Ventilators?

renerian, BSN, RN · Jan 28, 2005

If your looking for teaching information do a web search and you can find alot of information......

If you want one on one education if your agency is not providing call a respiratory company and ask if a rep can come to your agency for ed for the staff. That is what I usually do.

renerian

DDRN4me · Jan 28, 2005

Is your home health agency affiliated with a hospital? sometimes you can do an inservice with respiratory therapy with actual patients...much better than just "book training". Or, if your agency has clients with vents, ask to orient for a shift with another nurse .

DaSuperRN · Jan 28, 2005

Is your home health agency affiliated with a hospital? sometimes you can do an inservice with respiratory therapy with actual patients...much better than just "book training". Or, if your agency has clients with vents, ask to orient for a shift with another nurse .

Hi

I am so new to this this, and this agency told me I would only get paid for 2 hours of orientation. I can't stay any longer if not being paid. I learned very little in the 2 hours I was there yesterday I go tomorrow alone for 7 1/2 hours.

This vent patient is very stable which is good news, and she can even breathe some off the vent. She is coherent and can walk me through every bit of her care, but I am still worried. I supposed this is ridicilous of me, but I would prefer another more experienced HH nurse to mentor me or a preceptor. This is not LTC and it's certainly not acute medicine. We had a special unit for vent patients at my hospital so our nurses never dealt with it on my unit. We did have 10 telemetry patients, but we were all well trained by the hospital, and had class that lasted a two weeks, with cert test. We read strips and everything. I worked for the government and we were always supplied with good training on anything new.

Darcy

Home Health Columnist / Guide · Jan 30, 2005

I don't mean to be harsh but...

Why have YOU allowed your license to be put in jeopardy by accepting an assignment you knew you were not qualified for?

Any agency that states it will only pay for 2 hours of orientation, signs off a skill checklist for a nurse who has NOT documented they are proficient in vent and trach care and assigns a nurse to such a case is one to RUN FROM as they don't know the meaning of quality care and are liable for negligence.

BOTH the individual RN and agency would be at fault if an injury occured to this patient...and I'm sure the agency would be placing all the blame on the RN.

I don't buy the excuse that you can't afford to go on your own time to be oriented by another RN in the vent care and paperwork.

a. You shouldn't have too go on your own. Orientation is the EMPLOYERS responsibility.

b. Because you bought into their line that they only pay for two hours and YOU ACCEPTED the case anyway, responsibility shifted and now falls on YOU to make sure your qualified.

Since you stated you were desperate to escape hospital, you placed yourself in this postion and have three choices to PROTECT your license:

a. Orient with another RN on your own time until proficient along with reading all the website material we've posted here about vent care.

b. Call employer and inform them you need additional training and are not able to do any vent/trach cases unless training provided. Can employer contact patients vent DME company so RT can orient you (won't cost your employer anything.)

c. Leave this agency and find another one that will provide training.

If this company is the only one in your area doing private duty care and you feel there is no other home health agency to go with, then orienting on your own time to protect your license is much cheeper in the long run. The fact that med and treatment sheet in disaray (other thread that you edited) is another indication that this agency is flying by the seat of its pants. I'd inform the nursing supervisor of your concerns, in fact it's your responsibility to do so. If agency not receptive, then expect you will not receive any assignments.

My first homecare experience in 1985 was with a startup agency. Policies/forms were created as needed...as is oten the case especially with new regs coming out periodically. However, training WAS supplied by the owner who was a ICU RN and RT inserviced all new RN's without vent/trach care prior to our accepting a new vent patient case or assigning RN/LPN to established case. Quality care was stressed...mght have done something with phone guidance re new IV pump/med but better believe inoffice follow-up training occured before staff was placed in sitution again to protect agency and nurses from liability.

Only you can decide what to do in this situation. Wishing you a positive outcome.

Agencies that are associated with the VNA, Visiting Nurse Association --- original homecare association started in early 19th century, usually are the best ones to work for and foster high standards.

VNA locator: http://www.vnaa.org/vnaa/gen/html~home.aspx

DaSuperRN · Jan 30, 2005

I don't mean to be harsh but...
Why have YOU allowed your license to be put in jeopardy by accepting an assignment you knew you were not qualified for?
Any agency that states it will only pay for 2 hours of orientation, signs off a skill checklist for a nurse who has NOT documented they are proficient in vent and trach care and assigns a nurse to such a case is one to RUN FROM as they don't know the meaning of quality care and are liable for negligence.
BOTH the individual RN and agency would be at fault if an injury occured to this patient...and I'm sure the agency would be placing all the blame on the RN.
I don't buy the excuse that you can't afford to go on your own time to be oriented by another RN in the vent care and paperwork.
a. You shouldn't have too go on your own. Orientation is the EMPLOYERS responsibility.
b. Because you bought into their line that they only pay for two hours and YOU ACCEPTED the case anyway, responsibility shifted and now falls on YOU to make sure your qualified.
Since you stated you were desperate to escape hospital, you placed yourself in this postion and have three choices to PROTECT your license:
a. Orient with another RN on your own time until proficient along with reading all the website material we've posted here about vent care.
b. Call employer and inform them you need additional training and are not able to do any vent/trach cases unless training provided. Can empoloyer contact patients vent DME cmpany so RT can orient you (won't cost your employer anything.)
c. Leave this agency and find another one that will provide training.
If this company is the only one in your area doing private duty care and you feel there is no other home health agency to go with, then orienting on your own time to protect your license is much cheeper in the long run. The fact that med and treatment sheet in disaray (other thread that you edited) is another indication that this agency is flying by the seat of its pants. I'd inform the nursing supervisor of your concerns, in fact it's your responsibility to do so. If agency not receptive, then expect you will not receive any assignments.
My first homecare experience in 1985 was with a startup agency. Policies/forms were created as needed...as is oten the case especially with new regs coming out periodically. However, training WAS supplied by the owner who was a ICU RN and RT inserviced all new RN's without vent/trach care prior to our accepting a new vent patient case or assigning RN/LPN to established case. Quality care was stressed...mght have done something with phone guidance re new IV pump/med but better believe inoffice follow-up training occured before staff was placed in sitution again to protect agency and nurses from liability.
Only you can decide what to do in this situation. Wishing you a positive outcome.
Agencies that are associated with the VNA, Visiting Nurse Association --- original homecare association started in early 19th century, usually are the best ones to work for and foster high standards.
VNA locator: http://www.vnaa.org/vnaa/gen/html~home.aspx

Hello

Thanks so much for your concern. Don't worry I am not taking this assignment. I was supposed to go tomorrow and I told them I would not. I just needed a refresher on trachs, but my main concern was Vent care. Respiratory care is responsible for the vent. I was to assess Respiratory status, which I am a pro at since i worked cardia telemetry, and Med surge for years. I was uncomfortable with all the buttons and alarms. I refused to go until I get training. The ladys sister was there and she did the care not me she is in a medical profession although not a nurse, but trained in vent care.

I believe you and I think I am going to quit. I don't like the business tactics with this company. I am scheduled to interview with another on Monday. So I let you know how that one goes. It a shame the stuff some agency try to pull.

Sorry, I removed my post it was a silly move. I was offended by a poster. I feel better after reading your note.

Home Health Columnist / Guide · Jan 30, 2005

Your right: Respiratory care is responsible for the vent.

RN is responsible for assessment, knowing what to do in an emergency, meaning of vent settings which you be documentend each shift-start and leaving, removing patient from vent for suctioning, inner canula care etc, cleaning of vent tubing + circuit. Emegency battery hookup. It's much more than what was provided as part of orientation.

Good move that you refused another shift. You now know the questions to ask.

Hopefully will find a better agency employer.

renerian, BSN, RN · Jan 30, 2005

I hope I did not offend you? I got your PM. I think your doing the smart thing going elsewhere.

renerian

DaSuperRN · Jan 30, 2005

:Melody: sorry empty link

DaSuperRN · Jan 30, 2005

Well, when I oriented with the nurse those 2 hours I ask what all the things were, there was a tempature control it read 70 yet in the book on the vent paper the nurses were signing off 84, 88 and I question about the 70 reading and wondered if it was because the water was low and ask what was the accepted range. This nurse also was new been there a month, so you tell me. I also question what the 1:5 ratio was on the paper and what did it mean? She did not know??? I understood the off and standby button, and how to drain the tube of water before moving the client. I new how to remove it and put the of devices on like the one to allow her to talk when Vent was off during transfer. It was set a 9. I did not know what that meant. I am the type of person who wants to know what every button is is and alarm etc., and I will not mess with it otherwise. So her sister had to assume responsibility. The trach was really not a problem.

Thanks for the tips! I am getting less sensitive day by day on this subject. Today I am very sick with the Flu or something; chills and fever, aches so I will not be posting much. It just came over me probably the high stress hit my immune system hard, sore throat and all.

Home Health Columnist / Guide · Jan 30, 2005

Check out these Vent Links:

https://allnurses.com/forums/showthread.php?t=92989&highlight=vent+care

Will cross post in HH.

barefootlady, ADN, RN · Jan 30, 2005

Darcy,

I read your post with interest and concern. I think you made the right decision to refuse to continue this assignment until all of your questions are clarified and you have the training you feel that you need. It is a shame and sorrow this agency is allowed to continue to operate with issues such as you describe. I know just how difficult it is here to find a job, much less be treated badly by the agency and facility. Please remember to do what you need to do to keep your license safe. So many administrators, charge nurses, and head nurses here lie and say what they need to say to put guilt on you to do something they know is not right.

I wish you well, if there is anything I can help you with regarding certain places here in WV just PM me and I will attempt to give you and honest answer. Hope you feel better soon.