No trach experience

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I have only worked in a non-medical nursing specialty for about 5-10 years. I have started working for a company that provides home care and other things. I have been asked to care for a patient with a trach. They use a ventilator at night. I have only done a trach dressing change in a lab at school. I have suctioned patients before, and am fairly comfortable with this. I have never done a trach change.

The primary caregiver of this patient has a medical background and needs relief at times. They stated they can go over everything with me just one day. My question is IF I read up on trach care/watch videos for 3-4 hours and have this one hour overview of the dressing change, suctioning, and trach change...will this be enough? Or, should I tell the company I am not comfortable doing this? Not all job assignments the company provides are this medically involved, so I should have other options in the future. However, I don't want to seem incompetent or like a non-team player that leaves all the harder assignments for their other nurse. HELP!

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

That is not sufficient training or experience for independent care of a trach patient. Both of my agencies require 8-12 hours of classroom plus lab & videos then 24hrs minimum of preceptored shift work.

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

Sounds like private duty, not home health. This is certainly not enough training and is very dangerous. Suctioning is one thing (even that still has its risks), but changing a trach is risky if you've never done it and many things can go wrong very quickly.

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I've changed a trach about 5 times and I'm still not comfortable doing it alone and don't know if I will ever be comfortable doing it by myself. I have made everyone, I work with, aware of this fear. You're not incompetent. You're looking out for yourself and most importantly the patient. Just be honest to your employer and I'm sure they'll understand. Don't ever do anything your not 100% comfortable with.

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Specializes in pediatrics; PICU; NICU.

If the patient is on a vent at night, you need vent training, too. Even if you won't be working nights, anything can happen & there might be a time when the kid needs the vent when you're there.

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The family may be willing to "hold your hand" for a longer period of time until you get comfortable but that is shifting the burden of your training away from your employer, where it belongs.

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Is the family member with med experience staying with you in the house for their break? I would only agree if I could get enough tiem with another more experienced person until I was comfortable. I have turned this down before. I have finally been offered a position (private duty) where the experienced RN's will be with me for several weeks. So, I feel good about it. Practicing on dummies is one thing, but real life is another. Talk to your agency about your concerns, either they will give you more time and instruction or they will just give you other assignments. Not something to feel dumb about at all.

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Specializes in Peds(PICU, NICU float), PDN, ICU.
The family may be willing to "hold your hand" for a longer period of time until you get comfortable but that is shifting the burden of your training away from your employer where it belongs.[/quote']

The problem with the family teaching is some parents swear they know it all about trachs when they don't. Read some of the trach boards by parents and you'll see what I mean. They think because they know one piece of info that they know it all. Parents are great for showing where things are in the home and giving specific info about the patient. Some parents are as knowledgeable as we are about trachs, but many aren't.

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The problem with the family teaching is some parents swear they know it all about trachs when they don't. Read some of the trach boards by parents and you'll see what I mean. They think because they know one piece of info that they know it all. Parents are great for showing where things are in the home and giving specific info about the patient. Some parents are as knowledgeable as we are about trachs, but many aren't.

I believe the original post mentioned that the parent was a medical professional.

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Specializes in Complex pedi to LTC/SA & now a manager.
I believe the original post mentioned that the parent was a medical professional.

Doesn't matter. The agency is still responsible to provide adequate training, orientation & preceptorship. A family member with a "medical background" could be a pharmacy tech from CVS or a hospital janitor. Even if a nurse not all nurses are qualified in trach/vent she could be a nurse that doesn't work in direct patient care and only experience is caring for their child.

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This is a very dangerous situation that you are putting yourself in (for your patient and for yourself).

If you are not competent (although proficient would be better) in suctioning, trach changes, emergency trach changes, ventilator management, ventilator troubleshooting, assessments for the vent-dependent patient and CPR for neck breathers, you should not be on this case.

Yes, in our house, we took new and inexperienced nurses. But I didn't leave the house, had extensive knowledge of trachs and vents and we had been caring for my son for a long time.

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