pediatric HH, please help

caliotter3 · Jul 18, 2017

Were you given a copy of the plan of care (485)? That is where you start. After reading it, you look up any unfamiliar meds or procedures. Ask questions of the clinical supervisor. Were you sent to the home for a meet/greet with the family? Take your cues from the family. At some point they get used to orienting a new nurse to their family member's care. You should have an orientation from the primary, or other assigned nurse. If there is no other nurse, the primary caregiver will orient you, or even the clinical supervisor. The orientation will last from two hours to an entire shift for a complex case. If at any time you feel uncomfortable, you can decline to accept the case. Likewise, if the family does not take to you, they can reject your assignment without hard feelings. (In the beginning, I took my Peds text in my backpack along with my med book and my procedures text. Eventually I pared these down to my med book, and now I try to keep my cell phone/tablet/laptop charged).

caliotter3 · Jul 18, 2017

Is this a new case or an established case? Has the clinical supervisor or DPCS oriented you to the documentation? If this is a new case , you should take blank forms with you for your first shift. If the agency has not provided preprinted MARs, one of your first tasks after you introduce yourself to the patient/family and they have oriented you to any special ways they want things done, is to make up the MARs for the case. It sounds to me like you are going to be the primary nurse on a newly opened case, so you can't rely on things to be in place for you.

tami2017 · Jul 18, 2017

I didnt get my assignment yet, but i understand from the recruiter that its an established case in their agency. I have no idea yet what type of disorders the child has. I need learning material about peds in general, and HH peds care and advise what to ask from the agency as far as training and preparation so im not sent to the family unprepared...

tami2017 · Jul 18, 2017

Thank you so much. I havent received a case yet but the recruiter wants me to meet the family next week, before i train on anything or know what i need to know about the child. I need to come prepared to the interview with the parents so they dont get my clueless vibe and reject me as their nurse. Im a psychiatric nurse and know nothing about medically fragile children and their care, and dont want to be sent "cold" to meet the parents who will most likely ask questions such as "are you familiar with g tubes? Are you familiar with cp" etc etc.

I feel like i need a lot more training than a med surg nurse with my very non clinical background.

caliotter3 · Jul 18, 2017

You need to be honest without shooting yourself in the foot. Your clinical supervisor is your best resource, both to prep you in general, and to give you pointers about how to approach this family. Hopefully she has already discussed you with the family and they are open minded. Don't be discouraged if the family does not accept you for a trial run. Families of hh peds patients can be very anxious and particular, no matter if the nurse has decades of experience. The agency should have given you a copy of the 485 to review though, so everybody's time is not wasted should you decide against taking the case after reading the plan of care.

tami2017 · Jul 19, 2017

Thank you so much. I hope the agency has a clinical supervisor. So far my contact has been the recruiter, and i dont think i can ask him clinical questions.

Kitiger, RN · Jul 19, 2017

Your first move is to talk to the clinical supervisor. Every agency has at least one.

As I've done this for over 30 years, I would be comfortable simply asking the clinical supervisor to tell me what the orders cover. You are new to this, so you need to see the 485. This does not break HIPAA because it is needed for you to do your job. You probably should simply make an appointment with the clinical supervisor to come in, read the 485, and have the opportunity to ask questions.

You understand that you don't know what you don't know. Good for you! You can do this. :)

babynurse4u · Jul 19, 2017

Thank you so much. I hope the agency has a clinical supervisor. So far my contact has been the recruiter, and i dont think i can ask him clinical questions.

Tami, I was a clinical manager for several pediatric HH agencies for over 16 years. This is my pet peeve: sending out nurses who have no pediatric experience on cases with no training (you did not indicate that they are training you). My former agency has a pediatric training class we put nurses new to peds in. We also did an all day orientation to the paperwork, documentation, etc. and we checked off on skills prior to the nurses even meeting the family or accepting an assignment. We had a clinical supervisor or a preceptor to train the nurses bedside in the homes as well. You should not accept an assignment if you have not been properly prepared, and have every right and obligation to request assistance and training. Peds is an awesome specialty and if you are properly trained and prepared you will love the kids!

tami2017 · Jul 19, 2017

Thank you so much. Your former agency sounds great, very thorough. I wish my agency trained that way. From what i understood training is just on specific skills, such as g tube and trachs, with no training an peds and on paperwork. I will ask to make sure, now that i know what to ask based on what you described is out there as far as training.

tami2017 · Jul 19, 2017

Thank you so much. Do i read the 485 before meeting the family or after? I would like to know before so i can study up on the childs medical problems. The recruiter is pushing for me to meet the family first, maybe to see if they will take me in the first place? How long is the peds training? I hope it covers all the disorders i will be dealing with, it cant be just a few hours right?

How many shifts do i get to precept with a nurse at the child's home?

Brita01 · Jul 19, 2017

It's ok to freak out before experiencing something new, that's what we do when we care about doing a good job. I freaked out before my first homecare peds case because I had been away from the bedside for 6 years. My first peds case was 4 years ago and I'm still working in the field, still getting butterflies when having to take on a new patient that I'm not familiar with. Here is what helps me a lot. Make sure that on your first shift, you orient with the current nurse on the case for the entire shift and take detailed notes. Example: 0800 - Assessment, VS, check/change diaper or brief; 0830 - Start tube feeding (write down formula, rate, and how long); 0900 - Give meds (write down all meds due); 1000- Check diaper, reposition; 1100 - Bath, g-tube care, trach care; 1200 - Start tube feeding, etc, etc, etc. Write down what is done at each time until the end of the shift. At some point during the shift, check your notes against the plan of care and the MAR and thumb through the entire chart to see what's in it. If there is no current nurse on the day you go out and the patient has been with the agency a long time, the parent(s) is used to orienting new nurses to the case. They will take you through the steps of the day and you can take notes from them. I hope this information helps you out on your first case. Welcome to pediatric homecare, these kids will win your hearts.