New nurse under pressure

[google addikt]

OMG. I just got my first job at a home health agency. And everyone expects me to know what i'm doing, and i'm just so scared of having a patient die on me. I've been assigned two patients both in stable condition but i'm just scared of something going wrong. Will i get the hang of this? The pressure is overwhelming. I keep researching the disease processes of my patients, all the medication side-effects. I'm scared i'm going to miss something. What if bowel sounds aren't present? What if I miss a rash beginning to form. I will just die if something happens on my watch. Please someone tell me that it gets easier and that eventually i'll get the hang of this.

[roser13, ASN, RN]

I don't mean to sound callous, but this is exactly why it is not always a good idea to be in home health as a new grad. I totally understand your fears. I would have had them also before gaining some years of experience.

Assuming that this is the only job you could find?

[google addikt]

Yea that's the only place that would hire me straight from school. Where would you recommend starting first? I feel like there are so many variables, so many ways things can go wrong.

[meanmaryjean, DNP, RN]

First off, if someone dies because you missed a rash beginning to form - well, that's just NOT going to happen.

Secondly, while it sounds more like you are working a private duty case- persons requiring nursing care at home are at home precisely because they are not unstable patients. They are chronically ill, not critically ill.

Take a deep breath, keep reading and researching, ask questions of your clinical supervisors and other staff.

[Jules A, MSN]

First off, if someone dies because you missed a rash beginning to form - well, that's just NOT going to happen.

Ummm yeah they could if its SJS.

Don't let me scare the pants off you, OP, MMJ is probably correct in that your patients are likely more chronically ill than critically.

[TheCommuter, BSN, RN]

i'm just so scared of having a patient die on me.

I think your anxiety is overwhelming.

In general, patients in need of home health and/or private duty nursing care are in stable condition with predictable outcomes. Statistically, they are the least likely to die on your shift. You are more likely to encounter death at a hospital or nursing home.

In addition, death is a natural conclusion to the circle of life for every person in existence, you and me included. Do not fear it. Reassess your views on death and dying, because these facets are nothing to fear.

Chill out. Relax. Learn all you can from the cases you have been assigned. Good luck!

[OCNRN63, RN]

I don't mean to sound callous, but this is exactly why it is not always a good idea to be in home health as a new grad. I totally understand your fears. I would have had them also before gaining some years of experience.

Assuming that this is the only job you could find?

Thanks for saying what I have been posting for years. It's the rare new grad that can thrive in home health straight out of school. I've done home health off and on, and even with experience it can be daunting.

ETA: I realized the OP is talking about PDN, which is a bit of a different animal from home health. Patients can be pretty darned sick in home health and require interventions at home that we did not that long ago in the hospital.

[KelRN215, BSN, RN]

I don't mean to sound callous, but this is exactly why it is not always a good idea to be in home health as a new grad. I totally understand your fears. I would have had them also before gaining some years of experience.

Assuming that this is the only job you could find?

I agree. And especially PDN, where you can usually max hope for 1 or 2 shifts of training. The lack of training in PDN is really appalling when you consider that the kids, while true that they are chronic rather than acute, might by one error away from death. I wish I could find this article that one of my colleagues used to give to nurses who overestimated their trach/vent experience. It was about a trach'd child who was normally vented only at night...agency sends in a non-vent experienced nurse for a day shift because the child isn't vented during the day. Child decompensates while nurse is alone with him, she calls Mom who tells her to put him on the vent but nurse doesn't know how to put child on the vent. By the time EMS arrives, he's pulseless and apneic. Non-clinical people working in agency offices are notorious for deciding that this patient is a "stable trach" or a "stable vent" and that underqualified nurses can be sent to the case.

[sirI, MSN, APRN, NP]

Thread moved to Home Health forum.

[caliotter3]

If your anxiety continues to overwhelm you then you likely won't be successful in any other area of nursing either. The best way to get over anxiety about the job, other than gaining the experience with time, is to do what you are already doing, researching on your own. It would be best if you had a heart to heart talk with your clinical supervisor or DPCS and come up with a plan for your training and development. If neither show any interest in your concerns, then it is time to look for a new employer.