Not doing what I was hired for

[MomRN0913]

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.

[MotherRN]

I really don't think the OP has a poor attitude. Her attitude is the product of a poor working environment. She is getting dumped on, and from what is sounds like, her supervisor is knowingly doing it because she doesn't want the most difficult cases.

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I agree. There is such a thing as self love too. It doesn't make you a bad person or bad nurse because you need to look out for your own well being also. I know what it is like to never get a meal during a long shift and have too high of a patient/nurse ratio, even though I am new. Walking into neglected homes on top of that with pest infestations, and all the charting (sounds like off the clock work maybe). It's just an abusive situation. I understand your need to vent. Go right ahead. No judgement here. I hope you find a nursing position that meets your needs and those of your family as well. I am learning very quickly that as much as I want to be Mother Teresa, I have responsibilities to my family as well. Taking care of myself so I can continue to work and not bring home disease to them is a priority. Work is not the top priority. My duty to family comes first. If I had no family to care for, then missionary type work might be my first calling.

[nursel56]

I don't think you should be Mother Theresa and I certainly am not on a high horse. I totally sympathized with everything you said in your last vent. The entire first paragraph of this vent contributed to the overall impression of contempt for your patients, not the job. I've worked in some of those homes, and many are isolated and truly "stuck with" family members who do nothing for them and perhaps even steal their narcotics. They are truly in need, and as you pointed out "nobody wants them". Sometimes saying something in verbal shorthand like "I hate palliative care" is translated as something negative about the patient when combined with other words like "dirty" and "awful".

It bugs me that your supervisor said "I hate it", "you go see it" and that seems like normal conversation. That is how it sounded to me. I truly am sorry if I misinterpreted your post, just trying to let others know how we arrived at our "superior" sounding opinions.

[JMBnurse]

I see now. They were not completely honest with you about the work you were going to be doing. It seems like they may have been vague for a reason. You want to be a hospice nurse and take care of that type of patient and they are assigning other types of patients to you. There is no shame in not being happy with that. This does not make someone a bad or uncaring nurse.

My background was Med/Surg, Oncology, Hospice and Peds. I preferred patients who were 1. stable or 2. comfort measures. I would have been ticked if I came into work and they gave me critical care/ventilator patients mixed in with my regular patients. Some of my nurse friends would have been upset being asked to care for chemo patients or peds, since that was not their thing.

I would think it might be unrealistic to expect things to change drastically, though. You may put your foot down and negotiate for a fairer distribution of the patients and if you are successful, that may be enough for you to be more satisfied with your current job, but ultimately, this may continue to be a problem due to the issues with the supervisor. Also, things may ease up if they hire other nurses, but again, they may feel just as you do and end up leaving, putting you back in the same situation.

Have you investigated whether or not other Hospice facilities or programs in your area are strictly Hospice only? I think if I were in your shoes, I would quietly scope that out on my days off and be looking for any open positions. I would definitely ask up front in any future interviews about the palliative patients to make sure about it. If I was offered a position, I would not have any qualms about turning in my resignation and telling them exactly why. In an interview I would be honest with them too and tell them that I want to focus on the care of Hospice patients, which I feel is my true calling as a nurse.

I'm only suggesting you leave, because it seems you are so unhappy and I, like probably most nurses, have been there. It's sad to me to hear you say that in the months you have worked there, the only time you have been at peace and stress-free was when you were out for surgery. That's awful and it shouldn't be that way. You deserve to be happy with your job and work in the area you prefer.

I loved Hospice care. Of all the areas I worked, it was probably my favorite. I have great admiration for all nurses who are dedicated to the care of Hospice patients.

I wish you good luck and happiness in whatever you decide. :)

[Poochiewoochie]

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.

How many times have you seen rants about the obese drug seeking frequent flyers?? I seem to remember a thread here regarding things you'd like to say to a patient-maybe some of these nurses that are acting holier than thou regarding your comments should go to that thread and make sure they didn't make some disparaging comments about some type of patient they dislike.

[Kooky Korky, BSN, RN]

You have a poor attitude re what you call DUMP pts. (You also use the words CRAP and AWFUL and DIRTY.) You need to get out of your position NOW. It hasn't been what you expected and wanted and it has taken its toll on you.

Regardless of how discouraged I've been at times, I've never considered pts low-class and beneath my care. Sorry, but that's the judgmental attitude that's coming across as you vent. Too much negativity for your own wellbeing, but more importantly, for the pts at your agency. They deserve better.

Take some time off and make a change.

OP just sounds frustrated to me. I didn't feel she/he was looking down on anyone.

To OP: calmly say your piece. Don't lose your temper or they might fire you. Why are you charting on your own time?

[Kooky Korky, BSN, RN]

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

How do you know that?

[jadelpn, LPN, EMT-B]

Wow. I can sense your frustration and in your vent post a thousand percent, OP.

This type of nursing is not for everyone.

The only thing worse than being in the process of dying in a dirty roach infested apartment is actually dying alone in one.

And that breaks my heart.

With that being said, what are you expecting different by doing the hospice part of this job as opposed to the palliative part?

Perhaps an ICU with a more flex schedule/per diem would be better--or 3 overnights a week or something.

Part of what palliative care and hospice is all about is dying with dignity. If you are burnt to the point of not being able to do that, then it would be time to move on. ICU and hospice care are like apples and oranges, and if ICU is your passion, then perhaps try and make it work.

[MomRN0913]

Wow. I can sense your frustration and in your vent post a thousand percent, OP.This type of nursing is not for everyone.The only thing worse than being in the process of dying in a dirty roach infested apartment is actually dying alone in one.And that breaks my heart.With that being said, what are you expecting different by doing the hospice part of this job as opposed to the palliative part?Perhaps an ICU with a more flex schedule/per diem would be better--or 3 overnights a week or something.Part of what palliative care and hospice is all about is dying with dignity. If you are burnt to the point of not being able to do that, then it would be time to move on. ICU and hospice care are like apples and oranges, and if ICU is your passion, then perhaps try and make it work.

My roach infested people are not people dying in their homes, they are not hospice patients for the millionth time! Why is this the only focus of the message?! I don't get it. I also never ever said or intended that I am burnt to the point of not being able to care for these patients. I do it and I do it pretty well for a newbie into the field of hospice. I have ensured dying with dinity on ALL my patients. Who said I haven't? My care has not been affected to anyone. People are just making things up now and it's getting frustrating! And I think I explained many, many times what I am expecting different by doing palliative and hospice care patients different, because they ARE indeed NOTone of the same. And the difference is not how these patients live.I appreciate, really, the time taken by those of you who actually understand what my post meant and where I am coming from. Those who understand the content and decided to take the time to ask questions and understand what I meant instead of reading one line and jumping to conclusions about the kind of care I live.In all my orientation/ follow up meetings, I have been praised for the care I give, been told I'm a great nurse, and have gotten feedback from the most "unkempt" people that I was a good, caring nurse. So where the conclusions of me not making sure my patients in dirty homes are not cared for, is bull.Agin, thank you to the ones who get it and aren't drawing your own highly inaccurate about the kind of nurse I am and for the constructive advice and support you have given me.

[angel337, MSN, RN]

I can see both sides of this issue, but I think we need to place ourselves in the position of the patient and their family. Would you want a nurse with these thoughts taking care of your dying mother, father or child??? I don't think so.

[PMFB-RN, RN]

Why don't you explain it then?

*** Casue I didn't want to be seen as being condecending by explaining basics that any nurse should have learned in nursing school.

[joanna73, BSN, RN]

Your remark is rather condescending. There is very little difference between the two. I've looked it up, and discussed same with a clinical nurse specialist.

[MomRN0913]

I can see both sides of this issue, but I think we need to place ourselves in the position of the patient and their family. Would you want a nurse with these thoughts taking care of your dying mother, father or child??? I don't think so.

that's fine, you are all entitled to your opinion.

Then only perfect nurses should be taking care of patients I guess. The nurse who says quietly to herself "OMG, he pooped again?" you wouldnt want that nurse either. or the one who says in their head "stop rining the call bell, I'm going crazy, wasn;t I just in here turning your TV channel?" Bet their family wouldn't want their nurses having those thoughts. guess they shouldn't be taking care of anyone either.

If you never had a negative thought about a patient, you are a liar, end of discussion!

Even my company sees palliative care as different from hospice patients. My director does too. When our homecare nurses help us out, they only help with palliatve, not our hospice patients, BECAUSE THEY ARE DIFFERENT.

Wasting my time here.