Scared of new job

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I was hoping that some assurance from some other nurses would make me feel a little more confident before I start my new job on Monday. I took on a job taking care of a 16 year old boy with a tracheostomy. I very nervous because I have only changed a trach once, and suctioned one twice. Is it normal to be so scared of trachs when you are first starting out? In your opinion, is somebody who has only worked with a trach 3 times qualified to handle this type of job? I may be over reacting just out of pure nervousness; I know the steps of changing in an emergency, and I know how to suction..How did you feel with your first few trach patients?? And what is an estimate of how often a trach emergency occurs?

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Specializes in psych,maternity, ltc, clinic.

Are you getting any orientation? You'll need to find some way to know his schedule.......

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Specializes in Home Health, PDN, LTC, subacute.

I started a job where I would be a vent/trach homecare nurse and I had NO experience with either. I had a lot of orientation with a preceptor before I took the case. You will feel 100% better when you start working with the trach every shift. IMO trach emergencies happen with babies all the time, but adults don't usually decannulate.

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Specializes in Mixed Level-1 ICU.

I'd be scared as hell!

You do not want to be just "learning" about a device that, if it things go south, will leave you essentially seconds to decide what to do.

You should be absolutely comfortable with every aspect of this care, including emergency care, before hand...period!

Now, if you will be in a hospital with him that's different. You'll have backup. But if you will be at his home, alone, my advice is to get some real practice in, read everything you can find about his particular trachs and trachs in general, and then you need hands on care while being observed by an expert.

You'll feel relieved and more confident having demystified the whole thing. Your fear is the first sign that you are on the right track.

No one should be screwing with airway before knowing what they're doing.

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He is 16 years old and I wont actually be at his home. I pick him up every morning at the Childrens Hospital and ride the school bus with him to a special needs school and stay in case of an emergency. There are supposed to be a couple other nurses there with other children with trachs, so hopefully I can ask them for help if I need it. I will take all of your advice and take the first trach class I can find; however I do start tommorrow. I am just praying on my first day he doesnt cough out his trach! I know that you suction when you hear them starting to "rattle" a little bit, but does anyone know about how often that will be?

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Specializes in Mixed Level-1 ICU.

OK, now we I have more information about your job.

He will not "cough out" the trach unless the trach ties are improperly

tied or way too loose.

But you need to be comfortable with this basic stuff and your questions clearly indicate you are not.

Now....take a deep breath...

First, be sure to tell the nurses there that you are new, brand new to this and do not, I repeat, do not hesitate to get that fast if you need help.

Making them aware of your "newness" will put them on guard and let them know that you are being responsible.

The "rattling" before suction is not always the case. Look at your patient and listen. Certainly phlegm will rattle, sometimes, but you will soon get a "feel" for your guy and will know instinctively what's up with him. Obviously, there will be others who care for him. Do not assume they have done a good job. Check everything when you come on.

By all means inhale those classes and dive in and decide to make trachs your specialty. When I am unsettled about a particular patient condition I take the "jump off the cliff" attitude.

Embrace your fear and soon you'll be wondering what all the fuss was about and others will be coming to you for answers.

Do the work reap the rewards!

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I hope you are getting a lot of training on trachs before you're left alone for him. You're going to be the sole person responsible for his emergency care and if you aren't trained properly you could end up killing him. In the hospital, you have lots of back up, so it's OK to know EVERYTHING, but if you're alone, you had better know everything.

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Specializes in Med surg, Critical Care, LTC.

Honey, working with trach's make's me really nervous, and I've been at this 17 years!! So I know where you are coming from.

However, it really isn't that difficult. You will learn when he needs suctioning, he will be able to cough up quite a bit of secretions himself, so make sure you have dressings with you, always!. Basically, keep him clean, assess his lung sounds q4h, and suction him at least q4h and prn. That is what I would do.

If he's having a hard time breathing, and you've tried suctioning and it's not helping, he could have a mucus plug - those buggers can be difficult. If you have some saline, put about 2-3 cc of saline into his trach, use an ambue bag to push the saline around and hopfull thin out his mucus, and then suction him. Always remember to give a break between suctioning to give him a chance to catch his breath.

Take advantage of the other nurses knowledge. You'll do fine. Good luck

Blessings

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Well, I just got back from my first day and it was horrible. He used to go to school at the hospital he lives at, but the county that he came from wanted him to try the local public school; however I do not feel like it was good for him at all. He get startled at any loud noise and sometimes sends him into a seizure..He had FOUR today (including one on the school bus)! There werent any other nurses like I told there would be, and the school nurse said she hasn't even touched a trach in over ten years. Everytime he had a seizure he would cough so bad and need to be suctioned. The whole day I was on edge and worried about something happening to him. His special education teacher thinks this is the wrong place for him and the school nurse is going to call the charge nurse to tell them she is worried about the amount of seizures he is having. However, when I talked to her when I brought him back from school that "he has seizures sometimes, but he will fine." I do not feel comfortable with this situation at all, should I go back tommorrow, or tell my agency that I cannot handle this case?? I am new with trachs, and he is having 4 seizures in about 5 hours, I dont know what to do. I feel like he is too sick to be in a public school outside of the hospital for the first time, and I am not sure I want to be the one responsible if something goes terribly wrong in this new enviornment. Please let me know what you think.

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Specializes in Med surg, Critical Care, LTC.

4 seizures in 5 hours is too many seizures. He needs his levels checked and probably his meds adjusted. Does not sound like he is well controlled at all, or perhaps he has another illness that is throwing him off, could be as simple as a UTI.

I agree that until his seizures are under better control, he should not be in a public school scenario.

You have to do what makes you comfortable - but by the same token, you can run from every challenge. Think it over, and if you really feel you can't handle it, then let your supervisor know.

Good luck hon

Blessings

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Well, my second day was as horrible as the first. Today there were 3 seizures in the four hour school day and he coughed his trach out even though it neck ties were secure (other nurses that have worked with him have said that happens from time to time because he is such a bad cougher). I have talked to the school nurse, the nurse at the hospital where he lives, as well as the teacher that he had when he attended school at the hospital. They all agree it is not the best idea to be transporting him to and from public school, but all say it is not up to them. After I voiced my concerns about this case to the agency they are going to have me sit with him at the hospital all day tommorrow to "get to know him better", because they feel the more I know him the easier this job will get. I dont think so. I can handle the seizures and trach in an appropriate setting, not in a public school with no backup in case of an emergency. I plan on going to sit with him at the hospital so that they can see I am giving it my best shot, but I think it is best that I just quit this job. I do not want to be any part in this stupid idea of taking such a sick child out of a hospital enviornment and into a public school with only one nurse on site (me) and risk my license if something were to go wrong. If he goes into a seizure when the intercom comes on to announce something at the school what is going to happen at the first fire drill?? Do you agree that this is just a job I should leave, even though it has only been a few days?

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Specializes in Med surg, Critical Care, LTC.

SBH2: This is your first nursing position, and I would not walk away lightly, try to remember that you are first and foremost: your patients advocate, this is a tough case for a new nurse with little confidence. As his primary nurse, you have the right to consult with his physician - and I would do just that. I would tell him of the number of seizures, find out if he is due to have his levels checked and what his levels were the last time they were checked. Take the time to look through his records and read previous nursing notes to find out the frequency of his seizures in the past. When were his last med changes?? If they were recent, maybe the med isn't agreeing with him - gather all your information, including VS, how long his postictal periods are, etc... call the MD. If your not satisfied with the response you get, then discuss your concerns with your direct supervisor, including your call to PMD and outcome of the discussion. I don't care what anyone says, having 3-5 seizures in basically the same number of hours is not good control - do some research tonight on line, take notes, so you'll feel more confident.

I know this is rambling, but I wouldn't quit until I've had my concerns regarding this patient addressed - I would quit if they aren't addressed to your satisfaction or if after all the information has been gathered and your concerns addressed, your still not comfortable.

Remember, you first responsibility should be to your patient. Do your homework, and don't be afraid to speak up. Do let us know how it goes?

Since this is rambling, write down my suggestions rather than try to remember them all. His PMD may be prescribing his anti-seizure meds but most likely he has a Neurologist.

God Bless

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