On call with no experience. Help!

caliotter3 · Apr 30, 2011

Your post reminds me of the time an infusion nurse visited us for a patient in the middle of the night. She was clueless and was asking the staff what to do. It was interesting to say the least. Could you arrange some more shadow visits and get the phone number of your backup resource? I would try to get the number of at least one person who knows more than me. Good luck.

G'smommy · Apr 30, 2011

I'm making a list of things I need before I'm on call next week. I am requesting a list of staff phone numbers as well as manuals for every pump we use. I'm not clueless about taking care of the patients. I'm just clueless as to what to expect when on call. Like do you get a lot of questions about pump alarms or VADs that are not flushing? Are there a lot of things you have to go out in the middle of the night for or does it usually wait till am?

IVRUS, BSN, RN · May 2, 2011

I'm making a list of things I need before I'm on call next week. I am requesting a list of staff phone numbers as well as manuals for every pump we use. I'm not clueless about taking care of the patients. I'm just clueless as to what to expect when on call. Like do you get a lot of questions about pump alarms or VADs that are not flushing? Are there a lot of things you have to go out in the middle of the night for or does it usually wait till am?

The home infusion company that you work for should have the best answers for these questions as they should know their populi... however:

1. Know your scope of practice for the state you live in as it relates to infusion and equally as important, follow your agencies policies.

2. If it's the agency's policy to only "go" to calls during specific hours, then that is what you'll stick by. So getting a call a 2AM may not be an emergent issue, except by the patient.

3. Always have a list of "hazardous" zip codes.. or areas which you should not go alone into, or at least, not after dark.

4. Education of the patient and their s/o or family is so important in home care. You'll need to reinforce this education which can be done by having a firm grasp on your agency's policies and procedures. This P&P book should be with you at all times, unless you've gotten to the point where it becomes second nature to you and you can recite it in your sleep. LOL

5. Know your pharmacy hours... Can you pick up Cathflo for an occluded PICC at 6pm for use first thing in the morning, or will you have to be at the pharmacy in the AM.

6. Will you physically be placing the IV lines, (short term peripheral, MIdline or PICC's) or will you just be trouble shooting and making referrals?

7. Get quite intimate with all of the therapies that your agency provides. Know the side effects and manifestations of each drug/therapy. i.e. a patient on Chelation therapy with IV Desferal wants to take a walk on a cold Jan. morning with her CADD pump... Can she do it? What precautions do you give her?

A patient on low dose Dobutamine via ambulatory pump has gained 1 lb in the last week... Is this clinically significant?

8. You will be asking alot of questions initially, but as you gain knowledge and confidence, it will get better.

Hope this helps.

G'smommy · May 2, 2011

Thanks IVRUS! I have a feeling I've signed up with a not so good company. I'm betting they don't have P&P. I've asked so many questions and haven't really gotten answers. Thanks for taking the time to answer.

iluvivt, BSN, RN · May 3, 2011

Well they better have some P and Ps. I can not imagine they would not. I agree with everything IVRUS has said. I have worked for a home infusion company since 1994. I used to work for Apria in Ca..but there infusion component was bought out and I was hired by that company. I also worked for a short time for a nationwide company. They all had very extensive policies and training manuals. My current Co has now switched everything to a company website. I can tell you the things we get the most common calls on

1. Flushing and how to do it. It used to be how to draw up NS but now everyone uses pre-fills.

2. The next is spiking and priming and getting the air out of tubing

3. PICC with blood at the site (almost always a newly placed PICC)

4. Pump issues. Yes you need to know the pumps backwards and forwards..especially the terminology used by the pump company. One of the ones we use if you say resume when you hang a new bag of medication instead of repeat the infusion will complete long before the medication is infused. You will be working with ambulatory pumps and syringe pumps for mostly antibiotics and steroids. Will you be infusing IVIG?

5. A TPN (3 in1 ) can be a bit complicated if you have not done it before. You have to know it really well to teach another.

6 GOOD TEACHING is the key to success in home care. Find out immediately if the company sends out a drug profile for each and every drug they send ,including the flushes. So say for example your pt is on 2 antibiotics that have a known complication of ototoxicity and nephrotoxicity . You need to direct them to the pt drug profile and review that with them so they know what to report. You also then need to document that you instructed them on this and the pt and caregiver know what actions to take.

I think you need to get their master teaching list and you need to be signed OFF on every pump they use and every therapy they use. This may take a few weeks but it is not fair to send you out after only a few visits. The company also should be concerned and what to document your competency. You also need an entire day in the office reading through the policy and procedure manual. Yes its boring but I always insist everyone I train do this. I think you need to go back and advocate for more orientation. You do not want to shortchange yourself or your patients because they need to fix a staffing problem. Did you ask in the interview how long an orientation you would get? You want to succeed here

G'smommy · May 3, 2011

Thanks so much. I will be asking for these things today. I'm studying my butt off to be competent and putting together all the resources I can find to have onhand.

iluvivt, BSN, RN · May 13, 2011

How are things going?