pediatric HH, please help

caliotter3 · Jul 20, 2017

Regardless of the agency parent company, the personnel in each office conduct their business how they see fit. The DPCS, clinical supervisors, and staffing coordinators in any given office can be as different as night and day from one day to the next, when there is a change of personnel. Sending the nurse to a meet and greet with the family without first giving the nurse a rundown on the patient's medical condition, starting with the 485, plan of care, is a warning sign of an agency that might be free and loose with day to day precautions. This is particularly telling when a nurse has already identified herself as being new to home care. One would think that there would be increased efforts at support rather than trying to get her to commit with a "hard sell".

Wlaurie, RN · Jul 20, 2017

Well, I had one yr experience working ltc before I took a peds hh job in December. I will preface my comments by saying when I graduated nursing school I knew I didn't want to do vents or children yet here I am. I had a sad experience with a child during one of my nursing rotations and both my parents died from lung ailments so I didn't think I wanted to deal with either one. When I took the job I was scared like you are. The agency that hired me told me to take as long as I wanted to orient. I worked one full shift and came in for a few hours for a few days. I took copious amounts of notes bc that how I deal with things to help me feel I'm prepared. Did a lot of research online also. Haven't found a good peds vent book yet but I made my own folder up with info that I have learned that I carry with me. My agency has been great to work with and so is the family I work with. But in the end the scary part is that you are working with a sick child and there is just you there to deal with it. However the parents can be a great resource and help. Don't be afraid to say you haven't had as much experience with whatever it is. You can somewhat fake it with saying show me how you do it so I can do it the same way type of thing which is ok bc as long as it's good practice it's continuity of care for the child. Go over in your head or on paper what you would do in an emergeny. I.E. not getting good air I will bag and suction bc it's proably a mucus plug. The great thing about home health is that you have one patient. I feel that the care I give makes a difference. You proably will like it and will do better than you think. I would encourage you to give it a try. Don't be afraid to say you need more training, ask questions, and try to think out the worst case scenarios. Also I was quick to be hired. They are not going to get the highly qualified icu nurses bc they pay less. Most of the time it is a low stress job. I have enjoyed it and I've gotten good at trach and vents which is good experience. Hope this helps!

tami2017 · Jul 20, 2017

Exactly , you are so right caliotter3. Should i just leave the agency? I orderd a bunch of books about pediatric HH but feel that company training including hands on is a lot more effective

tami2017 · Jul 20, 2017

Thank you Wlaurie your reply it was very helpful. Im so sorry for what you have been through. Kuddos for pushing through those obstacles and doing great. I will put in a lot of effort using books i bought and online videos and can only hope my journey turns out well like yours.

Kooky Korky, BSN, RN · Jul 20, 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.

You need to get the diagnoses, the med list, the care plan and get them now, not 5 minutes before you meet the parents. Do your study on your own time in the office (if concerns about HIPAA) if need be.

Get to the Clin Sup. Today.

No need to bemoan your lack of Peds experience. Just do this education NOW so you can give good, correct, confident care. Take the initiative and tell the agency what you need and want - info on this specific case, charting, policies and procedures, skills, everything.

If the agency can't or won't at least get you started on orientation for this case, seek a different agency that will treat you - and their patient - better.

Kooky Korky, BSN, RN · Jul 20, 2017

You are so right i wish this agency was half as prudent as you are. Im afraid i will get very little training and will be thrown in to sink or swim. I have a bad gut feeling and feel like backing out of the whole thing. As a psych nurse all i did pretty much was give PO meds and do psych assessments. Nothing clinical at all except maybe IM shots. This is a whole new world for me and i honestly dont understand how they could have hired me, i think its irresponsible.

They hired you because you are breathing. They need workers so they can make money. Nothing wrong with that. They're not wrong to hire you but they do need to orient you and train you well. Everybody starts at the beginning. I know how you feel. I was once hired for a job that no one else wanted, although I didn't know it at the time. I stayed about 8 years. It had good pay and benefits and they did give a good orientation and training. Yes, it was scary and painful at first. But I ended up loving it and the people I had come to know.

Did you do any tubes, IV's, dressings, feeding, toileting, positioning in school? How long have you done Psych? What made you want to switch specialties?

Get a box of gloves from the agency office to have with you when dealing with the tubes, etc. I once got to an HIV case and there were no gloves! The full-time nurse on the case had taken them with her when she got off work Friday evening and to H with the weekend nurse! The patient's friend ran out to a pharmacy to buy a box for me/other fill-in nurses.

Think about some other basic supplies you might need and take those to the case with you - if you accept it after orientation. Scissors, tape, saline, alcohol pads or bottle of it, gauze pads - clean and/or sterile, a hemostat, half a dozen working pens, rubber bands, a little stapler or paper clips, all charting forms you might need, flashlights, tongue depressors for mixing stuff, oral med syringes, mortar and pestle or pill crusher. Better to have and not need than vice versa. Some clean newspaper on which to set your purse, your backpack, or other personal belongings. It's hot now but in cold weather, you might leave your coat in your car trunk.

Get a graduated pitcher, too, in case you have to measure anything. Where's the Ambu bag? Where's the phone you will use in an emergency while you bag?

Take some paper or a small notebook on which to write your daily plan of action, notes, questions.

Take your food and beverage, your own toilet seat covers/paper towels/Kleenex, a fan and extension cord if you are hot a lot, charger cord for your phone/tablet, maybe a little bleach for cleaning your bathroom, etc. Is there a comfortable chair and writing surface for your use? Sufficient lighting for you? Clip-on lights in case you need to supply your own light. Take a sweater, feminine hygiene items, and clean underwear in case you need them. You never know. Again, better to have and not need than need but not have. Take some small bags to dispose of your personal trash. Take it home with you and dispose of it there if you'd prefer. Use a rolling bag, such as you'd roll in the airport. Get a decent size and strength roller bag so it will last. You can always use it in other than your work, so it's worth the investiment.

Make sure you know all of the phone numbers for parents, doctors, a neighbor or whoever the family says is the person to call for immediate, close by help.

You should also carry a sterile urine specimen cup and suction catheters, also an extra cannula for the trach if there isn't one there already.

Make sure controlled substances are properly accounted for (count at shift change every time) and stored. Make sure about who handles keeping prescriptions and the supplies refilled/restocked. Mom? Nurses?

Study procedure for if the feeding tube comes out or if the trach comes out. Study on trachs - cleaning, cuff deflation, speaker button, etc. Do these now.

Are you a real new nurse? How long have you worked Psych? I think you'll do well if you get them to start your training now, before the interview. You need at least the info about the pt and the case, diagnoses, meds, and what treatments are involved.

Best wishes. You will do well if you start taking the initiative.

Their training rate of pay is probably negotiable. It's good you're getting a full shift.

caliotter3 · Jul 20, 2017

Agencies tend to be hit and miss with orienting a nurse new to home care (and/or nursing skills). Good, comprehensive training programs are few and far between. Changing agencies at this point is no guarantee of getting a better situation training-wise. You need to be proactive with getting the clinical supervisor to work with you. The orienting nurse will show you how s/he does things, but it is the responsibility of management to show interest in your training. If they insist on withholding information about the patient before you go to the home, I would look elsewhere. But keep in mind that anywhere you go that is not a psych environment, will pose a responsibility on your part to do your homework. You get your homework assignment by reading the 485.

tami2017 · Jul 20, 2017

Thank you so much now i know what to ask

tami2017 · Jul 20, 2017

Thank you so much. Thats a lot of supplies where do i get them?

Yes im a new nurse, 1 yr psych experience.

tami2017 · Jul 20, 2017

Thank you so much. Thats a lot of supplies. Where do i get them?

Wlaurie, RN · Jul 21, 2017

Agency told me not to bring anything but I always carry a large nursing bag. I have my own pulse ox stethascope and such. Supplies are furnished by the state case worker. I am always well stocked which from what I've heard is not the norm. Just to clarify I only work with one patient. Some home health see several clients a day so not sure how they are stocked.

Kooky Korky, BSN, RN · Jul 22, 2017

Thank you so much. Thats a lot of supplies where do i get them?
Yes im a new nurse, 1 yr psych experience.

Most of them will likely already be at the pt's home. But your agency should have a supply closet for things like gloves, alcohol pads, dressing materials, and certainly for the charting forms. Others, like fan, extension cord, pens, scissors, stethoscope, you can get from your home or your favorite place to shop. Buy them, own them, keep stuff in your bag or car trunk. You won't need every item for every job.

Don't forget your food and beverages, your own silverware, whatever seasonings you like.

Why are you changing specialties?

If you become the primary nurse on a case, you will be responsible for keeping supplies stocked probably.