Pediatric home health questions

OrganizedChaos, LVN · May 1, 2014

Are you doing visits or staying in the home?

MerissaS · May 1, 2014

I haven't gotten the specifics of the shift times yet but the current nurse who works for them works from 4:30 to 11:30pm

OrganizedChaos, LVN · May 1, 2014

Sounds like private duty, not home health. I would caution any new nurse to do PDN, you're the only one there with no back up.

If you can get a good agency that will give you a low acuity case (although the chance is there with any patient that something bad could happen) & enough orientation, maybe.

allnurses Guide · May 1, 2014

Hi Marissa! Congrats on your upcoming graduation! I think you will find a lot of useful information in the Private Duty Nursing Forum, as that is where we normally discuss working shifts as opposed to doing multiple visits to different clients in one day.

I will say straight out that there are people who say that a new grad should absolutely not work in this environment, but I am not one of them. However, this would depend on a number of factors which you must have in order to be successful.

Generally, those factors will be the agency you work for, the family situation of the child and the child's medical status. Chronically ill children cared for at home can have a wide variety of levels of medical stability.

You will need a very supportive agency with a Case Manageir and DON who are willing to take the time needed to train you and are actually available by phone in a short amount of time for consultation. You'll need a family primary caregiver or another nurse on the case who will give you a thorough orientation and shows willingness to answer all your questions. You'll need to go through the child's care plan with a fine-tooth comb and make absolutely sure you know every aspect of the child's diagnosis and care.

You may find that this field of nursing has some challenges that arise from our working within their homes, so it's best not to start out with a family that is so dysfunctional agencies are always looking for new nurses due to a high rate of turnover. These are not the best cases for a new grad to start with though the agencies are often willing to place them there to fill empty spaces in their staffing rosters.

Children who receive skilled nursing care in the home can vary a great deal from a stable school-age child with a g-tube, a child who is trach/vent but has generally stable respiratory status, to kids who require constant monitoring of oxygen sats and suctioning and other parameters which put them into a category of "medically fragile".

If you have a lot of support, a good family situation and a child who is fairly stable I don't see why you shouldn't take the job. If you search within the Private Duty forum you'll find lots of discussion of this topic and experiences of new grads who have successfully worked PDN and gone on to jobs in hospitals or pediatric outpatient clinics. Best wishes!

KelRN215, BSN, RN · May 2, 2014

Sounds like you are talking about Private Duty nursing and not home health visits. What is this child's medical condition? Does he have a trach? A vent? On TPN? G-tube? You will be on your own in this environment and I do not believe it is the best environment for a new grad. My agency does not hire new grads but one that we often co-vend with does. They had a sentinel event involving a 10x dose of a medication administered to a patient we shared by a new grad who didn't think to question the dose despite the fact that she needed to administer mutliple syringes of this medication for the dose she gave.

Here's an article one of my colleagues used to give to nurses to read when they came in and said they had sufficient trach/vent experience but couldn't back it up: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fstage-nursing.wkh-mr.com%2Fnu%2Fovidfiles%2F00004045-201202000-00007.pdf&ei=0OFiU7mcB6mO7Qarn4GICw&usg=AFQjCNHgR76BI_H2hv9uyxsuqe-DVVKOlQ&sig2=Hv9PawJnW2zuwVmYX55qfQ&bvm=bv.65788261,d.aWc

LadyFree28, BSN, LPN, RN · May 2, 2014

Sounds like you are talking about Private Duty nursing and not home health visits. What is this child's medical condition? Does he have a trach? A vent? On TPN? G-tube? You will be on your own in this environment and I do not believe it is the best environment for a new grad. My agency does not hire new grads but one that we often co-vend with does. They had a sentinel event involving a 10x dose of a medication administered to a patient we shared by a new grad who didn't think to question the dose despite the fact that she needed to administer mutliple syringes of this medication for the dose she gave.
Here's an article one of my colleagues used to give to nurses to read when they came in and said they had sufficient trach/vent experience but couldn't back it up: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fstage-nursing.wkh-mr.com%2Fnu%2Fovidfiles%2F00004045-201202000-00007.pdf&ei=0OFiU7mcB6mO7Qarn4GICw&usg=AFQjCNHgR76BI_H2hv9uyxsuqe-DVVKOlQ&sig2=Hv9PawJnW2zuwVmYX55qfQ&bvm=bv.65788261,d.aWc

I was trained by the two nurses that authored the article through the VACHP through my home care agency when I was a new grad; this program should be the rule, not the exception...and some of the instances and scenarios I have seen where T/V nurses couldn't back it up; during a 6 month review, I snatched an ambu bag out of one of my colleagues hands during a sim because she didn't know how to bag a trach pt, despite her status of being one. :eek: Even though it was a sim, I couldn't stand to watch her stumble through the sim, my instincts went into overdrive. :shy:

I am one in the camp to say that starting out as a new grad in PDN can be successful; however, one MUST be willing to advocate for themselves properly before going on cases; menacing, ask questions, DON'T take a case until you have been trained AND had another more experienced nurse precepts you, and above ALL, REALLY comfortable in taking a case; NEVER NEVER NEVER take a case that you are NOT comfortable with EVER.

I am one whose experience in home care and have been a trach/vent PDN nurse for most of my career; it has allowed me to be marketable for step-down/critical care positions; I currently work at a post acute facility for children; most of my load is care with trach/vent children; that's my niche. :yes:

MerissaS · May 2, 2014

I am still waiting to hear back on the details of exactly what the acuity is of this client. The only detail I have been given about them thus far is they do have a trach. Sooo knowing that it's obvious oil not a low acuity patient. Which I have ZERO experience with trach care. But my instructor is the one who told me about this position and she said that her daughter in law is the one who currently has this job would be willing to train me.

JustBeachyNurse, LPN · May 2, 2014

I am still waiting to hear back on the details of exactly what the acuity is of this client. The only detail I have been given about them thus far is they do have a trach. Sooo knowing that it's obvious oil not a low acuity patient. Which I have ZERO experience with trach care. But my instructor is the one who told me about this position and she said that her daughter in law is the one who currently has this job would be willing to train me.

Run away. New grads should NOT be doing complex cases especially trach cases. If anything basic care (meds, seizure precautions , g-tube feeds). Trach care requires a comprehensive orientation , preceptorship and training not just orientation by another nurse. Reputable agencies require at least a year of working for the agency in addition to a year of experience before training a nurse on trach or trach vent. There is way too much that can go wrong that cannot be anticipated. Please reconsider this job

KelRN215, BSN, RN · May 2, 2014

I am still waiting to hear back on the details of exactly what the acuity is of this client. The only detail I have been given about them thus far is they do have a trach. Sooo knowing that it's obvious oil not a low acuity patient. Which I have ZERO experience with trach care. But my instructor is the one who told me about this position and she said that her daughter in law is the one who currently has this job would be willing to train me.

If you have zero experience with trach care, this is not the case for you and, frankly, an agency who would place a new grad with no trach experience on a trach case is probably not an agency you want to be working for in the first place.

MerissaS · May 2, 2014

Not even if they offered training? I mean they have trachs on med/surg floors so I have to get experience somehow ???

KelRN215, BSN, RN · May 2, 2014

Not even if they offered training? I mean they have trachs on med/surg floors so I have to get experience somehow ???

VERY different when you're in a hospital with infinite resources at your disposal and when you're alone with a critically ill patient at home and it's just you. On a Med Surg floor, you push a button on the wall during an emergency and you have 20 people in the room within 10 seconds. At home, it's just you and EMS may take quite a while to get to you. Please read the article I posted earlier.