What kind of nursing

trach mom · #1 10-12-2002, 10:00 AM

I was just wondering for those of you who have nursing. Does your insurance pay for an RN or an LPN. Right now we have an RN but they are looking for an LPN because that is all the insurance is paying for. We have had LPN's but I think an RN would be more appropriate. I am considering fighting them to get an RN.

christyw · #2 10-12-2002, 01:32 PM

We have Arkansas Medicaid, Gaithy has already hit her million in insurance. Medicaid apparently pays for either one, but my hunch is that the specific agency that we use prefers to hire LPNs because they are paid considerably less within this particular company.

To second Melinda, I have had RN's who were clueless about Gaithy's needs and LPN's that were quite competant (and those who were very incompetant also.) I had to do training for both types...Generally, RN's have little to no experience with trachs/vents, etc...unless they have specifically worked in a unit or setting that deals with it and all of their other education isn't going to mean much unless they can come up to par with the trach issue. My husband is headed towards nursing school-RN and he has worked in an ER with all kinds of nurses, the chemistry classes along with other courses make the RN a more advanced nurse, but caring for the trached child is something that we as parents have learned and so can others people, nurse or not, RN or LPN. I weaded thru my nurses (we've had some interesting ones) and kept ONE nurse to do 40 hours a week, because that's how many hours I decided I really wanted. She is an LPN, she loves Gaithy, and gives her lots of attention in the eight hours (M-F) that she is here. She is fully capable of giving meds/feedings, nebulizer treatments, suctioning, etc...and I'm happy with that. (She also went with me to Arkansas Children's Hospital and went thru the same type of trach training that my husband and I went thru back before Gaithy came home, which I appreciated her doing. A lot of the nursing agencies send nurses to a home for a vent/trach patient without requiring or giving any training, which I feel is really irresponsible of them.)

The main thing is, the nurse we have isn't always trying to outsmart us, the parents, and she doesn't try to run our home or dictate the way we raise our daughter, (this is important since medical care is a big part of the way we raise our daughter, if the nurse were to be constantly dictating that, then we wouldn't feel like parents, you know?)

Basically, I would go with whatever YOU want, and what you feel makes you happiest and your child safest, and, of course, whatever is in anyway feasible to get. My only claim is, for this situation, I don't think it matters the ranking, only the competance in training for your child specifically.

christy

Shari · #3 10-14-2002, 09:23 PM

Depending on what state you live in, you may be able to fight your vent company using the nurse's educational background. Although I do not want to offend anyone or step on toes, there are a lot of differences in the education and training of an LPN vs an RN. First, an LPN is required to work under the supervision of an RN. Is your agency close enough to your home and is an RN available quickly for back-up? Does the LPN have any formal training on a vent? Most LPN's are educated in a vocational type school for less than a year and do not learn about vents or ICU at all. LPN's learn very little about child development, the psycho-social difficulties of the family with a chronically ill child, complex genetic issues, etc. Courses such as anatomy, physiology, microbiology, advanced math, nutrition, psychology, and sociology are not required. Although I have some excellent nurses who are LPN's, it always puzzles me that a teacher has to go to college for 4 years to teach a 5 year old to read, yet a nurse goes to school for less than a year to keep my vent-dependent child alive. It really depends on the person, for sure, but you should have the option of hiring RN's if you choose to do so.

trach mom · #4 10-14-2002, 09:48 PM

Fortunately, my child is not on a vent. I still would feel more comfortable with an RN. Now even more so since you mentioned all these new reasons. My agency is more than 30 minutes away and the backup nurse lives an hour away. And I feel like I should have a choice in who takes care of my child.

christyw · #5 10-14-2002, 10:33 PM

Dear Trach Mom,

That's definitely true, you should have a choice. Hopefully you will be able to fight for and get the nursing care that you want. Maybe some of your doctors can get involved. We had some trouble with a few nurses in the beginning and I kept my daughter's doctors informed, but I don't think they ever came down on the company like I wanted them to! Like I said in my first post, some agencies send nurses to a home with a trach and/or vented baby and require them to have no specific training...or at least they don't enforce training policies if they have them. That's just crazy and I felt like the children's hospital should be able to do something about that irresponsibility, since the hospital REQUIRES us to have nursing before we can take our babies home. I wasn't allowed to take Gaithy home until the agency could promise us 24/7 coverage. They promised it...but it was never true, we never had that kind of coverage, AND none of the nurses we did have then knew what the heck they were doing, so how was this supposed to help me, my husband, Gaithy??? Anyway, maybe the doctors didn't have much power and that's why they didn't do something...I have no idea, but MAYBE they do have the power to make things change and just didn't.

christy

Adam's Mommy · #6 10-21-2002, 05:08 PM

We have both an RN and an LPN that take care of Adam. I think they both do a very good job. The LPN has years of experience and has bagged and saved lives... she has been in the homes of many kids with trachs and vents, and definately knows what she is doing. We have also had an LPN straight out of school come to our home (very young girl, very inexperienced), who almost put 5ccs of Motrin down the saline port of his Ballard suction catheter, mistaking it for his NG tube!!!

It really depends on the person and their experience. I always checked them out very well, asked for their credentials and experience, asked them how often they have utilized their trach CPR training, etc... There should also be a state website where you can check out nurses and their records. You cannot always trust who your nursing company is sending into your home, as we had a guy (RN) come in that we just felt strange about, and it ended up that he was on restrictions for giving narcotics due to abuse. Needless to say he was out the door and the nursing company and I went round and round about how extensive their background checks are, and who they send to my home.

Adam has spent alot of time in the hospital this summer (VP shunt surgeries--brain), and the LPN's are the nurses on the neurological unit are the ones that always take care of his trach when I am not there or sleeping. They work under the RN, but the RN never stays in the room just for the trach...

Anyway, I think you need to do what is comfortable for you, and go by their experience. Unexperienced RN's can be pretty scary, I like to know that they have had lots of hands on...

Peace,