(Yes, …hi, it’s me again..lol…sometimes i have stuff to say and other times i go into seclusion for a bit- warning- long post)
I have recently realized that of all the things i have posted about on here, the one topic i have missed( not intentionally) is my actual job. I have mentioned a few times that i am a nurse, and how i paid my way through school without loan debt, etc. But i’ve never really explained what i do.
I never wanted to be a nurse. It was never something i imagined myself doing. And i especially never wanted to work with kids. As a single mom, i had my hands full with my own. Never the less, the universe knows whats best, and thats exactly how it happened.
At the time, i knew i had waited long enough to start a real career. I had worked in labor and unskilled employment since i was a teen. At age 30 i needed to get a sustainable, reliable job that would enable me to care for my children and self for the long term. Back then, newspaper ads were still where to find work.There was internet but job ads online were not commonplace. Every week i would see 10-20 jobs listed for nurses, and so that’s what i decided i would do.
What’s funny is, whenever i tell people i am a nurse the first thing i’m asked 75% of the time is “What hospital do you work at?”This is generally the idea in someones head apparently when they think of nurses. Not a bad thing but a very very very limited way of thinking. Kind of like someone saying they are a teacher and automatically people ask “what school do you teach at?”
Not all teachers work at schools and not all nurses work at hospitals. In fact , i have worked as a Nurse Educator- combining both- and not in a school OR a hospital. The nursing field is more diverse than most realize.
But what i have done for 90% of my career is private duty pediatric care. In other words, i work in people’s homes to care for their medically fragile child. Unlike a hospice situation, or a visiting nurse i stay for an entire 8 hour shift each night and its generally an ongoing situation( meaning 99% are not terminal). I have typically cared for clients under the age of 3(but have done some up to age 16) with a huge variety of medical issues-most listed under the broad category of “failure to thrive” as their initial diagnosis. This can encompass many many things such as prematurity, chronic and/or genetic diseases, and developmental delays of all types among other things. Generally nurses in home care do not care for those with very low medical needs- such as the majority of autistic kids, or those with minor disabilities. Those children go to CNA’s or Home Health Aids as their needs can be met by these licenses.I was an NA for a brief time at age 19 but quit after 2 months due to caring for an infant at home and back pain from the job. it was not a certified position then and very poorly regulated. Injuries were almost guaranteed.
So i started as an LPN. I began in the Mental Health/ Mental Retardation sector as a new graduate. After about a year in that facility i moved into private duty ( we call it home care in the field) with children . I remained in that area for many years , even throughout my studies to become an RN. Once i had my RN degree i needed experience in a hospital setting to gain any credibility here so i did a year in a Critical Care Specialty Hospital. That was nuts and super stressful. I was then offered a position as a clinical manager at a home care agency and i took it, only to find i hated all the paperwork, and began to teach onboarding classes for the agency part time.I was working all 3 jobs at once. Eventually, the company merged and a new , salaried position as one of only 2 Clinical Education Specialists was created. I was able to quit the hospital.and move out of the management position. I loved teaching but very soon they expanded my responsibilities so much that i was doing the work of 5 or 6 people. The hours( 60 plus per week including nights and weekends),lots of travel, and constant daily hassles with the upper administration became overwhelming and frustrating. I left that company and moved back out into direct home care with another agency, and have been doing that again since. Oh, and i tried a nursing home somewhere along the way but after only one night i knew it wasn’t for me.
So what exactly do i do in home care? Well, that has varied based on the client.In the first 2 years or so i dealt with what we call low and medium tech kids. Low tech is any child without a trach or vent. Medium tech is trached, high tech is both. I specialized in high tech kids for about 9 years, which is what led to my position as an educator. These kids are generally hospitalized from 4-9 months after birth until they are able to come home on a portable ventilator. Yes, they have tracheostomies and yes that is scary at first. a childs trach in home care is not 2 pieces like what most nurses see in facilities and hospitals, which have inner and outer cannulas, and you only remove the inner part for cleaning leaving the outer one intact in the neck. It is one piece and when you have to change it out the whole thing comes out and a new one is inserted directly into their “neck hole”( stoma). Dealing with any medically fragile child scares off many nurses, but this, along with the noise and technology of a ventilator ,and the higher chance for complications scares off even more.It was my job to make them feel comfortable, yet knowledgeable. Ironically, what many do not understand is that when there’s a ventilator reading everything going on inside, you have way more advance notice of impending illnesses.The numbers change .You can also ventilate them manually much more easily as you do not have to struggle for a seal around their nose and mouth, and you become much more experienced with things that even seasoned hospital nurses aren’t comfortable with- especially making independent decisions. The skills you can gain in this end of the spectrum will serve you well in any future setting where calm/cool /organized collected actions are required. Panic is not an option.
Generally the vented kids are premature or very low birth weight. We call the ones under 2 lbs at birth “micro preemies”. Some preemies and micro preemies, however, can survive without a trach or vent and come home when they reach 5-6 lbs and are stable. They are so tiny, you would have to see one to believe it. A few i have literally carried around with one hand for a month or so. Their little heads are barely bigger than a golfball. The issues are vast- from undeveloped lungs, hearts and other organs, to nutrition issues requiring a stomach tube which usually attaches to a pump for feedings. I have gained a tremendous amount of knowledge in these areas and too many others to count in the years i have been a home care nurse.
The job itself is going into the home and staying for an 8-12 hour shift . I work nights while the parents sleep. There are day nurses for while the parents work, and if vented, also an evening shift nurse too as vented kids always get 24 hour care per insurance regulations in most states.Individual cases outside of vents will vary in coverage. For instance, if one parent doesnt work, they will get less hours of nursing. The day nurses also go to school with the kids, to doctor appointments, and participate in their therapies( usually speech, occupational, and physical). Night nurses have less physically active duties- in general because ideally the child is sleeping- but most often are responsible for all cleaning, equipment change outs, med counts ,and most aren’t aware- more emergencies as these tend to happen most often at night.We also organize, do laundry, and deal with supplies and monitor for expanding needs or changes needed in treatments/ doctors orders.Of course we still provide direct care and give meds or treatments as needed but these tend to be less as enough sleep and adherence to regular schedules are priorities.Lots of diaper changes and untangling of equipment cords for safety – which becomes quite a challenge as children get more and more active as they improve and age.
Being usually the only caretaker for a shift, we do not get smoke breaks, lunch breaks, etc. We cannot run out to the store for anything( as in, bring your lunch, your medications and feminine products- you cannot leave to go get anything, sometimes not even out to your car). Night shift cannot order out so as not to wake anyone with deliveries.You can’t have friends visit or usually even give you a ride because of HIPPA laws. You are 100% responsible and liable for your clients care, even if the parents are home, awake or asleep. You cannot fall asleep so you need to bring stuff to keep you awake during the large amount of downtime in dimly lit rooms.If the next shift doesn’t come in or is late you must stay until another caretaker or a parent is able to get there.
Now i hope i didnt make it sound terrible because those are just some things to keep in mind.You get used to it, and it really isnt that bad. At this point i will tell you the bad things that CAN happen, but remember– it is my opinion that i would still rather deal with these everyday than work in a facility. It was that awful for me.
So, you may have clients families that aren’t very clean or hygienic. You may have some that are bat sh*t crazy or not very nice. There may be pets or even siblings you aren’t crazy about. You may not have great parking options or your case may not be in the safest areas. You may have emergencies and have to go to the hospital with them – riding along in the car so the parents can drive or in an ambulance if the parents aren’t available.And yes, you may have to do CPR and call 911 and have a child life-lined- However, in 20 years this last bit has only happened to me a handful of times.
NOW…… let me tell you the best things, and these are the things that despite the low pay, crappy benefits, and sometimes boredom or chaos- make me love my job.
You are valued and not just another #. Almost 99% of the time- you are treated like family (or even royalty!) once they trust you. And once you have gained that, they are loyal, will fight to keep you and go out of their way to do so.They will make you comfortable- a nice chair to sit in, access to wifi, and even sharing food and treats and special holiday gifts ( within limits of course- there are laws- i usually get some cookies or a nice candle ).These families truly, deeply rely on you. Your are their life line.they have to work. They have to sleep.They cannot just call a babysitter if theres no nursing or drop their kids off at day care. Initially, once the client is released from the hospital, the family is a nervous wreck- they are scared, and unsure of themselves and strangers in their home. You have to earn their trust. It may take a few tries but once you find a good fit, you are golden. I can’t think of a more rewarding job in the world.
The kids are great. They rely on you as well. Nothing is more stressful to a child than inconsistency in care so it becomes a huge deal for a family to keep good nurses. All you have to do is your job, but honestly most nurses i have known do so much more. And this is because you are well treated , and giving back becomes a pleasure.These kids really do love you. While you cannot allow yourself to overstep boundaries or become overly attached, you genuinely begin to care for these kids as much as you would any child you care for daily for long periods of time. You want the best for them. You will fight for them and their care. You will worry similar to a parent when they get ill.
Also when i started out, i wanted to get as much experience as possible, and so for years i hopped around as a fill in nurse. I got to learn so many things… so many i can’t begin to list. I cared for terminal children of all types – cancer, rare diseases, organ failure- but those were rare. Mostly the ones i cared for eventually outgrew their prematurity issues and years later you would never even know how fragile they were.I worked with equipment most hospital nurses have zero knowledge about , unless they specialized in pediatrics..and even then, many home versions are more complex . It makes sense when you realize that in MOST facilities, there are separate “teams” to provide care for different things. Theres a “code” team ( to run life saving codes in emergencies), there is a respiratory staff, physical therapists, surgeons, doctors, dieticians,ENT’s, opticians, etc.Also — nurses aids- (who are the real super heroes in my eyes!) …the list goes on. In the home, machines and equipment must do more to make up for a lack of other staff. The home nurse must know and understand the equipment they are responsible for. He or she cannot call another department in the building and get help within a few minutes or hours.You cannot ask another staff member on duty for help. At best, you can try to reach someone on call in an office that might be available, albeit many miles away and might have an answer. But too often you get put on hold or the on call needs to call someone else, and so on. This is why you learn independence.
It’s been over 20 years now. I still cannot imagine or think of another job that is more interesting , rewarding and stable. I will likely do this type of nursing until i retire or get out of nursing altogether and pursue something completely different , like Entomology.
i hope this answers a few questions and clears up any myths about what a nurse does and where they work. The choices and diversity in employment are numerous and in demand. Theres a real shortage and has been for a vey long time. If anyone is struggling to choose a career, wanting a change or has a desire to be part of real change and hope every single day, i highly recommend looking into it as a career.
Namaste!
Wake up! 