fairly new grad in private-duty nursing, question about orientation

  1. As a new grad BSN, I worked for six months in a SNF in 2010 before being terminated (long story that I could elaborate on but is not really the point of this post). I have been looking for a new job for about 2 months, have had several interviews with hospice agencies (which I would really like to get into), but no job offers; I don't have as much experience as they would like. I signed up for a home health agency that a friend recommended and went for my first day of training the other day. The child had a trach, a vent, and a feeding tube. My only previous experience with a vent and trach was one of my clinical days in nursing school over a year ago. After one 8 hour training session I was supposed to work independently on children with vents/trachs, but I did not feel comfortable being on my own after just one day. I asked for another training day and they are going to set me up with one. My question is, what kind of training is reasonable in this situation? I felt after one day that I was getting it, but needed more time. For example, I did not yet know where everything was in the home, as well as the documentation requirements of the agency (I studied the forms ahead of time but I feel like I need more practice), and wanted more practice with the new equipment. Is having just one day of training when you have not done this kind of work before the norm? One problem that contributes to this is that I find that adjusting to new environments takes me longer than other people (i.e. I am kind of a slow starter) and do not know what to do about it. I have overcome this in the past in other (non-nursing) jobs and been an excellent worker, but so far my nursing career has not gotten off to a very good start and I am discouraged. Any feedback and advice would be appreciated. Thanks.
  2. Visit elizabethgrad09 profile page

    About elizabethgrad09, BSN, RN

    Joined: Dec '09; Posts: 46; Likes: 41
    from AZ , US
    Specialty: 7 year(s) of experience


  3. by   caliotter3
    How did the family take to you? That will be your biggest help or hindrance. If the family is willing to work with you, you can learn a lot from them and fit in just nicely as time goes on. If the family is totally turned off by your lack of experience and are making you uncomfortable with snide remarks about it, you should pass up on this case. If the agency is willing, get another eight hours of orientation. They probably will not be willing to spring for more than that. Are you going to be the only nurse on the case or will the nurse training you remain on the case too? You can volunteer to come in on your own time (nonpaid) to observe (ONLY) to help you get more familiar. Watch her do trach care more than once, suction the trach more than once, give a GT feed more than once, etc. Then, if she is nice, she will give you her phone number so you can call with any questions that pertain directly to taking care of this patient, otherwise, call the nursing supervisor. The paperwork is easy, get a copy of a filled out form and use it as a guide. Normal orientation to a new client is one to two hours, paid, or up to four hours paid. Six to eight hours if there is an extremely complicated regimen. As you get more experienced, you will need less and less orientation. And remember to ask questions of the family. They are usually eager to help. HTH
  4. by   Blackcat99
    I got a 15 minute training with trachs and a 15 minute training with vents with my agency. I was lucky with my patient. His Mom spent hours training me on exactly what to do with her child. I was completely honest with Mom when I met her and told her I had no trach experience. Mom said she appreciated my honesty and said she would train me and she did. My patient has a trach only no vent. I told my agency that I will not do "vent patients."
    I hope you will get a good Mom who will provide you with good training.
  5. by   ventmommy
    Does the family like you and know that you are new? I much prefer nurses with AWESOME attitudes and good basic skills that I can train to take care of my child than a super-experienced nurse with a bad attitude!

    That being said, I would probably make you come places with me like the store, library, etc. rather than leave you alone with my baby until I was more comfortable with your skills.
    Last edit by ventmommy on Dec 24, '10 : Reason: I had bad grammar :(
  6. by   Elektra6
    I had one year of nursing experience and my agency sent me to a one day seminar on trach/vents and we had to pass a competency exam. Each year we have to re-pass this test. I also had over 30 hours orienting with different trach and vent clients. I feel really lucky to have gotten this training!
  7. by   ArwenEvenstar
    My first agency...a "mom and pop" one...a new nurse on a case would always orient by working a shift or shifts with another nurse on the case. If it was an easier case, the orientation might just be half a shift. But a high tech case, you could get up to 3 or 4 days!! Also depended on your past experience. I know this agency lost money paying 2 nurses to be on a case. But they were very thorough, and pro-nurse, and wanted to be sure the clients got proper care. I know now how very unusual this was!

    At Maxim, orientation was just in-service materials at the office. They said that the parents oriented you in the home. Generally, parent orientation would work. (As above posts mention...good parents will want to properly train you. And would never leave you alone with their child until you felt confident, and until they were comfortable with your skills.) But there are exceptions! I remember one high tech case where the family had basically withdrawn, let the nurses take over, and they really did not know all the details of caring for their own child. Sad, but true. An in-experienced nurse would NOT get a proper orientation by this family. And Maxim of course did not care.

    With home care in general (but especially with an agency like Maxim) the nurse needs to be pro-active. Know what you know, and know what you don't know. May need to refuse a case, if you can not get an adequate orientation whether from the agency or the family.
    Last edit by ArwenEvenstar on Dec 24, '10
  8. by   elizabethgrad09
    ]Thanks, everyone, for your replies, they were very helpful and I now understand much better how different agencies handle a private duty situation. It sounds like my one shift of training was about average for the industry, and that the Mom often fills in if more is needed. Elektra6, that is great that you got a seminar plus 30 hours of training, congratulations to you and your agency! By the way, my agency pays $8/hr for orientation, I don't know if that is standard. I can certainly see and agree that the relationship with the Mom (family) is key. I was very honest with her after my one training shift. I told her that I was eager to learn, wanted to do things exactly how she wanted them done, and wanted her to feel very comfortable. She said that she liked my attitude, but was still leery, and I completely respect that. When I talked to the DON at the agency the next day, she suggested an additional day of training on a different case, which I think is for the best. Again, thanks to everyone for your feedback, it is so valuable to a newbie.
  9. by   valeriana
    wow! it is astonishing to read about the minimal training that goes on in private duty nursing. After reading this i feel so lucky to have landed with the current agency that I am working for. i went through a 1 week course (reading, lectures, videos, tests, competencies...etc) before even going out to precept for another week in patient's homes. It was nerve wrecking because I had to pass every single aspect of the course in order to even continue with the precepting phase. now every 6 months I have to pass an emergency competency scenario to continue staffing vent and trach kids. All the training is well worth it because I feel my license is safe and so is my patient.
  10. by   Flatlander
    I was just hired as an RN in home care, and was scheduled to train my first day with a nurse for 12 hours. (Initially I was told training would be about "2 weeks".) I just got word from the agency that the nurse for my training day "called out", so I will be training with the family if no other nurse can come, and that they are very knowledgeable in the cares.

    I feel uncomfortable about this. I am a new nurse, have no experience in home nursing care, and will be working with trach and suprapubic catheter, quadriplegic adult, multiple meds, hoyer lift, bed baths, etc. Not to mention charting which I've not looked at as yet with this agency.

    Oh and the nurse I met at my first meeting with the family informed me the nurses have been cleaning house, doing laundry, and cooking meals. Also wondering if this is unusual.

    Am I unnecessarily worried? Input welcome! Thanks!
  11. by   nursel56
    Hi Flatlander - my experience was that I took a two-hour vent class and supposedly a 2 hour orientation but the agency didn't seem to have a different orientation option depending on the nurse's experience so I did quite a bit of studying and research on my own.

    I don't think it would be a problem to have the family orient you to your client, but you'll have to make sure to document it properly in the client's chart. In the chart you should find a Plan of Care or "485" that is your blueprint for delivering skilled nursing services.

    I think if it were me I would at least go meet the patient and family. Vent patients vary in acuity, but adults on vents for many years most likely have well-established routines. I would ask the agency for a copy of the 485 with the name removed to get an idea of what to expect.

    Another suggestion would be to find out what kind of vent he has and study the manual. That is always an ongoing process and you can never learn too much about these amazing machines.

    As far as cooking, cleaning etc., no I wouldn't do that. There are a lot of reasons for that, but obviously if you take the case you'll be expected to do the same thing. We are paid by a third party most of the time, and paid for skilled nursing, not home health aide type of stuff. We've gone around and around on the housework thing here on AN before. All I can say is the right answer is the one that works best for you. If I needed a job and that case was the only choice I'd probably do it at least until I found something else.

    Those are a few of my thoughts, best wishes to you!
  12. by   Flatlander
    Thanks, Nursel56 !

    That helps a lot. You are so right about needing the job and hanging on for the time being. Also, since the precedent has been set, I'm sure the family would be disappointed not to have the extra housekeeping and meal prep they've been receiving. I have met the family and they are nice, the home is clean, roomy, and well organized. There's no doubt they need and deserve the care. Fortunately there is no vent, just the trach and catheter to care for and I'm guessing quite a few pain meds. I had two full days' training in vents, Central lines, and TPN, but no hands on with the patient, which was supposed to be part of the deal.

    Anyway, I think you have relieved my anxiety. It's just kind of scary having so much independence as a new nurse. I've talked myself down from quitting before I've started several times in the last couple days. Now I'm just takin' it one day at a time! I've promised myself to stick it out for at least 6 months even if I hate it, so as not to be seen as a job-hopper.
  13. by   brillohead
    I agree that an appropriately trained family member training you is adequate -- it doesn't need to be a nurse, provided that the family member is experienced in all of the things that you're going to be doing, which if this is a long-term case, the family member is probably as good or better than any of the nurses that could train you.

    I also do a lot of my own research (often at work during downtime) regarding equipment, supplies, and cares. YouTube is full of all kinds of videos, and manufacturer websites typically have downloadable equipment manuals so you can learn about settings, maintenance, troubleshooting, etc. I also find a lot of Powerpoint presentations on various issues are posted as part of CEU presentations, etc.

    When it comes to housework/meal prep, I would tell the family that since you're a new nurse and new to this case, you'd like to concentrate all your time in the house on learning all about your patient's care, getting comfortable with the routines, making sure you're not missing anything, making your charting accurate, etc., and if you spend time doing non-nursing things while you're there, it will take away from your learning things completely and properly. I don't see how they could argue with that logic, and by the time you're an "experienced nurse" on the case, they'll already be used to you not performing those types of duties.

    And for charting, I liked reading the past charting from other nurses. Not only did it help me see what types of things were expected in my charting, but it also helped me to see how other nurses organized their workflow.... did they do the breathing treatment before or after the bed bath? Vitals before, during, or after a tube feeding (or all three)?

    Good luck!
  14. by   Flatlander
    Thanks Brillohead (luv the name)!

    Lots of good advice there, which I will for sure make use of. Really like that approach on the cleaning/cooking issue, and the need to focus on nursing-related activity during my shift.

    In fact, that was one of my concerns... that I would be paid at nursing rate for unrelated duties and also that I would be claiming those hours as RN job experience. Both would be inaccurate and possibly unethical (?). I can see it's kind of a gray area. I'll check in this site for more discussion about that.

    Although I could ask my clinical supervisor for her opinion, I hesitate because I don't want to come in as a new nurse and start upsetting routines. It sounds like a good way to stir up problems with the home and staff... Your suggestion is probably the best, the more I think about it.

    Thanks again
    Last edit by Flatlander on Sep 13, '14