Not doing what I was hired for

Nurses General Nursing

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Another vent again. I was hired as a hospice nurse into my company 5 months ago. I was told there would be " a little bit of palliative care". Well, its only me the supervisor and the director in the hospice division of our HH company because they can't keep. Uses ( one left after me being there for 3 weeks) and that can't find anyone. So I am stuck with all of the palliative care. I hate palliative care. I do hospice revisits, but my intention was to be a hospice nurse, as I was told, not the person to just pick up the crap no one else wants to do. Almost 6 mo ths and I haven't done a hospice admission or pronounced. My supervisor knowingly dumps the most awful patients on me that she opens up and announces " I hate this patient, you go see it". I am the dump job nurse, left busting my butt to see the patients no one else wants to see, not even what I was hired for. And my supervisor said " get ready, the palliatives are picking up and they are all yours"So, tomorrow is a progress meeting with the supervisor, director and educator. I have mentioned my desire to really the lean the hospice that I desire to do, they say " yes, we'll start doing it, and they never do. I want to say something again. I am at wits end at this Job, sick of working my butt off and charting all the time on my own time. My happiest times in this last few months I have worked here was in the last 3 weeks where I had 10 days off for a lap chole! It's the only time I have felt free and destresser. Not worrying about having to wake up at the crack of dawn to do paperwork or going to roach infested homes of dirty people who can't take care of themselves and no one else wants to see. My tolerance is gone. I feel like I'm gong to say everything I mean tomorrow and it won't be good.I'm a former icu nurse. Loved it there and had to leave because I couldn't do shift work with my family situation. It's been aMost 2 years since I've been gone and I'm friendly everyone there and they say all I have to do is ask if I want to come back. It's a great system. I wish I could figure out a way to do it. With all that ranting I lost sight of the question. Should I speak up tomorrow? I chose hospic for a reason. I did not want to be a palliative care nurse. I don't mind doing it when needed, I'm a team player, but I want to do what I was hired to do and have a passion for.

Specializes in ICU.

Holy Cow! I haven't been on here in a few days, and I am shocked at the responses I got! Although not surprised, because it seems as if these days, some nurses on this board have been taking the holier than thou attitude quite often these days. The ones who didn't write me off as a horrible nurse actually understood the content of my post instead of reading words like "dirty", "roaches" or "crappy" and making their own interpretation.

Perhaps I am shocked because I know who I am. A compassionate nurse who cares deeply for her patients. I always have. I cry and hug the clean ones, the dirty ones, the annyoing ones, the sweet ones. I give my best and equal nursing care to every patient I have seen int he different setting throughout my 6 year career. When off on the weekends I will call my patients at home if they had a particularly difficult week, just to see how things have been going. I wake up at night worried about some of my patients. I sit there and think in my bed what I could do to make them more comfortable. So, maybe if some of you stopped jumping to conclusions and actually read the meaning behind the content of my vent, or actually asked some relevant questions before ASSuming, you might get to know that.

My description of my patients were that as described by my supervisor. And yes indeed, some homes gross me out. The patient who spit his sputum into his pee filling urinal right in front of my face, grossed me out! I have an actual phobia of roaches, they gross me out. The time I sat down in pee, grossed me out! I am a bad uncompassionate nurse because of that? No, that makes me human. Have I ever given any less care to these patients? No. Do I not help them just the same emotionally, and physically? No.

How many nurses in the hospital and on these boards cant stand having the PIA every night sitting on the callbell to fluff their pillow? Howmany vents are there on here about that? What about the guy who likes to paint the walls with his poop? We've all taken care of him! If we are a bit grossed out by that, are we uncompassionate? Any nurse who says they prefer all patients as equals and doesn't vent about the ones they just can't take of every night is a liar.

The difference about feeling this way, is if we are compromising care, which, I assure you I am not.

Anyways, obviously the meaning and content of this post has been totally lost. But back to my original thoughts. I thought going into hopice I would be rendering end of life care to ensure a peaceful and comfortable death at home. I did not think I would be constantly going to end stage disease patients to constantly go in and send them to the hospital. It happens quite frequently with my palliatives. Palliative care and hospice patients and care are different, they are not one in the same. There are many hospice's that only render end of life care at home. My company is also a homecare company, so it's not all we do.

In ICU I was getting burnt out on coding 92 lol and cracking their ribs. It affected me emotionally. So I thought hospice care was a good fit, because I was very good with the patients who's life support was DC'd and on comfort measures only. Oh, and this shockingly horribly uncaring nurse would sit in the middle of the night with the guy on a morphine gtt and a heart rate in the 30's about to die holding his hand because his family wasn't there.

Perhaps I had a misunderstanding of what my job was or how that company functioned. But indeed, I am knolingly getting all of the undesireable cases, it is verbalized, and it is upsetting. I am sure if the same nurse went back to the floor every night to have the patient who is most difficult that no one else wanted ot take care of for whatever reason ( you know, the PIA who waits for you to leave the room to hit the call bell, that is mentioned here quite often) you would get burnt out too and feel drained.

It's not because I have no respect for them, or think they are "gross", which I don't even know what that had to do with the palliative vs. hospice care patients

I did indeed bring this up to my director. My supervisor called out sick and did not make it the meeting. My director was understanding, talked with me 2 hours, understood where I was coming from, she clarified some things for me that i may have misunderstood likewise. She thinks I am going to make an excellent Hospice case manager and does want to give me the tools to do it. Unfortunatley staffing is bad right now. There were many people who left before me for much of the same reasons, before 3 months time. People can't believe I made it 6 months. My director actually called me at the end of the day because she was worried I would think about this all weekend and think things won't get better. I am going to do the best I can to make it a year. Then I willd decide if this is for me or not. I was educated that a decent percentage of our palliative cases is where we get out business from.

ANd yes, the paperwork is more with the palliatives because of the OASIS questions and become more in palliative and home care because the patients quite often are in and out of the hospital, so you SOC, ROC, transfer, discharge OASIS which take a darn long time. It was advertised to me in this job I would be doing "a few" palliatives, but it turned out it is mostly palliatives.

So, there you have it. If you think I am a horrible nurse, don't worry, you don't have to have me take care of you ever. For the time being, my patients, no matter what walk of life or conditions they come from, get equal and compassionate care and quite frequently say to many of the staff how happy they are with me and go out of their way to make a mention. But to some peoples high an mighty opinions, I guess I should just get out and stop rendering that kind of care.

.

Specializes in ICU.
With your attitude the way it is, you don't need to keep your current job. Hospice care makes me think of utmost respect and care in the final times of a person's life, and you cannot provide great care if you feel the way you do.

Roaches don't make the person bad. I'm sure they are ill. Otherwise they wouldn't be on hospice. Before you judge remember that those patients depend on you. If you cannot be dependable, quit so maybe they can get someone who is.

I hate to even waste my time quoting the ignorant , obviously didn't read a word of what I said posts, and insulted me after reading the first few sentences, but, let me ask, when did I say roaches made a person bad? No, the dirty home with creepy crawlers make me queasy. I never said they were a bad person...... you ASSUmed that. And that patient for your info, is not a hospice patient. What's not dependable about ME? I never missed a visit, when i went to that patients apartment and no one was answering, i could do what the other nurses do, write it off as a "no answer", instead, I asked around and looked around the building and found her in the laundry room. I spent over an hour with that patient. I could have done a quickie visit, but I didn't.

So Amolucio, my post was interpreted wrong. Many conclusions were jumped to about the kind of care I am rendering. People again ASSumed that because I felt a home was undesireable, that they recieved subpar care, in which I never even insinuated.

Funny, how I can called judgemental, when there are some quite judgemental nurses on here assuming things about the kind of care I give.

Specializes in ICU.

Oh and last, but not least, i can see how one thing could be misinterpreted, but I typed it out wrong in a state of stress.

I said "dirty people who can't take care of themselves" Yup, that sounds bad and was meant to be "dirty people who CHOSE not to take care of themselves. Yup, that frustrates me. People who can't, I really really feel for and go to lengths to help them to get the resources so that they can. The ones who don't, because they don't want to are a bit frustrating to me, yes. That probably makes me an awful subpar nurse too, though. Because when a patient tells me her lady parts stink and her sister tells me she refuses to wash it, well, eeewww.

Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
This should be good........................

Not at all. The one's with the filthy homes have been living that way long before they got sick.

Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
Geez, the nerve of these hospice patients having not kept up with their house cleaning. /sarcasm

Not even, these folks have lived in filth long before they got sick, usually.

Specializes in ICU.

The Difference Between Palliative Care and Hospice

This is a nice little summary about the difference between Hospice and Palliative care.

I think Palliative care is a great thing. When someone is undergoing treatment for aggressive illnesses, they need well congtrolled pain and symptom management as long as psychosocial support.

It just so happens my focus and desire with my career is to help patients die a peaceful death at home. Which is hospice nursing.

Specializes in Med-Surg.

Do you feel better about your job after your meeting today? I sincerely hope that things get better for you.

But palliative care is clearly a very, very big part of hospice nursing. Much of any hospices nurses's time will be spent doing palliative care. People are often on hospice a long time before they die. How can someone die a peaceful death *without* palliative care? No, they're not the exact same thing. But hospice care will always, by definition, involve lots of palliative care. Right?

Specializes in ICU.

Thanks Halycon. I do feel a little better. My director was very supportive, and I am left with a little hope. Some things are just the nature of the job, like the paperwork that is never ending. It is hard for me to work on my own time, I'm a single mom and my daughter started kindergarten and our day is go, go, go with homework, dinner, cleaning, baths, you know, life, I have no help and I am clearly just pooped and fried to do any work on my own time. I've been waking up before the sun is up to catch up on paperwork because my mind is fresher. My ex husband has our daughter every other weekend and half a night a week, and that time is usually spent catching up on everything.

But that is my own issue. I do like the people I work with. They aren't like my old ICU crew who I am very close to like family to this day, but they are good people, and in the whole company. as a whole are very nice people. My supervisor is burnt. she has been doing this for 20 years. I will give her the credit that when she says negative things about certain patients, she will still render excellent care. She took me to see the GIP's the other day so, yet again "I hate doing the GIP's, so now you can see them" but when she went into those rooms, she was extremely loving and caring to the patients and families.

I'm not now, nor have ever been a boat rocker. And I felt very uncomfortable telling my director how I felt. She wants to solve it and address it and I am nervous because I don't want a bad relationship between me and my supervisor who is also my preceptor. I think she is a good person and I like her as a person, but she is burnt out. My director assures me she will approach this in a way it doesn't leave anyone feeling blamed. I hope that's true.

I'm really trying. My issues aren't with the patients. I just want to get through my days in one piece and not a stressed out mess. I also have a child who needs mommy completely burnt out.

Specializes in ICU.
But palliative care is clearly a very, very big part of hospice nursing. Much of any hospices nurses's time will be spent doing palliative care. People are often on hospice a long time before they die. How can someone die a peaceful death *without* palliative care? No, they're not the exact same thing. But hospice care will always, by definition, involve lots of palliative care. Right?

When i say Palliatve care is what I don't want to do, it is not the actually palliative care piece I'm not interested in. That's what people are misundertanding. Case management of Palliative Care patients is different than hospice. Its actual home care case management with a palliative focus. They stick around for 3-4 weeks. MUCH paperwork is involved in that 3-4 weeks. Many are going through aggressive treatments still. Hospice Cases are managed differently than palliative cases.

So, it's not that I don't want to render the actual Palliative Care.

Specializes in Oncology, Med/Surg, Hospice, Case Mgmt..
When i say Palliatve care is what I don't want to do, it is not the actually palliative care piece I'm not interested in. That's what people are misundertanding. Case management of Palliative Care patients is different than hospice. Its actual home care case management with a palliative focus. They stick around for 3-4 weeks. MUCH paperwork is involved in that 3-4 weeks. Many are going through aggressive treatments still. Hospice Cases are managed differently than palliative cases.

So, it's not that I don't want to render the actual Palliative Care.

So, as a Case Manager, are you doing hands on care of the patients, whether hospice or palliative?

Specializes in ICU.

Home care, whether being Hospice or regular homecare/palliative with mostly teaching, but there is hands on in both. I disimpacted my hospice patient the other day. I do wound care, I assist in cleaning patients while I am there if needed. Not much of a difference. With Palliative there is more coordination of medical care with doctors appts, therapy appts and the such.

Hands on care doesn't bother me at all. It took a toll on my body in the ICU and I have a few herniated disks giving me trouble, but being an ICU nurse, I have much experience in giving full hands on care.

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