Nursing Student as PSW

[EspressoYourself, BSN, RN]

Hi there,

I was wondering if I anyone could extend some advice to a Nursing Student based in Ontario in their second half of the BScN program.

I recently had a job offer to care for a person in their home. It is a PSW/Caregiver position managed by the family for another family member.

Because this is not through an agency, and I am STILL a student - What are some of the things I should consider? I'm aware I am not supported under the CNO if I were to fulfill this position, so I am wondering if there are specific precautions I should take?

Some of the tasks I am being asked to perform are administering meds through a g-tube, as well as tracheotomy suctioning/care, and using a floor lift. The patient is also on a ventilator.

I was told I could train with other care givers, and that I will receive all the assistance and training I need until I am 100 percent confident to care for the patient.

I hope to hear from you all! Thank you

[hellohobbit]

Hi, I'm working as a PSW in hospitals during my nursing school years. Always remember that you're an unregulated healthcare provider and you're definitely not supposed to do any nursing skills like meds administration, tube feeding, trach care etc. You can assist but not do/perform for them. You should confirm your role with the agency again because from what I know, you're NOT suppose to do all these. Patient's safety is always #1!

[dishes, BSN, RN]

@hellohobbit, you need to consider the patient's environment, in this case the environment is the patient's home and the patient/family is the employer, not an agency. A patient/family can hire unregulated workers and train them (or have other staff train them) to do all of the patient's activities of daily living.

[dishes, BSN, RN]

@espressoyourself, suggest you ask the patient if they have previously or currently have a nursing student working for them? if so, can you speak to them before you make your decision?

I don't know if you are aware but there is a transitional home ventilation service offered through Westpark healthcare centre, if you are interested, there is a video on the website describing a patient's experience of using the service to transition from ICU to the community.

The more you look into people with disabilities living in the community, the more you will realize that it is possible for people with complex disabilities to live safely with the support of trained unregulated healthcare workers. Some patents in this situation like to employ nursing students as the learning/training curve may be slightly easier and students already have basic patient safety awareness.

[LPN2BECanada]

I am working as a HCA/PSW for both facilities and in home support bonded and insured, but be aware that an HCA (PSW, RCA, YCW, PCA) can only provide medication reminder. HCA with a Medication Management/Administration certification can administer certain types of medications. Still, HCAs are not allowed to perform nursing skills, unless it is delegated by a RN and under close supervision.

Since a HCA is an unregulated heath care provider, anything like this can happen. The best way to summarize is that, you should be provided with the best hands on training for the delegated tasks you'll be required to perform and your client should demand that you be checked off properly for the delegated tasks you'll be required to do at least by a qualified professional like a nurse. And that you should feel confident and safe to do it.

[EspressoYourself, BSN, RN]

@espressoyourself, suggest you ask the patient if they have previously or currently have a nursing student working for them? if so, can you speak to them before you make your decision?

I don't know if you are aware but there is a transitional home ventilation service offered through Westpark healthcare centre, if you are interested, there is a video on the website describing a patient's experience of using the service to transition from ICU to the community.

The more you look into people with disabilities living in the community, the more you will realize that it is possible for people with complex disabilities to live safely with the support of trained unregulated healthcare workers. Some patents in this situation like to employ nursing students as the learning/training curve may be slightly easier and students already have basic patient safety awareness.

Thank you for your feedback! I have decided to take the job, and I have been training with another nursing student who has been working in this position for quite some time.

I intend on learning more in depth about the ventilator with the suggested resource thank you!

[EspressoYourself, BSN, RN]

I am working as a HCA/PSW for both facilities and in home support bonded and insured, but be aware that an HCA (PSW, RCA, YCW, PCA) can only provide medication reminder. HCA with a Medication Management/Administration certification can administer certain types of medications. Still, HCAs are not allowed to perform nursing skills, unless it is delegated by a RN and under close supervision.

Since a HCA is an unregulated heath care provider, anything like this can happen. The best way to summarize is that, you should be provided with the best hands on training for the delegated tasks you'll be required to perform and your client should demand that you be checked off properly for the delegated tasks you'll be required to do at least by a qualified professional like a nurse. And that you should feel confident and safe to do it.

I understand, but depending on environment like dishes mentioned, i am able to perform certain tasks.

You may not be allowed to perform these tasks as a PSW due to the restrictions your agency has in a facility.

But as for a home-environment, technically the employer is the patient themselves - and I am allowed to perform routine scheduled tasks such as medication administration, suctioning etc GRANTED I have been evaluated for competency. This would be the same as a spouse or child caring for the patient, therefore the delegator is the patient.

I spoke to Nursing faculty, and I was told that the main priority is that I am comfortable, and if so then it is good experience.

Thank you for your feedback

[dishes, BSN, RN]

I understand, but depending on environment like dishes mentioned, i am able to perform certain tasks.

You may not be allowed to perform these tasks as a PSW due to the restrictions your agency has in a facility.

But as for a home-environment, technically the employer is the patient themselves - and I am allowed to perform routine scheduled tasks such as medication administration, suctioning etc GRANTED I have been evaluated for competency. This would be the same as a spouse or child caring for the patient, therefore the delegator is the patient.

I spoke to Nursing faculty, and I was told that the main priority is that I am comfortable, and if so then it is good experience.

Thank you for your feedback

You are correct, ADLs can be delegated to unregulated care providers and/or family members, did you search the CNO for documents that explain the requirements for delegation and working with unregulated care providers?

[LPN2BECanada]

I understand, but depending on environment like dishes mentioned, i am able to perform certain tasks.

You may not be allowed to perform these tasks as a PSW due to the restrictions your agency has in a facility.

But as for a home-environment, technically the employer is the patient themselves - and I am allowed to perform routine scheduled tasks such as medication administration, suctioning etc GRANTED I have been evaluated for competency. This would be the same as a spouse or child caring for the patient, therefore the delegator is the patient.

I spoke to Nursing faculty, and I was told that the main priority is that I am comfortable, and if so then it is good experience.

Thank you for your feedback

Hi there,

No matter how hard our intentions are trying to achieve 100% mistake free in medication admin and performing delegated tasks, there will be times that we will make a mistake. However slight or serious it is, patient safety can be compromised. In my case, I am insured/bonded by my facility, agency and my union I work with.

Hope this helps..

[dishes, BSN, RN]

@lpntobe, your thinking is based on your experience with an agency, presumably you do not work in Ontario because lpn is in your user name. The op is in Ontario where some clients have direct funding to self-manage attendant services. These clients are responsible for directing their own care and being knowledgeable about their medication and treatments. The clients who use the self managed route, often report that they are safer with the care provided by staff they have trained themselves, then they were when they previously relied on agency staff.

[LPN2BECanada]

@lpntobe, your thinking is based on your experience with an agency, presumably you do not work in Ontario because lpn is in your user name. The op is in Ontario where some clients have direct funding to self-manage attendant services. These clients are responsible for directing their own care and being knowledgeable about their medication and treatments. The clients who use the self managed route, often report that they are safer with the care provided by staff they have trained themselves, then they were when they previously relied on agency staff.

I work in British Columbia, Canada and we also have similar direct funding arrangement to self-manage attendant services. It's also true that care givers properly trained to perform delegated tasks can provide safer care to clients. But I am not sure what Ontario provides in regards to protection of unregulated care givers in the event of a mistake in care which causes harm to the patient? In my case, I'm insured/bonded by my agency and in the facilities I work with. Unless of course one thinks one never makes a single mistake in care every time so no need to worry about this liability.

[dishes, BSN, RN]

Being bonded means there is insurance for theft, it isn't Liability Insurance.