View Full Version : Your nursing agency's guidelines for nurses right out of school working w/trach?

01-28-2010, 10:32 AM
We have 3 agencies on our case.
One has super strict guidelines. The new nurses MUST work for one year before even signing up with the agency. Then they have mandatory trach - trach/vent courses and exams followed up by supervised trach change on a living person, child if they're working in pedi.

The second has similar guidelines.

The third has none! They send nurses who just graduated from LPN school who have never even touched a trach on a patient. Never worked, no references. They send them solo to care for trach and trach/vent kids. And that's OK with them. They send *anyone* as long as they have some sort of nursing degree.

They're throwing Right-out-of-school- Faster than you can say LIABILITY, nurses. And behave as though I'm unreasonable. huh??

01-28-2010, 10:41 AM
Our agency requires at least 6 months pediatric experience before they will assign a nurse to a case. I also know they have a lot of in-house training and the nurse also has to be able to show (on who, I don't know) that he/she can change out a trach. I don't get too many nurses who don't know *anything* because we have the added bonus of a ventilator and most nurses don't want to work our case because of it. Do you think it would do any good to report the nursing agency to your state's nursing board or to whatever state agency oversees nursing?

01-28-2010, 10:48 AM
See Ann, that's what I think is crazy because what nurse in her/his right mind would *want* to take on a trach case solo if they didn't know what they were doing?? These nurses do!

And this is why I'm wondering about other's agencies...it doesn't seem right. There has to be laws protecting patients! And are there?

01-28-2010, 10:54 AM
File a complaint with New Jersey's Board of Nursing (http://www.state.nj.us/lps/ca/nursing/)

Let them know that the agency is knowingly sending out untrained nurses. I have no doubt they will be investigated. I would definitely report them, not only for the safety of your boys, but for all the other families getting these nurses.

01-28-2010, 02:19 PM
Kerry -- I just figured out why you and I have been on opposite sides of the fence on nursing discussions. Man, oh man, if I had an agency with the requirements of your two, I would have been so happy. Our agency was like your third agency, as are most of the agencies in the area. But, only the one agency would even touch us, so we had ZERO options.

Our agency had trach clinics, but I think they didn't really start that until I complained. I might be wrong about that. I'll never know, and they wouldn't tell me the truth if I asked.

If I had one wish, it was that we all had access to agencies with the kind of standards of your two stricter ones. I understand LPNs need to get experience somewhere, but I wish for so many of them it wasn't on my watch.

I didn't even know there were such standards. Bless them! Bless them!

PS -- adding: it always sounded to me like your nurses might have been more well-trained than mine, but I was afraid to say something. Here I was thinking all this time that I was just too critical! Now I'm willing to bet that most of your nurses ARE better than most of mine were. Or at least ... they are a whole lot less scary! Our agency's logic was that any nurse was better than no nurse, and they took most nurses' word on their application that they had experience. I disagree with both those policies. Their answer? "There is a shortage. What can we do?"

I will say the nurses we had from time to time who worked in NICU/PICUs at least for awhile were worth their weight in platinum. They were few and far between.

01-28-2010, 02:50 PM
Our agency's logic was that any nurse was better than no nurse, and they took most nurses' word on their application that they had experience. I disagree with both those policies. Their answer? "There is a shortage. What can we do?"

This was always our problem too.. and why I did away with nursing so fast... I think of the 30or so I was sent there were 2 who were experienced with trachs-- (not vents, but that was a whole other story)

I think if the other agencies in your area are able to have guidelines; this one should be able to have them also..

01-28-2010, 03:40 PM
The first agency we had requirements "on paper" and would verbally tell you and the hospital staff that nurses had to have a minimum of 1 year of hands on skilled care. HA! The bulk of nurses they sent had just marched off the graduation platform and right into their office to apply.

The other 2 agencies that we've worked with do require experience and have requirements for demonstrating skills as well as continued education.

If I had known THEN what I know NOW, I'd have reported that agency. I was just so glad to be rid of them, I didn't want to deal with anything else with them.

01-29-2010, 07:57 AM
The first agency we had when we were discharged sent us some nurses with experience, and some not so much. But the term experience is a broad one, and we found out later, although the agency was pretty up front about the nurses that had real experience with trach (and vent) patients and those that didn't, their answer to the problem was to send the nurse home with a two page write up on trach care and/or vent care and call them trained. We ended up refusing quite a few, and the agency still tried to send them to the house when we were short despite my claims that they were not fit to care for my child.
The second agency we got on board is pediatrics only and does a much better job of in-house training on vents. But they sent us a nurse pretty fresh out of school that we had for about two weeks before we sent her packing. She was full of book knowledge, but had little hands on experience...although the real reason we got rid of her was b/c I found her sleeping in the baby's room on her night shift.

Most of the nurses we have had tell me all the agencies are pretty much the same with respect to how they schedule and assign cases. My experience hasn't shown me otherwise - and it sounds like your other 2 agencies are better than most.

01-29-2010, 08:41 AM
One of Max's best nurses came to us with no peds trach experience. But I could tell she was a smart cookie when I met her, so I didn't mind...and then I trained her myself. She did, however, have experience in other fields of nursing, but was transitioning to home care. That became more of a requirement to me than the actual trach experience. I wanted someone who could prove to make the right decisions in an emergency.

I don't think I would take someone with ZERO experience. I'd complain.

Alex's mom
01-29-2010, 10:08 AM
Our agency has similar guidelines as your first two. The first agency we worked, with, not so much.