New grads and Home Health -placed on Vent Cases

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I have a question about working in home health. I'm a registered nurse in IN and employed at a small home health agency. My concern is that they have such a high need for staff that they are hiring brand new graduates, mainly LPN's and placing them with critical cases such as patients who are on vents; etc. With no training. My concern is for both client and nurse. We were all new to the field and naive at one time. Is it legal to hire a new grad for home health? And especially for complicated cases, such as vents being LPN's? I'm not downgrading LPN's and their capabilities,I've worked with some of the best LPN's who could run circles around me.

I fear that these new grads are being manipulated and placed in situations that may be out of their scope, especially as a new nurse, just for the company's sake of making a profit. And it's the nurse and the client whom are both being placed at risk.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Hello and welcome to the site.

Your thread has been moved to the Home Health Nursing forum where it should receive more views and responses.

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I am an Lvn who I believe fits into this category. I received my license in 2013 but go to life only recently was hired as an Lvn. I am SCARED in my current position. I have been with this company for about 2 months and really feel I need to search for another position. I am working with trach pt's and vents... I am not vent certified and was told I was going to be sent to get vent certified ( but that went out the window once they changed supervisor) Also work noc shift with no pay differential. My orientation consisted of being hired(not even a pretense of an interview) given my hrs and trimming consisted of two shifts with working nurses... I am comfortable with 2 of my pt's that are going to be my regulars but if something happens I am scared of doing the wrong thing.

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I'm a newly certified CNA working as a Home Health Aide for 1 month. I recently had an incident where I feel I was taken advantage of by my agency. There were several call outs by regularly scheduled aides and they were desperate for any warm body.

I was left alone with little to no information on a hospice case. Actually I was given incorrect information from the beginning and was put in several situations that I was not comfortable with and felt were out of my scope.

I learned quickly that Home Health is like the Wild West. It's up to you to be your own advocate and say NO to cases that require more experience. I will never go on another hospice case for my company again. I will stick with the assisted living cases and basic in home cases I have been doing until I get more experience.

I had no idea that Home Health Agencies were run like this until I worked for one and I'm shocked that there aren't more protocols and training provided. Oh and yes they absolutely take advantage but I can't believe they get away with it.

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I'm confused why this work is being called home health, isn't this Private Duty Nursing?

You could get more well rounded experience working on the home health side.

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Specializes in Complex pedi to LTC/SA & now a manager.
I'm confused why this work is being called home health, isn't this Private Duty Nursing?

You could get more well rounded experience working on the home health side.

Shift work is private duty. Most trach vent is shift work not intermittent skilled visits

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Specializes in Peds(PICU, NICU float), PDN, ICU.

This is PDN, not home health I assume. No new grad should be doing PDN. Too many risks. Many think they can handle it, not realizing they are over their head til it's too late. A good agency will offer lots of training. My agency won't put a nurse on a vent case until they have been with the company for about two years. The exception is verified experience.

I'm an LPN that went through the RN program. Last semester, I had to leave school for personal reasons. Sat for LPN nclex. Been doing PDN for many years. I work vent cases and have for years. In my opinion, experience can't be taught. If a nurse hasn't worked with a trach, they have no business working with trach/vent cases. Basics first. Not to mention, the additional complication of family dynamics and parents insisting things are done their way...which could be wrong. A nurse that doesn't know better may not catch what the experienced nurse will.

They have no safety net. They are your eyes/ears and the PCPs eyes/ears. Sure, they can call you or the physician. But nothing beats personally eyeballing the pt. Plus, peds/infants crash faster. There isn't time to make calls when things go wrong.

We all learned from somewhere. But this isn't the place to do it. That also goes for new grad RN's.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

As stated, this is Private Duty Nursing rather than Home Health Nursing.

And in the vast majority of states there is nothing preventing the hiring of a new grad for PDN work paid for by Medicaid. Similarly, there is no restriction for trach/vent patients to be cared for by LPNs. In my area, almost all PDN nurses are LPNs. The only thing LPNs can't do is IV work -- those have to be staffed by RNs -- and there are very few IV cases (for cases with chronic kids with a port, the parents usually do the IV work when needed and the rest of the care is handled by an LPN.

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As stated, this is Private Duty Nursing rather than Home Health Nursing.

And in the vast majority of states there is nothing preventing the hiring of a new grad for PDN work paid for by Medicaid. Similarly, there is no restriction for trach/vent patients to be cared for by LPNs. In my area, almost all PDN nurses are LPNs. The only thing LPNs can't do is IV work -- those have to be staffed by RNs -- and there are very few IV cases (for cases with chronic kids with a port, the parents usually do the IV work when needed and the rest of the care is handled by an LPN.

Now I'm getting confused. Haha! Can you please enlighten those of us who work for Home Health Agencies (per diem 2, 4, 8hr+ shifts per case) the differences between the two?

Also the OP is specifically talking about experiences at the Home Health Agency she/he works for so I guess I'm curious where this Private Duty topic came from. Is it called different things depending on location or are they actually two different jobs?

I'm just trying to learn, not give anyone a hard time. I start nursing school in the fall and I never heard the term private duty before. Thanks!

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Specializes in Complex pedi to LTC/SA & now a manager.

Generally speaking skilled intermittent visits (often lasting 30-120 minutes) by a licensed nurse. Nurse sees multiple patients per day. Home health. Home health aides work under a plan of care created by an RN and under the supervision of an RN/LPN, in conjunction with skilled intermittent nursing visit. Most are Medicare and adults. Very few pediatric patients get skilled visits with HHA. HHA work shifts in home health to supplement skilled visits

Shift work by licensed nurses for chronic care (seizure management, respiratory care, trach/vent, may accompany a child to school for 1:1 care) is private duty. Most clients are pediatric or young adult. Common diagnoses are CP, SMA, intractable epilepsy, SCI, TBI, neonatal or infant stroke, feeding tube dependent). HHA cannot do private duty nursing as they cannot manage trach-vent, give meds or manage tube feeding.

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Gues I'm private duty then. But I am technically a new grad I work with peds that need gtube feedings and have vent and trach...so yeah I feel like I really don't have the backup I need

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Specializes in Peds(PICU, NICU float), PDN, ICU.
As stated, this is Private Duty Nursing rather than Home Health Nursing.

And in the vast majority of states there is nothing preventing the hiring of a new grad for PDN work paid for by Medicaid. Similarly, there is no restriction for trach/vent patients to be cared for by LPNs. In my area, almost all PDN nurses are LPNs. The only thing LPNs can't do is IV work -- those have to be staffed by RNs -- and there are very few IV cases (for cases with chronic kids with a port, the parents usually do the IV work when needed and the rest of the care is handled by an LPN.

LPNs can do IVs. Depends on your state. We are taught IVs in school in my state. No certification needed. Some states require certification or classes beyond nursing school, but not all states.

I do infusion cases as an LPN. However, there are a couple of meds I can't give. We also can do TPN.

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