Published
I started out in private duty Home Health in 2004. It is quite unique! Literally, every case is different, and if I had to come up with a blanket set of rules for this type of work, it would be very hard to do.
I seriously doubt that you will offend the parents and not know it, though. The one piece of advise I can give, is that very often these parents have over time, made adaptations and developed routines that aren't textbook nursing. Sometimes nurses who take the authoritative stance of hospital nursing into the patient's home, will irritate the parents, because through years of trial and error, they essentially know what works. If you respect that first and foremost you will have gone a long way to building a trusting relationship.
Families with a chronically ill child sometimes develop an actual aversion to anything that screams "hospital". If the child is 4, they've had four years of doctors, hospitals, clinics, meds, fears, grief, anger and frustration. Some families cope with that by becoming helicopter parents, and some are happy to get some free time and leave it to you to take care of their child.
Though it's important to observe the family and take your cues from them, we still have to assess, educate and communicate in our professional role or we wouldn't need to be there. Again, after you've developed a rapport with them, they will respect your opinions, just don't say, "I have to educate you now. It's part of my job." :)
About that sleeping thing? Yeah. It's quite common, actually. There are a bunch of threads over on the Private Duty and Home Health forums discussing that issue. Best wishes in your new job!!!
If you are caught sleeping on the job, you can lose your nursing license. I have been doing High Tech Pediatric home care for many years. One of the reason parents have night nurses is so they can sleep. In all my years of taking care of kids I have never met a parent who wanted you to sleep. I'm sure you will do fine. I was very intimidated on the first vent case I was on in the mid 80's. But, as you have already found, the vent has alarms. High pressure/ something is blocking or partially blocking the vent, low pressure/something is unhooked. I bet you are using an LP10, when I started there were LP6's. Relax, I know you can do it. As far as getting along with the parents. Just show them you are there to take the best possible care of their child you can. I have learned over the years that once you gain their trust, it's all smooth sailing from there. Good luck!
Suggest you do some reading in the home health forum. And that nurse that sleeps on duty is risking everything. On my first shift with a vent dependent child the father told me that he had to fire a nurse that was fast asleep while the vent was alarming. The vent alarm woke the father who was further away from the patient than the nurse. She was lucky that she got fired from the case, and presumably the agency did not fire her. I have had many parents or other family members who make "sneak" attacks at night to catch the night nurse sleeping.
Just wanted to add one more thing. NRS KarenRN has these posts with lots of links to helpful "nuts and bolts" sites dealing with all things ventilator.
allnurses: A Nursing Community for Nurses (Tracheostomy and Vent Information)
At the top of the Pulmonary Nursing forum are a bunch of "sticky" threads, too.
Thanks :) I guess I am just nervous because it is so different for me. I downloaded the manual for the vent from the manufacturer's website last night and skimmed through it, now I have that if I need it. I guess I just want to be as good a nurse as I am in the ICU, you know? It is a little hard for me to be the new kid on the block again, but I am learning.
I totally agree with the sleeping thing... Pt's mom told me this morning that she had one lady that was crawled up in there asleep before the patient was even in bed, blanket and everything. I was like... WHAT!? That's when I told her that I take this job VERY seriously, just like I would any ICU job that I have, and that she would never see me asleep. I value my nursing license much more than sleeping on the job.
The pay at this company is very good, I was surprised that they offered me $32/hr(very good for this part of the country). That is without negotiating. I can say the rate here because this is anonymous. They have a strict rule not to talk to coworkers about your rate, which I agree with.
I find myself focusing on goals for the shift. Wow, I haven't had to really think about goals in a long while!
*Be on time
*Don't fall asleep!
*Maintain professional boundaries
*Be really quiet and try not to wake up mom-after all, that's why I'm there, so she can sleep. But--
*Don't be afraid to wake up mom if there is an important need
and lastly
to read the information on the links you guys suggested... Thanks everyone.. I might be posting again with more questions.
I knew there was a reason I loved this forum.
At that pay rate, you are in heaven! Make certain you put forth every effort to keep things on a positive note! (And by the way, there are situations where the nurse is allowed to sleep on duty, with specific instructions from the patient or family to keep the lights off, etc., as long as they can respond to the vent alarm or other problems; however, I always tell my clients, even if the lights must be off, I'm sitting there awake because I can't monitor the vent and the patient if I am sleeping! I have my little flashlight that I use for this purpose.)
I started out in private duty Home Health in 2004. It is quite unique! Literally, every case is different, and if I had to come up with a blanket set of rules for this type of work, it would be very hard to do.I seriously doubt that you will offend the parents and not know it, though. The one piece of advise I can give, is that very often these parents have over time, made adaptations and developed routines that aren't textbook nursing. Sometimes nurses who take the authoritative stance of hospital nursing into the patient's home, will irritate the parents, because through years of trial and error, they essentially know what works. If you respect that first and foremost you will have gone a long way to building a trusting relationship.
Families with a chronically ill child sometimes develop an actual aversion to anything that screams "hospital". If the child is 4, they've had four years of doctors, hospitals, clinics, meds, fears, grief, anger and frustration. Some families cope with that by becoming helicopter parents, and some are happy to get some free time and leave it to you to take care of their child.
Though it's important to observe the family and take your cues from them, we still have to assess, educate and communicate in our professional role or we wouldn't need to be there. Again, after you've developed a rapport with them, they will respect your opinions, just don't say, "I have to educate you now. It's part of my job." :)
About that sleeping thing? Yeah. It's quite common, actually. There are a bunch of threads over on the Private Duty and Home Health forums discussing that issue. Best wishes in your new job!!!
You gave excellent and realistic advice to her - just wanted to offer you kudos for that.
The OP's original post reminds me of myself. I am in nursing school, currently a CNA. I have tried home health in the past and I hate it. The reason I hate it is because I am always afraid of doing something someone in the home won't like or maybe I'm not doing it the way the former CNA did or something. We all know how the older population are, many of them resist change. Some clients will tell you what they want but with the last one I had, no way. She is the sweetest thing and I miss her but it was always "Just whatever you want to do, honey". I could never be sure whether she was really satisfied with my work. My agency did get compliments on me so I must have been doing okay! But, I always have that uncertainty.
If you haven't been to Aaron's page, go. Now. Read some of the essays. Below is my favorite. (Actually I ahven't read some of the new ones.) I used to give this to new nurses I oriented.
I recommend NOT reading the boards until you've been in the scene for a while. There are some *bad* nurses out there and upset (as they should be) parents. A lot has changed since I jumped through hoops to prove I was competant, safe, and trustworthy to be hired by a HHA.
Welcome to My Home... I Think
By Sharon Burleson
Clarksburg, WV
Hi, Welcome to my home. I think, I mean, maybe you're welcome. I'm not sure yet. When I get to know you, I'll know for sure.
My child is disabled, and I need help to do all the things he needs done. So I need you. He needs you too, because he gets worn out and bored with me and sometimes dislikes me about as much as I sometimes dislike him (please don't start making judgments about me -- we just got started. It's just that I'm honest, and as much as he is the sole reason for my existence, there are times when both of us wear thin).
Your agency sent you here. I called for help, but I don't get a choice of who comes into my home and my life. you come at your convenience, usually between 9am and 3pm Monday thru Friday. I'm on my own evenings and weekends, when my other children tug at me and want and feel slighted and offended and I feel stretched to my limit. You call and tell me your coming Tuesday morning so I put the stack of unanswered mail and the unpaid bills in the cabinet with the cereal bowls, race dirty and clean clothes up and down the stairs, shove toys and unmated shoes in closets and under beds, and run the gauntlet with Fantastic to get fingerprints off everything, and then you call and tell me you have to cancel because of a meeting. Oh sure, I understand, yes, that's fine, Friday afternoon? Well, I was going to try to go to the library and maybe take a nap.... what? Oh. That's the only you have? Well sure, I know it's important that you come. And we really need help. Fine. Friday at 1:30. We'll be here.
My husband resents people coming in and out of our home. He says he feels as though he is living in a goldfish bowl. He says getting help means sacrificing our privacy and spontaneity. He can't scratch his stomach as he walks down the hall in his shorts anymore. Now he has to have clothes on and such in his gut and put on company manners. And he really hates it after you leave, because sometimes I cry because I feel inadequate and stupid and foolish and just plain wrong. Sometimes you make me feel that way when you act suspicious of what goes on when you're not here and try to trip me up when we're talking to find out if I really am doing the goals and objectives, of if I'm just taking the money and fudging the paperwork. Sometimes it's nothing you say or do, it's just that your perfectness unsettles my motherness.
Sometimes when you are great I feel threatened and because of others who came before you, I feel judged and talked about, and as though you have met with others and have developed a plan to implement on me.
I can't always tell when you're real, but my son can. So I watch him. If he responds and welcomes you, then I set aside my needs and cares and let you have everything I have, including my son. I have to trust you because he trusts you and looks forward to your step on the porch.
What? Oh, good grief! I forgot your paperwork again! Wait, I know it's here somewhere. I was working on it last week just after the hot water heater burst and right before my husband came home laid off. Wait... I think I wrote on the back when the bank called about the deposit to cover the overdraft. Yeah! I found them! Right behind the peanut butter ... wait, I'll just wipe them off a bit.
You know, I used to be normal. I used to have control of my life, my time, my home. Having a disabled child turned my life upside down. My priorities changed. What I would settle for changed. What I would ask for changed. Who I would accept changed. All that changed because my child needs things and people and ideas and funding. So my life consists of meetings, regulations, documentation and paperwork, social workers and agency people, policies and procedure manuals and administrative decisions, delays and rumors of delays in checks, people not showing up when needed, people quitting, and people showing up when they're not needed.
Please don't judge me. And I'll try not to judge you. You see, in the long run, if I don't measure up I still am his mother. So we're stuck with each other, and I'm willing to try to make the best of it. Help me to grow, help me to become better. Accept me as a person, not some perfect saint. I really DO know my child better than anyone else, so help me express that and put it to best use. Walk with me a ways, not to judge me, but to understand my role within the heart of my family. Give me tools and words and people that, like pieces in a jigsaw puzzle, interlock to allow for my strengths and compensate for my shortcomings.
Please don't push me past my endurance, because if you do, you'll see me at my worst; short-tempered, impatient, inflexible and emotional. I'm no good to my son then, either. Each one of us has that fine line. I try to recognize when I'm approaching my line, and usually that's when I'm most cranky and complaining to you. Please realize that one facet of me is the tired *****, just as real and acceptable as the superwomen who overcomes unbelievable obstacles. There are sunny days and then there are thunderstorms, all part of a temperate climate.
Well, anyway, hi. Welcome to my home. I think.
If you haven't been to Aaron's page, go. Now. Read some of the essays. Below is my favorite. (Actually I ahven't read some of the new ones.) I used to give this to new nurses I oriented.I recommend NOT reading the boards until you've been in the scene for a while. There are some *bad* nurses out there and upset (as they should be) parents. A lot has changed since I jumped through hoops to prove I was competant, safe, and trustworthy to be hired by a HHA.
Welcome to My Home... I Think
By Sharon Burleson
Clarksburg, WV
Hi, Welcome to my home. I think, I mean, maybe you're welcome. I'm not sure yet. When I get to know you, I'll know for sure.
My child is disabled, and I need help to do all the things he needs done. So I need you. He needs you too, because he gets worn out and bored with me and sometimes dislikes me about as much as I sometimes dislike him (please don't start making judgments about me -- we just got started. It's just that I'm honest, and as much as he is the sole reason for my existence, there are times when both of us wear thin).
Your agency sent you here. I called for help, but I don't get a choice of who comes into my home and my life. you come at your convenience, usually between 9am and 3pm Monday thru Friday. I'm on my own evenings and weekends, when my other children tug at me and want and feel slighted and offended and I feel stretched to my limit. You call and tell me your coming Tuesday morning so I put the stack of unanswered mail and the unpaid bills in the cabinet with the cereal bowls, race dirty and clean clothes up and down the stairs, shove toys and unmated shoes in closets and under beds, and run the gauntlet with Fantastic to get fingerprints off everything, and then you call and tell me you have to cancel because of a meeting. Oh sure, I understand, yes, that's fine, Friday afternoon? Well, I was going to try to go to the library and maybe take a nap.... what? Oh. That's the only you have? Well sure, I know it's important that you come. And we really need help. Fine. Friday at 1:30. We'll be here.
My husband resents people coming in and out of our home. He says he feels as though he is living in a goldfish bowl. He says getting help means sacrificing our privacy and spontaneity. He can't scratch his stomach as he walks down the hall in his shorts anymore. Now he has to have clothes on and such in his gut and put on company manners. And he really hates it after you leave, because sometimes I cry because I feel inadequate and stupid and foolish and just plain wrong. Sometimes you make me feel that way when you act suspicious of what goes on when you're not here and try to trip me up when we're talking to find out if I really am doing the goals and objectives, of if I'm just taking the money and fudging the paperwork. Sometimes it's nothing you say or do, it's just that your perfectness unsettles my motherness.
Sometimes when you are great I feel threatened and because of others who came before you, I feel judged and talked about, and as though you have met with others and have developed a plan to implement on me.
I can't always tell when you're real, but my son can. So I watch him. If he responds and welcomes you, then I set aside my needs and cares and let you have everything I have, including my son. I have to trust you because he trusts you and looks forward to your step on the porch.
What? Oh, good grief! I forgot your paperwork again! Wait, I know it's here somewhere. I was working on it last week just after the hot water heater burst and right before my husband came home laid off. Wait... I think I wrote on the back when the bank called about the deposit to cover the overdraft. Yeah! I found them! Right behind the peanut butter ... wait, I'll just wipe them off a bit.
You know, I used to be normal. I used to have control of my life, my time, my home. Having a disabled child turned my life upside down. My priorities changed. What I would settle for changed. What I would ask for changed. Who I would accept changed. All that changed because my child needs things and people and ideas and funding. So my life consists of meetings, regulations, documentation and paperwork, social workers and agency people, policies and procedure manuals and administrative decisions, delays and rumors of delays in checks, people not showing up when needed, people quitting, and people showing up when they're not needed.
Please don't judge me. And I'll try not to judge you. You see, in the long run, if I don't measure up I still am his mother. So we're stuck with each other, and I'm willing to try to make the best of it. Help me to grow, help me to become better. Accept me as a person, not some perfect saint. I really DO know my child better than anyone else, so help me express that and put it to best use. Walk with me a ways, not to judge me, but to understand my role within the heart of my family. Give me tools and words and people that, like pieces in a jigsaw puzzle, interlock to allow for my strengths and compensate for my shortcomings.
Please don't push me past my endurance, because if you do, you'll see me at my worst; short-tempered, impatient, inflexible and emotional. I'm no good to my son then, either. Each one of us has that fine line. I try to recognize when I'm approaching my line, and usually that's when I'm most cranky and complaining to you. Please realize that one facet of me is the tired *****, just as real and acceptable as the superwomen who overcomes unbelievable obstacles. There are sunny days and then there are thunderstorms, all part of a temperate climate.
Well, anyway, hi. Welcome to my home. I think.
Fantastic! Where is Aaron's page?
Magsulfate, BSN, RN
1,201 Posts
Hello my fellow nurses at Allnurses!
I just recently got a new job and am on my first night shift *alone* off of orientation. I have started working 3 nights a week for a company that does pediatric home health and private duty. My patient has a ventilator and that is all. This is my first HH patient and all my other experience has been in ICU, ER and LTAC ICU. I had about 6 months mixed pediatric experience when I first got my RN license but that has been several years ago.
I want this to work out because it would allow me the time to go back to school (online) and it is less stress so I could handle the hours along with my hospital job (a lot of stress sometimes).. and will totally help me catch up on my bills.
I wanted to hook up with other pediatric private duty nurses for advice. I am so nervous still, even though this is much less stress for me than it is to work at any hospital. I guess what I am really worried about is that I will do something to offend or upset the mom or dad and not even know it! I don't know why I think this, but it is a fear. I just want to be a good nurse for them and stay out of their way while taking good care of their child. I must have a very watchful eye all night, as the child is on a ventilator and moves around the bed sooo much at night, knocking the vent off.
But, what really suprised me was when my preceptor said she slept, and even did it in front of me. I would never do this! I guess I have seen how easily a person can lose their airway and code.