Pediatric home health questions

JustBeachyNurse, LPN · 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 ???

Are you willing to risk a child's life if you make a mistake with no back up? The trach is their airway. There is little room for mistakes.

There is a reason reputable agencies require a minimum of a year experience plus offer extensive training (online, classroom, simulation, preceptorship over a several month period) before a nurse can work with pediatric trach patients even as an orientee. I work for 2 agencies (one national, one regional ) in pediatric home health & private duty both have the same policy.

JustBeachyNurse, LPN · May 2, 2014

In some areas Bayada Home Health offers a new grad program with extensive orientation, skills lab, classroom & preceptorship. One criteria was a recommendation from your pediatrics clinical instructor. These new grads start with basic care (Meds, resp/nebulizers, g-tube, seizure precautions) with extended case orientation with an experienced preceptor.

This is a better choice than on-the-job training on a medically fragile child with a trach.

MerissaS · May 2, 2014

These are all very good points thank you for your recommendations. I'm definitely inclined to reconsider this and at least really delve into what kind of training and orientation this agency provides. But no I do not want to put a child's life at risk. That is the LAST thing I want to do.

mluvsgnc · May 2, 2014

Hi Merissa-

I was a new LPN grad when I got my first nursing job: PDN for a pediatric pt. w/a trach and GT (among other challenges). I took a trach training class from my agency, and then oriented three times (24 hrs) with other nurses on the case before I went on my own (I had the option to train more if I wanted).

It has been a successful foray into the nursing world for me. While my pt. has a lot going on, he's mostly stable and, here's a bonus, has strong family support! These factors have helped me be successful as a new nurse in PDN. Plus the fact that I'm super proactive with the case and provide great care

So I think it depends on the case. I don't believe it is a black and white issue of new grads should or should not do PDN- I think there are several factors to consider. If your instructor told you about the job, she must believe you capable, right? I would find out more before declining anything. And check out the PDN forum- it will give you good perspective on the pros and cons of the job.

Esme12, ASN, BSN, RN · May 2, 2014

thread moved for best response

mmc51264, BSN, MSN, RN · May 2, 2014

I have been a nurse for 2 years in a hospital and have zero trach experience. I did HH aide work for a ped pt w/G-tube. You have to remember w/ped pts is that the parents are very involved, probably know more than you and will turn on you in a heartbeat. Make sure if you take the job that you have your own insurance. I wouldn't touch this one.

OrganizedChaos, LVN · May 2, 2014

I have been a nurse for 2 years in a hospital and have zero trach experience. I did HH aide work for a ped pt w/G-tube. You have to remember w/ped pts is that the parents are very involved, probably know more than you and will turn on you in a heartbeat. Make sure if you take the job that you have your own insurance. I wouldn't touch this one.

I've had parents who weren't that involved. It really depends sometimes.

JustBeachyNurse, LPN · May 2, 2014

I've encountered several cases that parents were hands off when nursing was in the home. Whether work, family obligations, other kids they trusted the agency to send a confident, experienced, qualified nurse to work with their child.

My one agency has a new grad program we've had to pull a few new grads from cases because they were out of their skills/experience and there was a patient change in condition. (The newer grad that nearly got sick because an infant with an NGT vomited...she thought the NGT (for supplemental feeding) would prevent vomiting..was noticed by the new mom)

ventmommy · May 3, 2014

I am not always in favor of new grads and this is from a parent's perspective. However, in the right home, with the right skills, a willingness to learn and a good agency support system, this could work.

That being said, you need to fully understand the ramifications of caring for a trached child. The trach is (usually) his only airway, because of respiratory failure, upper airway obstruction, BVCP, etc. If your emergency trach change skills are not top notch, you could permanently brain damage or kill the child.

I always gave new grads a chance. But I never left them alone, I was absolutely proficient in my child's care, I was completely on top of everything that was happening, I trained all the nurses (even the most experienced ones) on how things were done for my son and why they were done that way and I believe that new nurses deserve a chance.

It didn't always work out. A couple didn't like my lack of trust in their abilities. In my world, trust is earned, not given. One I just couldn't stand. She had a terrible attitude. And the rest worked out.

If you are going in to a home where the parents are out of the house while you are there, it's not a good fit. You really aren't ready to be on your own with a trached child. If this child needs to be suctioned 40 times an hour, also not a good fit. If the agency DON is not going to answer your call on the first call, every time, it's not a good fit. If the parents aren't willing to train you and deal with your learning curve, also not a good fit.

I'm not trying to completely dissuade you but I think you have a lot of questions to ask and a lot of things to think about.

JustBeachyNurse, LPN · May 3, 2014

^^^^listen to vent mommy. She's a highly experienced parent of medically complex/fragile children with trach/vents (by CHOICE as she fosters & adopts these special kiddos) and we are honored to have her input on these boards from a parent/caregiver point of view. She is also healthcare savvy, while not a nurse, she is an experienced critical care medic.

SDALPN · May 3, 2014

New grads have no business doing private duty. As others have said, you can talk to private duty nurses in the PDN forum. You stated that a family member will train you. There is a reason nurses teach nursing school and nursing skills. Would you be comfortable learning from a lay person at school or a nurse? Same thing in the home. We are in the home to teach the parents, not the other way around. If the parent knows more than you, that's not good (Ventmommy is the exception). Kids change faster than adults. When things go wrong, they happen fast with kids. You don't have time to think or lay out your supplies before doing a procedure...you just work. Just because you need work isn't a good reason to take the job. You have a license and you need that license for many years. Look at the long term of it, rather than short term. If you lose your license on your first case, there is no more nursing and your time in school will be wasted. Plus you live with knowing the harm you caused to a child. Come back in a few years and read your post and you'll see how scary it really is. Also medicare/medicaid require a year of nursing experience, so it's fraud if you are misrepresented. These nursing agencies will tell you anything you want to hear simply because they want warm bodies with licenses. If you lose your license, another nurse will take your place and the company will continue to profit without you. And they will throw you under the bus!