Private Duty for New Grads

Specialties Private Duty

Published

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.

Specializes in NICU, ICU, PICU, Academia.
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.

BBM: This! ( I am on a night case right now and just spit my coffee out on the table! :) )

Specializes in Pediatrics, Emergency, Trauma.
I'm certainly concerned by many of your comments. But here's a thought---most LVN's work in LTC's or clinics versus acute care hospitals AT LEAST in my area. If you are an LVN and let's say you have experience, you're not a new grad--but it's in a LTC facility. You don't have pediatric, nor acute care experience. Does that mean you shouldn't work in PDN? I'm an RN, not an LVN---but I don't see how everyone who works in PDN has the "acute care" experience which is so necessary to be successful.[/quote']

I didn't, and I currently work in a facility, and have been complemented on my assessment and nursing decision making by my DON, so it does work in reverse. :yes:

I was a new grad when I started; they sent me to a T/V class within a month after I started and had a tube-feed therapy case. One of the things I did was get EXTENSIVE education when I started doing vents; I had classroom time for a total of 24 hours (6 hours for 4 days) which included review of A&P, common signs and symptoms that have an effect on having a T/V; education on the most common and uncommon vents, BiPAP machines, coughalators how to set them manually and place on auto and when to use which settings depending on pt physiology, different types of trachs, setup, changing, cleaning and utilizing back up vents. The course was ran by vent nurse agency and a RT.

When I went on my first vent case I had 8 hours of orientation; and that was due to that I had another job in a Rehab hospital where I had vent patients; I had 12 hours with a RT; there were also shifts where I was the respiratory nurse under my belt; the population was mostly adults, although we had T/V patients as your as 13 at the time.

When I went to another agency, I had 24 hours with a preceptor. I have worked with pedi T/V cases 6-7 years out of my 8 year career as a nurse.

It does take a particular personality and know-how to acquire a solid skill set to succeed and be a VERY competent T/V nurse; those skill sets have made me very competent in other places and areas of nursing as well. :yes:

OP, if anything, if you feel as though you need more training, if there are area vent classes and agencies that have in depth training or any CEUs, get then; I am very fortunate that in my area they have a T/V agency and will educate nurses intensely in becoming a competent T/V nurse. Part of your nursing practice is strengthening your nursing practice well after you get your license; you can start that now. :)

awesome post ladyfree. glad to know you were given a lot of support, succeeded, and have moved on to hospital work. I'd love to hear more about your experience! How long did you work in PDN?

Specializes in Pediatrics, Emergency, Trauma.
awesome post ladyfree. glad to know you were given a lot of support, succeeded, and have moved on to hospital work. I'd love to hear more about your experience! How long did you work in PDN?

I worked in PDN for 7 years out of the 8 years I have been a nurse.

Hey everyone, just an update: I had my orientation with the agency and my first shift orienting with a client. Everything went very well, except I've noticed some things that weren't cool---the LVN that oriented me was way too lax in her job, not checking for residuals, checking off on emergency equipment that wasn't where it was supposed to be, giving meds with formula that should not be given with food. During my first shift I already found outdated orders like with VS parameters of when to call the doctor. I will bring this all up during my next office orientation day. I won't work with the kiddo unless some things get changed. I will be oriented to several other patients though so hopefully I find a good fit. Overall, I am optimistic.

Specializes in Peds(PICU, NICU float), PDN, ICU.
Hey everyone just an update: I had my orientation with the agency and my first shift orienting with a client. Everything went very well, except I've noticed some things that weren't cool---the LVN that oriented me was way too lax in her job, not checking for residuals, checking off on emergency equipment that wasn't where it was supposed to be, giving meds with formula that should not be given with food. During my first shift I already found outdated orders like with VS parameters of when to call the doctor. I will bring this all up during my next office orientation day. I won't work with the kiddo unless some things get changed. I will be oriented to several other patients though so hopefully I find a good fit. Overall, I am optimistic.[/quote']

That is typical. Its possible that the agency could let you go if you complain about it. Residuals aren't always checked. It depends on many things. My agency policy is to have an order to check it. If you go in with the attitude that you are going to change everything and go exactly by the book, you won't last and you will not make friends. Of course it would be ideal if everyone followed every rule and did things exactly by the book. But PDN is everything the book doesn't teach. The last thing you want to do is make waves when you are new with an agency.

Good advice. I'm just concerned about protecting myself. Thanks

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

Document. And keep your own documentation as well. Most agencies don't have time to read the notes. Some will read all of them.

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

My agency requires physician order to check residuals. Don't assume orders you saw are not current if the 485 is current. You may not be looking in the right place

Specializes in Peds(PICU, NICU float), PDN, ICU.
My agency requires physician order to check residuals. Don't assume orders you saw are not current if the 485 is current. You may not be looking in the right place

That's true, but the 485 is good for 60 days. Lots of changes can happen in that time. Its best to look at the most recent orders. If there is conflicting info our something, is best to clarify the order with the Dr. However, sometimes there is more to the story and the supervisor may be better to talk to so the Dr doesn't think you or the agency doesn't have it together. The Dr office will call the agency if they have concerns with a nurse. Welcome to being the middleman! If the "game"isn't played right, the nurse always loses.

That's true, but the 485 is good for 60 days. Lots of changes can happen in that time. Its best to look at the most recent orders. If there is conflicting info our something, is best to clarify the order with the Dr. However, sometimes there is more to the story and the supervisor may be better to talk to so the Dr doesn't think you or the agency doesn't have it together. The Dr office will call the agency if they have concerns with a nurse. Welcome to being the middleman! If the "game"isn't played right, the nurse always loses.

I have worked for at least two agencies that wouldn't lift a finger to update the 485 until recert time, if then. If change orders were sent forward by field nurses, whether or not already signed by the doctor, nothing would be done and the updated order sheet would not be returned to the home; so yes, you can not depend on the 485 to be complete or correct. That is one reason why the suspense copy of order changes is kept with the 485 until the next 485 is produced.

+ Add a Comment