Trachs/Vents - How much training? - page 2

I am leaving my position as a School Nurse to be home with my kids, but I am strongly considering applying for a weekend night position advertised with a private duty company. They advertise trach... Read More

  1. by   kdavispn
    In my area, typically you get a class, and 1-2 days of orientation. However, you may requests more days from your agency. Also, you might want to just do G Buttons to start, get comfortable, and move on later. Additionally, you want to watch, and also make sure you do... Before you're on your own, don't just let your preceptor sign off that you saw them. It's your license and it's very easy to loose in home care.
  2. by   kdavispn
    Quote from umcRN
    I have no experience with home vent training but as a NICU/Peds CICU nurse I ask that you PLEASE make sure you get adequate training and feel comfortable with the patient and their needs before taking them on your own. I have full respect for the nurses that choose to work private duty nursing for complex patients, god knows I don't think I could do it, but I love those kids and it breaks my heart when they come in coding because the home nurse was uncomfortable with the care they needed, didn't escalate in time or didn't react appropriately to an emergency situation. This could be form inadequate experience, inadequate training or an issue with the agency not assigning nurses appropriately. I have seen too many kiddos come back in coding and suffer devastating brain injuries after coding from a plugged trach.

    And like another person said, definitely train with not only the nurse experienced already with the patient but also whoever the primary caregiver is. If it's a child the parents almost always know what is best and right for their child and can show you how they like to do trach care, trach changes etc. So long as it is safe I don't try to change techniques even when they are inpatient in the ICU
    I totally agree with you. My major concern with so many of my peers in home care, it's we do not get the benefit of acute care training with these kids. The system is what it is, and certainly we are skilled, but the reality is that the training that parents get on discharge is many times superior to what will be offered to inexperienced nurses from their agency. Very sad.
  3. by   kdavispn
    Quote from ColleenRN2B
    My first (and current!) RN job is through an agency and I take care of a 1 year old on a vent. Got my peds-vent certification as required by the agency, listened to everything the parents had to say, read everything in the house related to her equipment and case and was trained by excellent RN's with previous vent experience.
    There is an LPN who is on this case as well and she is always saying how stable our little one is---drives me crazy b/c if she were truly "stable", she wouldn't require machines to breath for her and deliver her nutritions! I think some are a little too relaxed with such situations and all of a suddden, BAM, everything umcRN is saying happens!
    I don't know. There are definitely some cases that I consider to be more stable than others. Anything can happen with any patient. Or healthy John Doe walking down the street could have a seizure and pass out. The stability the nurse is referring to could mean the patient is tolerating the home care environment and treatments at this moment with no or few adverse reactions, v/s are staying within the parameters that the MD expects for this case, and they have not recently required regular admits to acute care. They did not need CPR.
  4. by   kdavispn
    Quote from Purple_Scrubs

    Not discouraging at all...this is what I want/need to hear. I want to be sure to be vigilent and proper training to recognize when things are going south is a huge part of that. Working with this population after I have been out of acute care for so long is something I will not take lightly. I am already signed up to take an RN refresher course (although the focus there is mainly adult med/surg), and I will certainly brush up on my peds acute care issues.

    Thanks to everyone for your input...this will help me know the right questions to ask when I interview!
    In most cases, I'd advise you not to think the agency will be concerned with much more than having documents signed by you stating that you know how to do the procedure, releasing them from liability. I hope you're working with an agency that cares about their nurses, and patients.The help is there. Insist that you get it. Good luck with your RN refresher course, and case.
  5. by   poppycat
    I've been doing full-time private duty home care with teach/vent kids for over 5 years. The agency I work for provided very good review of trach & vent care but will only hire nurses with previous vent experience. Remember that when you are in a patient's home, you are the only nurse there. If the need arises, you have to be able to change a trach & not be afraid to do it. There are no other healthcare people there to help you.
  6. by   Not_A_Hat_Person
    I work with adult trach-vent clients. After studying a pretty long book, passing an written test,and completing a skills check in the office, I did 3 orientation shifts with a trach/vent client. With new trach/vent clients, I do 1 or 2 shifts of orientation.

    My peds rotation was in LTC for children, so I got some trach/vent experience in school.
  7. by   Nurse Connie
    I am a new grad and have been offered a private duty case for a 2 1/2 yo girl. I took 2 orientation classes at my agency, one for pediatric assessment and on for vent/trach care. I will also be mentoring with another nurse and will not work alone until I am signed off on skills and I feel comfortable working alone. I'm meeting the mom tomorrow and then I will begin mentoring.
  8. by   anon456
    trach/vent kids are very fragile and like previous poster said, things can go wrong very fast. Make sure you are truly comfortable, take trach CPR, practice changing out a trach on a real kid before you are on your own, and know how fast it would take EMS to get to the house if you need to call them. And carry your own malpractice. Not to scare you but it might be that nothing goes wrong or everything does.
  9. by   tothepointeLVN
    You can work your way up step by step. I started with a preteen with a G Tube (microcephaly). Stable in the sense that she hadn't been inpatient in years and had reached her maximum potential. All you had to do was maintain her quality of life. Next was GT plus O2 then I tried trach and GT on a toddler who was expected to transition off both pretty soon and probably would have been if mom wasn't delaying it by missing appointments. I didn't really do much complicated than that for more than a few days.

    I was with one of my kiddos at school and the nurse of one of the other kids on a vent seemed confident. I pointed out that her vent was silent alarming with low pressure but figure she knew best when she said it was ok. I felt bad when the kid started desating about 1 hour later. Not sure if it was related since I'm not vent savy.
  10. by   LPN4life2004
    I have been doing adult and child vent/trach for over 6 years. I was fortunate to get a case where they were weaning the child off the vent, which allowed (what I felt) less rush with some things. I agree with the person that said that kids are on different levels of stability. I have had kids that I was concerned all day about their condition, constantly having seizures,etc, to ones where they haven't had to go to the hospital or even had an infection in well over a year and thriving very well. Some even went off vent and trach altogether. But my thought is with every case. I will always be on guard and looking for any (even little) signs of trouble. My hope is to prevent problems before they become a problem. Eventually you learn things and feel more comfortable with your skills. When I first started, I was fortunate to be able to take vent/trach training with a respiratory therapist from the local children's hospital. Sadly my employers don't do that anymore and some nurses concern me when they come for an orientation. My agency usually says the nurse should come for a 4 hour orientation not even a whole shift, but they will allow more if requested (they don't always tell you that). Good luck to you! Btw I am surprised how many RN's here do PDN with trach/vents on here. In my area the RN's are rare and they actually get a reduced salary compared to other jobs.
  11. by   NyteshiftLVN
    My best advice would be to ask for a patient who can sprint off the vent for at least a few minutes at a time to get comfortable with the vent/trach/suction equipment and alarms to learn what they mean. Next I would know at all times where the back up trach tray is, the bvm, the suction machine and anything other essential equipment and keep it within arms reach. On top of that, get a good full report and don't be afraid to ask questions. You already sound like a diligent nurse so that is a plus, and remember to trust your instincts if something doesn't seem right don't second guess yourself. Best of luck!