Not enough training


Ive been in Home health for 1 year and it has been a very steep learning curve. The computer documentation takes hours and hours and I feel I haven't been adequately trained in several skills including the computer software system. The other day I was assigned to admit a new patient on the weekend to teach them how to self administer TPN in their new PICC line. Ive been promised for the last year they would send me out to train how to do this but never got around to to it. I've administered TPN in the hospital years ago but teaching a young, stage 4 cancer patient and their family how to do it in their home using needles and adding additives and the CADD pump etc etc .was daunting not having seen it done before. When I told my boss I felt very unprepared to do this since I hadn't been trained in it before she said she was sending out another new nurse who hadn't done TPN before but was familiar with IV admissions from her last job and the cadd pump and she felt confident we could "figure it out" together and I could probably look up a video about it on UTUBE. We were both quite unnerved about this. Luckily I was able to find one of the other experienced nurses to come with me. She ended up doing the teaching and it was very helpful for me. Im really angry about this situation but not sure what to do. The older nurses all say they have had in services about these things and training when they started years ago but since budget cuts etc and several nurses retiring early theres no one to train me. I guess I could refuse to go out but I've managed to survive thus long by Gods grace through helpful coworkers. What would you have done? I feel like going to my boss's boss and asking her is this how we train magnet nurses in home health now? We refer them to watch a Utube video? This is not safe or fair to the patient, the family or me.

nutella, MSN, RN

1 Article; 1,509 Posts

I worked in home care and while they provided an overall good orientation, there was no way I could learn everything within orientation as some things show up occasionally and then not for a while for example home TPN, pleurx catheters to drain, spheres infusion systems and so on and forth. Do they have a responsibility to train you adequately ? Absolutely. Are they providing the training in a way that is considered pro-active and sufficient? well - often not. What you experienced is not uncommon and I am not saying it is right. If you are unable to perform a task because you have never done and learned it you should absolutely speak up and tell your supervisor that you can not see the patient because of it and to provide training.

Your agency should have a sign off sheet on which your skills are signed off to have evidence that you got trained.

Anyhow - here is how you can go forward.

Make a list with all the skills that you have not learned to this day (example CADD , pleurx or what else) and send an email with that list and include a nice text like

Dear xyz ,

as you know I have been a nurse for xxx with the agency. I enjoy community nursing very much but have noticed that I still need training for certain skills :

List of skills

As I am striving to provide the best care to my patients, I wonder if there is a timeline for me to attend training with the educator. It would be beneficial for me to make joint visits with the educator or a nurse who is proficient in those skills.



I guess you get the idea . The thing is that you send the email to your manager / supervisor and cc it to the educator and director of nursing. If they want to talk to you about it, you can also ask if new nurses will start soon and if you could attend some of the training that you have not gotten with them.

If you are proactive this way it shows initiative and not just complaining and will look "better"...