Starting a New Thing

[Bukins]

Hello all, I am new here, and thought I would jump in with my first question. I will be starting a new position in private duty home care for peds patients. I must admit I am nervous, as I come from a 28-year back ground of only adult care experience.... primarily with long term care and hospice. I do have vent and trach experience, but its been awhile. I had to do a skills checklist and found that I have indeed done most of the skills on the list with adults, but very few of the skills with kids. My only peds experience was while in nursing school and what I have had to do with my 4 adopted kids, and assorted things with foster kids. I know my training will be "case specific," but I am wondering if there are any general things I should bone up on prior to starting? Also does anyone know of any good resources/web sites that would be good to have on hand as reference materials? Thanks for your input! Hope this is a good career move for me!

Bukins

[suzanne4, RN]

Peds vents are different from adult vents for the most part. You need to know everything about it, what every alarm means. If you haven't cared for peds patients in the past make sure that your agency gives you a very thorough orientation or you may find some of the families to be very intimidating to you.

As well as what to do when a GT falls out, etc. I would suggest that you get a few weeks in working in a facility that has these types of children to care for. Many of them have quite complex nursing issues, not just cut and dry things to worry about. And work on your pediatric assessment skills and tools.

Sorry if I am making this sound scary , but I work with many vent dependent children on a daily basis and am aware of many of the problems that can occur and do occur.

[MissJoRN, RN]

hi! i do pd peds home care, but never did adult m-s. you should have case specific orientation that will cover your skills. know how to feel comfortable saying to your supervisor- i need more orientation with this kid, i don't feel comfortable in that house, etc. they should accommodate. some nurses are better fits with some cases and not others, that's ok. your first cases should be relatively stable. most skills are easy and infrequent. it's the "other stuff" that keeps us busy in pvt duty. the whole shift is one long assessment, maybe resp, maybe neuro, with subtle interventions. then, here and there, a med, a tf, a seizure, etc. i do a lot of psycho social things with my cases, too. help with homework, play, introduce new speech or signing, deal with sensory integration, try to include "my" kid with the other kids at recess, anything that makes "my" kid's life happier and easier!

you're a nurse, ot, pt, st, teacher, nanny, etc! but never, never a parent! you do care for the whole family- deal with siblings who need an attitude adjustment, moms who want you to be their best friend (my advice, don't) and moms who cringe when they see a new nurse (what's this one going to mess up?) these families have a lot of stress and they need support. they know how the vent works, they know the pathophys of metabolic disease better than you ever will. they just want to know how to deal with the kid's grandma insisting he try to eat jello when he can't.

most common skills- vent/trach; mic-key buttons: venting, meds, flush, bolus and pump feeds, check balloons, change button, site care; pulse ox'y; aed use; applying braces; percussion/drainage; giving baths (wow, remember that :) )

resources? i like: "mosby's ped. nsg. reference" betz, sowden; a drug book; a sign dictionary; exceptional parent magazine; quest magazine (published by mda, very good general disabilities info) http://www.mdausa.org/publications/quest/q-curr.cfm try to "hang out" for as many types therapy sessions as you can (but beware!! that's usually your best break time!) sensory- "the out of sync child" and "the out of sync child has fun" carol kranowitz (my library had these)