What should I do??

[kerussll]

I am a new grad and I have worked for a home health company for 2 months now. Generally, we are in homes of kids with disabilities who need minor nursing interventions such as repositioning, respiratory therapies, dressing, hygiene, etc. So far I had only worked in two homes with adult children who needed minimal help and could talk me through everything I needed. The job is not bad, but I have to say the orientation process of introducing a new nurse to a new home is appalling.

Last week I was asked to fill in for a nurse who had called in sick in another town. I was told to go there, and another nurse would be there to show me around. The secretary from the agency who called me had no details about the patient's condition, but assured me the other nurse would show me everything I needed to know. When I arrived I found the patient to be a girl who could not be more disabled in any way. She was blind, deaf, severely retarded, and paralyzed. We were taking her to school, so the other nurse and I hopped on the bus and went with her. Once there, I found she needed continuous tube feedings, transfer with a hoyer lift, chest percussion therapy, and to be transferred around school from class to class. None of this I have ever done before and needless to say I didn't know my way around the school as I had never been there before. The nurse training me was with me for 3 hours, and did show me everything as best she could. Then she left me on my own and went home. (As she had been instructed to by our agency because they didn't want to pay for 2 nurses the whole day.) I felt completely overwhelmed and wanted to cry. I didn't know where to go in the school and was afraid something would happen with her equipment and I wouldn't be able to figure it out. Plus I felt totally uncomfortable, not knowing how to interact with someone who couldn't see or hear me.

This seems so wrong to me to do to any nurse, let alone someone with as little experience as I have. Would I be right to tell them I cannot work alone in a new house until I have worked a few shifts with another nurse and feel comfortable with it? I don't want to be difficult, but it's my license on the line if I screw up! Thanks a lot for listening.

[klone, MSN, RN]

This is why I disagree with new grads getting jobs in home health.

I'm sorry you had such a hard time.

[Up2nogood RN, RN]

Bottom line is that you always have the right to say *No*. It sounds like you're doing private duty nursing not home health. One company I worked for gave me a 2 night orientation for a difficult child on a vent. Another company I worked for didn't give me any orientation the parents had to show me where everything was and routines of the child.

It sounds like your company was in a pinch but they probably could have found someone who was trained to take care of this child at school. I would have felt uncomfortable as a new grad too so kudos to you for sticking it out. I would ask for more training with the difficult cases if they are going to ask for you to be flexible. If they won't pay for more training then you'll just have to say no unless you want to take those chances again.

[GHGoonette, BSN, RN]

This is a little off the subject but...blind, deaf, severely retarded, paralyzed....and she's at home, I presume living with her parents?

This astonishes and heartens me; so many parents would have simply institutionalized her.

As has been mentioned, you have the right to refuse. You were clearly not properly prepared to take such a responsibility and the agency was very wrong to place this child's life at risk by assigning an inexperienced nurse to take care of her. It is their duty to ensure that they have appropriately trained backup staff for any eventuality, in order to cover for anyone who cannot be at work on any given day.

[noahsmama]

I tried to get a home health job when I had less than 1 year of experience as a nurse, and was told that there is a JCAHO requirement that home health nurses have at least 1 year of experience, and that home health agencies could not make an exception even if they wanted to. So I guess I don't quite understand how it's even possible to get a job like this as a new grad?

Your situation demonstrates why it's a good idea to only hire experienced nurses for home health. As a nurse in a peds hospital I ended up getting a lot of experience with children like the one you described, but I definitely would not have been comfortable taking care of a child like that without that previous experience.

I would demand more training, refuse any assignments you don't feel like you can handle, and start immediately looking for another job where you'll get more training. In fact, if you can afford to, I would consider quitting now, but if you can't do that, then definitely at least refuse assignments you don't feel you can handle.

[CrunchRN, ADN, RN]

It is private duty nursing not home health. 2 very different things................

[klone, MSN, RN]

I tried to get a home health job when I had less than 1 year of experience as a nurse, and was told that there is a JCAHO requirement that home health nurses have at least 1 year of experience, and that home health agencies could not make an exception even if they wanted to. So I guess I don't quite understand how it's even possible to get a job like this as a new grad? .

Not all agencies use JCAHO for accreditation.

[klone, MSN, RN]

It is private duty nursing not home health. 2 very different things................

Can you explain to me how the two are different, as far as oversight and supervision?

The OP stated that she works for a HOME HEALTH COMPANY. I would assume that means that she does home health.

[Up2nogood RN, RN]

Can you explain to me how the two are different, as far as oversight and supervision?

The OP stated that she works for a HOME HEALTH COMPANY. I would assume that means that she does home health.

It is confusing from the OP post. At first it sounds like intermittent visits but taking the client to school would be the duties of a private duty nurse. Either the OP confused the 2 terms or the company she works for does both types of visits?

I was hired as a new LPN grad for private duty but I did have prior experience with peds as a CNA and med aide. Not exactly the same I know but the 1st private duty job I had didn't utilize much besides the most basic nursing skills and the client was a DNR with Hospice involved. It isn't far-fetched in my opinion to have a new grad in a private duty position with a stable client and proper/thorough training.

[kerussll]

I guess I don't know the difference between home care and private duty. The company I work for is called "Heartland Home Care" There is one nurse with this girl overnight at home, and one goes to school with her during the day, both from the same agency I believe. So maybe my company does both?

I will take all of your advice, and demand more training if I am to be going to any new houses. I was just hired a few days ago at a local hospital where I will get at least 6 weeks of orientation. Thank God! So I will be quitting soon. I do need this job to pay the bills until I start there in 5 weeks. Hopefully I can avoid getting put in any new houses until then.

[Not_A_Hat_Person, RN]

Last week I was asked to fill in for a nurse who had called in sick in another town. I was told to go there, and another nurse would be there to show me around. The secretary from the agency who called me had no details about the patient's condition, but assured me the other nurse would show me everything I needed to know. When I arrived I found the patient to be a girl who could not be more disabled in any way. She was blind, deaf, severely retarded, and paralyzed. We were taking her to school, so the other nurse and I hopped on the bus and went with her. Once there, I found she needed continuous tube feedings, transfer with a hoyer lift, chest percussion therapy, and to be transferred around school from class to class. None of this I have ever done before and needless to say I didn't know my way around the school as I had never been there before. The nurse training me was with me for 3 hours, and did show me everything as best she could. Then she left me on my own and went home.

I work private duty, and I understand your situation completely. Take away the continuous tube feedings and deafness, and you have my client. I got 1 day of orientation before I was on my own. Fortunately, I got my bearings quickly, and the school personnel have been very helpful. It helps that my peds rotation was in a home for children with brain injuries.

My agency has had a lot of babies as new admits, and they're trying to assign me one as a client, without any orientation. I've refused. I'm not about to open myself up to that kind of liability.

[himilayaneyes]

Best of luck to you hon. I work full time as a staff nurse at one facility and work as an agency nurse per-diem in various hospitals. I did home health for a short while. I definitely don't recommend new grads going into home health or private duty nursing. The truth, dear, is that these agencies don't care about you or how hard you worked to get your license. You have to look out for yourself. Congrats on getting a hospital job! Hospital nursing is definitely stressful, but you'll learn a lot and it'll prepare you for going into peoples' homes. Good luck.