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it's a tough job, but...

Posted Jan 27 2009 7:12pm

I've got a week of this private-duty gig under my belt (plus a couple of days) now, and things are falling into a regular rhythm. The elementary school I follow my client to in the mornings insisted that I wear some kind of uniform while I'm there, so I'm sporting my brilliant blue scrubs until I can find a white coat with sufficient pockets (where do you buy your white coats? Please respond).

I'm surprised by my own alacrity this week. I can slap on a pair of gloves and suction the kid's trach out in an instant, rinse off the catheter and power down the suction device before the preschool teacher even gets a chance to glare at me. If the kid throws their therma-vent (artificial nose) on the floor I can whip a sterile one out of my pocket and replace it so fast the para will still be reminding me to do it after it's done. I've got the diaper-changing routine down, the tricky part was positioning things so the kid doesn't grab poo and start smearing it on things (things that may be uncomfortably close to the trach). Feeding is still the trickiest part. On a good day, I -wont- spill pediasure and/or gastric mucous on something (most likely myself), but that's only happened a couple of times. I'm going to strive to have a good -week- in this regard, starting next week (too late for this week!).

The routine at school is much more relaxed now that a parent isn't coming with. Having them around is immensely useful at home, but at school they aren't allowed to do anything but observe, and their presence strikes fear into the hearts of the school staff. The parents are pretty blase about this, they're not there to critique the teachers, just to make sure their kid can go to school.

The kid only gets 15 minutes of ASL instruction a week, it's hard to imagine much getting done in that span of time, especially considering all of the interfering stimulus in the classroom. A tutor comes to the house once in a while too, but that's also infrequent (and temporary). The mom, unsurprisingly, taught the kid all of the sign they know so far.

I had resolved to use more sign while interacting with the kid, but I guess when it comes down to it I don't know what I'd even say. When it's time to suction, I suction. When it's time to feed, I feed. The rest of the time, we play. The kid's favorite stimuli as far as I can tell are vibrational. All the favorite toys vibrate or impart some kind of repetitive tactile stimulus. I can almost always elicit a smile by lightly drumming with my fingertips on their sternum, or causing my hand to vibrate using the muscles of my arm if the kid's latched on to it. I've had some small success using the sign for "look" to direct attention to something or someone specific, and I try to remember to always greet the kid by pointing to myself and making the gesture for "nurse" (gesturing by taking my own pulse briefly), which I've adopted as my name-sign on the advice of the tutor. Honestly I'm so language inept that I don't see myself getting very good at it. When I had clients who signed in the past, they only had an abrupt, truncated vocabulary of 5 or so signs, which is more or less where my current client is at.

Fun fact about me: I've trained my local bartenders to bring me water when I sign "water" at them (it's too noisy to do anything else)


I'm really happy with the agency I'm working for. I haven't gotten much in the way of clinical nursing support from them so far (I hear that will change in the coming months when clinical educators will visit me and do some skills training), but in every other way they've been very supportive. I swing by the office frequently, since it's walking-distance from my current place of residence. I'll stop by to fill out a time-sheet, pick up some gloves, catch the manager up on my client's situation. I mentioned off-hand that I had been planning on getting a pediatric stethoscope but wouldn't be able to until the next paycheck. The next day the guy just handed me one, no forms to fill out or anything. They're keeping me ankle-deep in gloves and hand-sanitizer. I keep running into more and more nurses who work for this agency, some people who are LPNs and going to school where I graduated, one RN who's the mother of an old elementary school classmate, a random acquaintance at a wedding, weird things like that. The RN-mother-of-former-classmate invited me to do flu clinics with her next winter (finally, I'll get to do some intra-muscular injections!).


This week I have orientation at the skilled nursing facility, looks like all my ducks are in a row.

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