Private Duty for New Grads

Specialties Private Duty

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1) First of all what is the difference between home health and private duty? My state BON advises against new grads working "home health"........HOWEVER....

2) I have been offered a pediatric private duty position with an agency offering extensive training.....several shifts being mentored with each client, I can ask for more if I need it, and lots of in office training. I feel really supported by the agency. I am several months out of school and this job is flexible with my needs.

3) But I don't want to take a job that is such a big "risk". I have MD's in the family who are concerned about me taking this position.

4) I really need a flexible job though, something relatively low stress, and I cannot work full time at this moment, so apart from the "risk", this job seems perfect.

My decision is not yet set in stone.

To the person who sent me a private message, I appreciate your input. I don't have enough posts yet to reply to you.

By the way, not saying experience doesn't matter, but those humidifier stories really strike me as a nurse who did not receive adequate training on how a vent works.

I actually don't think that either of those issues has to do with how the vent works but more with common sense and things you "just know" that comes from experience.

so ventmommy, have actually had any good "inexperienced" nurses? Competent ones who you felt were "Succeeding"?

Specializes in Complex pedi to LTC/SA & now a manager.
so ventmommy have actually had any good "inexperienced" nurses? Competent ones who you felt were "Succeeding"?[/quote']

I've only worked with a few new grads. Those most successful in PDN/HH were mature (attitude. & demeanor not necessarily in age) , were cognizant of their limitations of skills & knowledge and thus knew when to ask for help or additional training (the whole knowing what you don't know is as important as knowing what you do know), and had either some sort of healthcare (CNA, HHA), customer service or a child or family member with a complex medical situation or developmental disability. (The last part--experience with DD/complex seemed to help with the comfort level of interacting with the family).

The less successful were almost obnoxiously excited (not understanding it takes weeks if not months to have sufficient training & experience not to mention a schedule opening to get the coveted full time or day shift hours) and overestimated their skills/experience. Such as "I can handle any emergency with a chronic child as I was an EMT/first aider/babysat a lot. " yet not be able to tell the difference between a nebulizer, suction machine and a cable tv box.

Wow, well that is NOT me. I am overly cautious, sometimes TOO much so I think this could be a great area for me to find my confidence, but I absolutely will not hesitate to ask someone if I am not sure about something. And I will not use any equipment if I do not fully understand how it works---I mean come on, those humidifier stories, that's exactly the kind of things I'm always afraid of happening...it demonstrates a lack of common sense, a lack of fully understanding what you are doing. I guess I shouldn't underestimate myself when it comes to making sure I get the orientation I need, because if I don't feel ready, I will not work the case. Thank goodness my agency has promised me so much orientation.

Specializes in Complex pedi to LTC/SA & now a manager.

Just be strong enough to insist on adequate training & orientation. It wouldn't be the first time an agency promised extensive training had a hole in the schedule and convinced a new employee they were ready for solo work.

You don't want to be overly cautious. & hesitant. Such as there are some convinced CPT (chest physiotherapy) is painful and brutal looking. When don't correctly and aggressively it can make the difference in a complex patient staying in home vs a full blown pneumonia with respiratory distress and an extended inpatient stay. I've seen nurses & therapists barely pat the patients back No where near enough to properly mobilize secretions which is the whole purpose of a CPT order. (I can tell you from personal experience it is NOT painful and makes a huge difference when suffering with tenacious secretions and a weakened cough. )

I have had good experiences with new nurses. And their attitude was much like JustBeachy described. They knew they were inexperienced. They knew that our house was an amazing training opportunity. They knew that that one inner canula trach change on the adult mannequin was not anywhere near the same as an emergency trach change on a suffocating toddler. They absolutely respected the fact that I knew more about my son's diagnoses, medications, and equipment than they did. They did not complain in the least with my impromptu oral quizzes about emergency procedures or things on the vent or medications. They knew that I had every manual for every piece of equipment as well as cheat sheets for settings and they were expected to read and know what it meant (not memorize it). They knew that for the first umpteen shifts, I probably wouldn't even shower, let alone leave the house. EVERY nurse was fully aware of my rules concerning alarms - if you don't know why it's alarming, DO NOT SILENCE IT because I won't know there is a problem if you are silencing them away. Also, I will never be mad if you wake me up or interrupt whatever I am doing because you have a question or problem.

I did not allow routine trach changes to be done alone. I did, on several occasions, allow off-duty nurses to come (paid by the agency) to the house on trach change day so that the off-duty nurse could work with the on-duty nurse to do it together and I just stayed in the room.

As a new grad, if you are willing to learn, recognize that you likely don't know a lot, are absolutely committed to learning, can react calmly and logically in an emergency, have awesome assessment skills and if you can find a family that is experienced in every facet of the child's care, has a stay-at-home parent and the parent is willing to train you, you will probably be fine.

I can guarantee you that the fastest way to **** off a parent and lose their respect is for a new nurse to say "but we learned it like this in nursing school" because a lot of things in nursing school (like changing trachs) are not at all like the real world.

On the topic of CPT, I do it on my husband because he LOVES the way it feels when he is the least bit congested. I also do it on all the kids if they are really junky. Most of them like to sing or hum because it makes cool sounds while you're doing it.

Specializes in Complex pedi to LTC/SA & now a manager.

Off topic but funny story. I used to have a golden retriever/white lab mix. She was jealous in a funny way. If someone was getting a back rub she'd maneuver herself in between so shed get one too. My mom was doing CPT on me. She must have been bored since she started pounding on my back too. So I had a dog that did CPT. She was rather intuitive and would pound my back at the first sign of congestion or wheeze. I truly miss that dog.

I have one client that needs occasional CPT. The first time I did it in school the aides were shocked. But he likes and thinks its funny. They realized he was laughing not crying.

Specializes in Peds(PICU, NICU float), PDN, ICU.

There is also the problem with the agencies having you just train with any nurse. Some nurses have no business training another nurse. They train the new nurse wrong or give the wrong info and them the new nurse thinks they are doing right until something goes wrong. Also, some parents think they know more than the nurses. Ventmommy is not that parent at all!!! But I've had parents swear they know more than the nurses just because they were trained how to do a procedure. But the parent may not know why they are doing something or when not to do something they were taught. That's where we come in, but if the parent trains you wrong, you won't know to correct them. Some parents will lie to get whatever they want.

I was called this week to go to a case out of town. Apparently the trach/vent newborn has coded a few times at home with new to vents nurses. Those nurses were trained by other nurses from the agency after passing an agency class/test. I know one of the events with the kid was a nurses fault. This stuff happens all the time. But the agency is fine because the warm body was there and the agency is getting paid for the shift and the kid survived so the agency will continue to get paid. Disgusting, but true.

OMG SDALPN that is CRAZY!! WOW, you are really giving me some food for thought here. YIKES.

Ventmommy, I hope I work with a parent as awesome as you are! I would love to have that much guidance.

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