New to PDN, HELP!?!

I expect my nurses to know how to do a trach change and how to troubleshoot a vent but I spend at least one full shift with them and train them on everything including the feeding pump, meds, vent, suctioning, trach tie changes, cleaning the trach and g-tube sites, when to take new supplies, where to leave me notes, how to work the CD player, how I like formula made, how I like syringes washed.

They must assist me with one trach change, the next week I will assist them. They must demonstrate proficiency in emergency procedures (my LO turns blue and desats into the 20s at the drop of a hat).

That being said, our case manager is AWESOME! She comes over whenever we need and we can call her for anything. And when she does come, she looks over the nursing notes and flow sheets, write down questions I have and gets back to me within 24 hours. And our nurses can call her for anything as well.

Thank you for your input. With much thought, I'm going to refuse this and other assignments without formal precepting, at least a shift or two. Client safety, reducing liability has to be foremost.

I'd still like others to chime in; not being precepted on a new job in a specialty you've never worked in before seems more and more insane to me the longer I think about it.

Will your agency let you work a couple of shifts with the existing nurse? I know ours will let new nurses do that if we want them to (which we do when they are new grads). Someone with experience like you have and the ability to critically think would make you desirable to parents. That being said, if you don't feel comfortable on the case don't take it. I HATE having to ask a nurse not to come back because he/she is overwhelmed by my baby.

There are a couple of really experienced nurses that post regularly on this forum and I hope they will respond to you as I don't know what "normal" is for an agency.

I worked as a new grad LPN out of school in private duty peds nursing, and I received extensive training. I had training classes on vents, auxilliary medical equipment, and trachs. I also had at least 1 shadow shift with an experienced nurse on any new cases I went to work on. I always was told to ask for more orientation if I felt I needed it and provided with the resources to obtain help if I had a question or situation come up. It is unsafe to be thrown into a situation like that without any training or orientation, and unfortunately, with it being your license on the line, you have to stand up for yourself. Good luck!

Hi Stacey-

In private duty nursing, who did you get the orientation from, since you are your own business? I don't need Need the orientation with skills, but I would need to know what type of charting to do, who does the POC, how to get dr orders, etc. Thanks for any help!

Putting a bit of pressure on the agency, I've agreed to shadow a nurse for ONE shift (as much of an orientation as I could work out!?!?!?). Then I'll decide if it's safe enough for the client and myself to work on my own.

I had a mix of orientation. I did more of an HR, policies, paperwork, etc type orientation at the agency's main office. I then had an orientation at each client I worked with, usually with another nurse. In one situation I remember the family doing the orientation, but that was something that had been okayed by my agency. (they were more than capable of it). As far as skills, while the basics are the same, some clients did things a little differently and I had to become acquainted with that depending on the case I worked on. I always felt free to ask for more orienation if I needed it, so I would definitely ask for more if you don't feel comfortable after shadowing. Good luck to you and let us know how it goes!