The Meet-and-Greet with the pediatric home care clients was postponed until today because the agency director had a cold and couldn't be around the child. I showed up a couple minutes late, after driving past their house a couple of times. Doh! I was about to walk out the front door when my mother pointed out "you -do- realize you're wearing all black on your way to meet a three-year-old, right?" Oops. Old habits die hard.
It went alright, I think. Mom was there, the child was sleeping fitfully in a floor-chair. I glanced over whenever I heard his trach gurgling. Dad was at work.
This was the first time I met the agency director. He was smartly dressed in a suit and tie, and had a look and voice modulation pattern that was familiar to me after spending time in commissioned sales. We both sat on the couch while Mom sat on the floor and talked almost non-stop for a good hour or so (it was extremely informative, I knew mothers of special-needs children were practically nurses in their own right, but I'd never seen this in action before). She's around my age, maybe a little younger. Pleasant, articulate, and extremely knowledgeable about her child's care and condition.
She talked about their daily routine, their trips up to the children's hospital in our state capital, and the bevy of specialists that they see on a weekly basis. Cranio-facial, feeding team, neuro, surgery, the list went on for about 10 specialists I thought. The agency director intentionally didn't fill me in on what the child's diagnosis is, and when the mother mentioned the name, it slid right out of my mind. It was two words, very long, very difficult to pronounce correctly. I'll learn more once I start the clinical orientation with the current RN on the case.
Having learned a little bit from previous "interview" experiences where the principal interviewer seems to be doing all the talking, I jumped in with some questions for her about what she thought constituted good nursing care from an RN, and what previous experience has taught her about the difference between someone who's doing a good job and someone who isn't.
"Professionalism", she said. "RNs are more professional than LPNs". This caught me off guard, I was expecting something about clinical competency or maybe familiarity with developmental needs of special-needs children. She went on to explain that in the past, she's had problems with LPNs chatting about their home-life to people at their school, using the mother's make-up and leaving feminine hygine products lying around their bathroom.
I started to do that thing where one eyebrow creeps up.
"Lemme just piggy-back off of that for just a moment" the director jumped in, now. "Most of the problems we've had with home care nurses aren't clinical in nature. We want our nurses to feel comfortable while they're caring for someone in their home, but sometimes when people get TOO comfortable, we have problems."
The mother went on explaining the daily routine and nursing responsibilities, and it looks like I'm not even going to have to do any of the things a Para would do, they're going to get a para in ADDITION to an RN. Basically I'm going to ride with him to preschool, hang out and play with him, and be on hand to suction and deliver a bolus dose of feeding solution through his g-button. She also mentioned I'll probably be spending some time playing playstation with her husband while the child's asleep. Rock.
There are some privacy issues with this case that I'm going to have to spend some time reflecting on, specifically vis-à-vis blogging. Since I've written about hospital patients on this blog before, I've obviously put some thought into obfuscating my location and name, as well as the details about the people I've cared for. I've had a lot of great role models in the health care blogging community for how to go about this, and I'm confident that I have and can continue to do so responsibly. Since this is a 1:1 assignment, however, I have to make sure that I don't get -so- comfortable that I write something that could potentially identify my charge. The family has had some issues in the past that have resulted in them being very concerned about their child's privacy and safety. They know HIPAA backwards and forwards, in addition to everything else.
Since what's being proposed is basically welcoming me into their family, if I get the job maybe I'll write a test-entry and run it by them to see what they think of it. The best thing to do, I think, would be to focus on my own experiences and reflections on my own practice and stay away from the slice-of-life descriptions of "how my day went".
Tomorrow I'm supposed to call into the skilled nursing facility mentioned in a previous post and inquire about the status of my application. If I get both of these jobs, I'll have 40hrs/wk doing home care and 12 hours every other week in the nursing home (paid for 20). Both of these jobs together, before tax, would average out to be 1290USD per week. It's a pretty good combination of jobs, since the nursing home job will give me experience in wound-care, EKGs and IV therapy, while the home care assignment will give me steady work and pediatric experience (which is hard for associate-degree RNs to get in my neck of the woods). The pedi trach experience might later on be leveraged into critical care, which is what I'd like to be moving towards. Back in school I identified emergency/critical and pediatrics as two fields I wanted to explore (along with psych), so maybe I'm on the right track, even if I'm not in the hospital.