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.
I highly doubt 2 full shifts of orientation is going to happen. That's why a lot of employers seek nurses with one year experience. My agency schedules 4 hours of orientation as a standard. I usually call them after an hour and a half and tell them I'm good to go. This is not because I'm something special, but because I have years of experience. I have, on occasion, while orienting another nurse, called my agency and told them we need more time and they have always, albeit reluctantly, agreed. Being a new nurse is tough, no matter where you work, but remember, the steeper the climb, the sweeter the triumph. Think about all the experience you just gained from this case. You're only 2 months out of school and you already know so much more. Tough times are ahead, no doubt, but I want you to concentrate on the positives. Give yourself credit for making it through a tough shift and realize how much knowledge and experience you are gaining. You'll feel more comfortable in no time.
A great portion of people I graduated nursing school with were only able to find jobs in home health. I know at least 3 of them weren't able to stick with it and quickly bailed (2 of them left nursing altogether, having never found jobs in the hospital).
Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.
This terminology is right -- you work for a home health company doing private duty nursing. I've found the terms to be used interchangeably by many people but to put a fine point on it, most people take "home health" to mean the visits for admission, recertification for medicare/medicaid reimbursement, wound care, IV therapy, and blood draws. You would normally be supervising the nurses in the home as well.
Anyway, this field has some real challenges and lack of consistency from one agency to the next, one staffer (secretary) to the next, one DON etc etc so you really have to fine tune your radar for situations that could put the patient's safety or your license at risk. From what I've experienced in this area, your 3 hour orientation was actually more than I received with my first patient and as I've oriented many nurses myself I find so many of them don't care to spend much time learning about the patient and yawn repeatedly, look at their watch over and over, and interrupt me to ask if the homeowner has "wi-fi" This is a field where you have to set your own bar as high, as there are so many people who don't seem to grasp the fact that the shoddier your orientation the more at risk you and your patient will be if anything unexpected happens.
Luckily everything worked out OK and this will be a really good learning experience. Most agencies from what I have seen will not give a rat's *** (or they don't know) if you have enough orientation to safely care for the patient so we have to do that ourselves. I usually ask to see or have faxed the Plan of Care before I go. I've insisted on going back for orientation more than once if I didn't feel entirely confident I could do what needed to be done for that patient. They will pressure you because they want a space filled first and foremost. That case sounds like it could be very rewarding but after the learning curve of just getting her up, fed, transferred, moved, medicated etc etc - it wasn't fair to either of you to get tossed into the deep end on the first day!!! Best wishes to you!
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?
This could be a state by state thing as my agency has hired new grads for private duty in very selected cases with a lot of nearby support. If I had not worked at a Children's Hospital first I would have been very reluctant to have my first patient be a child with many chronic conditions and treatments/meds required.
I have to go to work in about 2 minutes but just wanted to add a quick reply.
First of all, I'm sorry that you had a horrible day and felt blind. Second of all, I'm sorry for the girl that you were taking care (no offense to you at all but you should have received more training).
I doubt that your agency would pay for 2 days of training on a new case. I'm also unfamiliar with agencies except for the one I am working for now. I know that they would let me come in for 2 hours only for orientation. That's it. I only have one patient (mentally and physically challenged) who I work with on a regular basis...once a week along with my other job. I chose to come in on my off time (without pay) at this clients home to get to know him better before I took on the assignment. I also took my 2 hours of training that my agency alloted.
(I am so sorry, in advance, about my grammer...I am getting ready for work and don't have time to critique my post).
This is a field where you have to set your own bar as high, as there are so many people who don't seem to grasp the fact that the shoddier your orientation the more at risk you and your patient will be if anything unexpected happens.
systoly
1,756 Posts
I highly doubt 2 full shifts of orientation is going to happen. That's why a lot of employers seek nurses with one year experience. My agency schedules 4 hours of orientation as a standard. I usually call them after an hour and a half and tell them I'm good to go. This is not because I'm something special, but because I have years of experience. I have, on occasion, while orienting another nurse, called my agency and told them we need more time and they have always, albeit reluctantly, agreed. Being a new nurse is tough, no matter where you work, but remember, the steeper the climb, the sweeter the triumph. Think about all the experience you just gained from this case. You're only 2 months out of school and you already know so much more. Tough times are ahead, no doubt, but I want you to concentrate on the positives. Give yourself credit for making it through a tough shift and realize how much knowledge and experience you are gaining. You'll feel more comfortable in no time.