finger off, finger on, finger off). You administered meds and (I'm guessing) feedings as well (Did you remember to check for residual?)

Welcome to nursing, OP! It is all you expected it would be, and more! Regardless of what some on here will say, you have a f**king license to practice f**king nursing! Quite the Adrenaline rush, isn't it?

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