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XB9S Guide 47,170 Views

Joined Sep 7, '06 - from 'United Kingdom'. XB9S is a Registered nurse. She has '22' year(s) of experience and specializes in 'Advanced Practice, surgery'. Posts: 8,603 (25% Liked) Likes: 3,899

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  • Nov 8 '15

    I am a hospice nurse. Unfortunately difficult deaths do occur. I have been in this exact situation and very often, sadly, it has been with young patients. Sometimes hospice can do as much as possible, 20mg morphine qhour, dilaudid, lorazepam, haldol, 10L continuous oxygen, reposition, EVERYTHING the MD can think of, EVERYTHING the RN can think of...but it just doesn't work.

    I have come to believe that when a patient is young, aside from their disease process, the body fights to live, even as the cancer prevails. I have found this to be true particularly in brain cancer. It is as if our other organs haven't yet realized the damage the cancer has done to the brain, and so they fight to keep working. Our heart wants to continue beating, our lungs want to keep oxygenating, our soul wants to stay, all the while the cancer is forcing it to stop.

    Hospice goal is comfort at end of life. But that is just the goal, sometimes no matter how hard we try we just cannot accomplish that goal. Sometimes the disease is much more powerful and progresses much faster than what we can get ahead of. I know this sounds strange but after some of my more difficult deaths, I have imagined that if my patient had just lived a little bit longer I could have gotten ahead of that pain, slowed that respiratory distress, calmed that agitation, whatever it is, if I had just had a little bit longer. Sometimes it is a battle against the clock, and only the cancer knows how fast the clock is moving.

    I understand your confusion and the grief you have for yourself, your friend, and her daughter. It is valid and you are not being critical at all. But please know that just as your friend and her family are tormented by their daughter's difficult death, so is her hospice nurse. It never leaves us, none of the deaths do. Also please realize, merely by the fact that your MD and RN were hospice speciality they were not afraid to give morphine. They do not need additional training, nor additional education. Brain cancer is a savage beast that takes everyone by storm, even those best trained to deal with it.

    I am so sorry for everyone involved, even for her hospice staff.

  • Sep 12 '15

    My thanks as well to the Admin and moderator team. Having once been a part of it, I understand how difficult it must be to conduct business as usual during this crisis, but you are doing a magnificent job of it. Hang in there, you all...better days are ahead, but we've all got to get through the initial shock and grief. (((HUGS))) to all of you!!

  • Jun 5 '15

    Quote from JonniBravo
    Thank you to you all for your reply, I work 12 hours shifts so its been difficult and if I'm honest I forgot aout this post. I have joined RCN and got some advice, basically I am a Band 5 newly qualified, I am making mistakes but they are not risky to clients they are mainly paperwork and because its a private company and I have been trained in the NHS I am unfamiliar with the paper files. A good example of how difficult things are for me is my mentor was working today, despite being really busy and showing my list of work/jobs she insisted I complete two care plans, my mentor said, you have had these files how long.

    I really felt like saying to her this is all outstanding because you wont support me! and other staff are not doing there bit.

    Other staff are really stressed because the CQC are due abd it become every man for themselves, the associate nurses are not completing there 1-1's leaving me in some weeks only work 3 days in a week having to do 1-1's almost daily to catch up with the standard, sometimes I find myself doing a 1-1 with the same person two day running. That's just a small part of the stress I am under, I love being a nurse and I am improving, but the manager has stated I have deadlines I'm not sure I can meet because the mentor is not supporting me and the associate nurses are despite being asked to complete parts of the care plans are simply not helping.

    I have been advised to write an email to the ward manager stating I don't feel supported "due to ward constraints!!!!" and flag the point I am not receiving meetings with my mentor.

    Sorry for ranting, I feel very vulnerable in this post a and I feel if I fail here my career is over.
    You need to do a number of things, it's good that you've joined the RCN, they should be able to give you much more tailored support from trained stewards and professional officers. They'll know the employment laws and things like that that you can use against your employer should you need to. Sometimes with the private sector it can be difficult to involve the union directly if they don't recognise them, but they should still be able to give you guidance.

    You need to document when you've ended up doing all this extra work where others have not been bothering, are these associate nurses the same as HCAs/NAs? If they're not doing their jobs then you need to bring this to the attention of your ward manager and have them dealt with. If you're getting into trouble and they're not when you're snowed under trying to do their job make sure they end up getting some of the heat. Document every time you've asked for support with your development and education and it's been refused or hasn't happened. Use all this as evidence for discussion with your manager/matron.

    Also, look for work elsewhere, you don't have to accept jobs, but there's no harm in applying for jobs. I see you're in the private sector at the moment, I'd strongly suggest you try and find a job in the NHS, there's much more support and rules for how nurses are supported within that organisation compared to the private sector.

    I hope it all goes well for you.

  • Mar 12 '15

    Quote from Khad
    I appreciate your reply. I have got some idea about site management but just wanted clarification as I am moving from a band 5 position from a super specialised small unit where we practically do everything skill wise except
    site mgmt.
    Sorry, but you do NOT understand what site management is if you think "we practically do everything skill wise except site mgmt." Band 7 is a management role and you will be dealing with site management at some point and I think I agree with XB9S, you are not ready for this move. Try to find a band 6 job first.

  • Feb 26 '15

    Quote from XB9S
    My first worry is that your afraid to ask for assistance with something you don't know. You really need to overcome this otherwise your not going to be a safe nurse.
    A THOUSAND times yes to this. You're a student. You haven't seen everything. Even once you're registered, you won't have seen everything. Don't ever undertake a new procedure without learning how to do it properly from someone who's qualified to teach it (and that does NOT include anonymous commenters on an Internet forum). Everyone was a learner at some point; don't ever be afraid to ask questions.

  • Feb 25 '15

    Quote from cheezwizz90
    Sounds like you're scared of what will happen when you die. Your coworker was trying to help you and didn't sound harassing or inappropriate to me whatsoever. If you can't handle some simple questions like those you were asked, I sure wouldn't want you to be my nurse if I had questions about my care. Jesus told His followers to share Him with others. We each can do that in our own ways, and she was trying her own method. I usually don't use her method, but I would like to hear her side of the story. As far as what you should do, probably you could start by thinking about her questions and examining the status of your soul in the light of God's teachings. You should be flattered that she loves you enough to throw out a lifeline. It is sad that you are fighting against imminent judgement with no hope in Christ to save you.
    I tried responding to this three different ways. The best I can come up with is, "Sigh."

  • Jul 18 '14

    Kind of agree with XB9S, you should know this stuff. Band 7 is a management post and if you do not know it, are you ready?

  • Apr 24 '14

    Hoping to start my BSN later this year with Dundee university so this will certainly come in handy

  • Feb 18 '14

    He had just turned 18 when he came into the ER with chest and shoulder pain. I walked into his room and introduced myself. He was polite and soft spoken. I asked him about his pain and the cough that accompanied it. He stated it was an 8/10 and braced himself as he coughed. When I asked him if anyone had been sick at home, he said no. Then, as I asked him more about medical history, he says, very matter of factly "Well, I have osteosarcoma in my lungs."

    "Oh.....and when was your last treatment?" Nothing on the triage note mentioned any of this, and he was listed as not being on any medications. I imagine it wasn't brought up. I didn't want to charge into this situation like a rhino on rollerskates so my mind scrambled on how to continue the conversation.

    "They stopped treatment about a year ago. There's nothing they can do, ma'am."

    "Oh....", I said, brilliantly, as this sweet teenager just told me he was dying as casually as if he was telling me the time.

    I asked him a little bit more. He had been on dilaudid prn at home but tried not to take it too often and it had been a few weeks since his prescription ran out. He had been hoping he wouldn't need it anymore as it made him sleepy. I finished my assessment and went out to chart and get his info in so I could get meds for him. An order for Ibuprofen popped up. I found the intern and asked if we could start with something a little higher up the chain. She said "We'll try this first." I felt like an idiot offering this kid 400mg of Motrin for his cancer riddled body. I started and IV and drew some labs too. "That wasn't bad," he exclaimed, "It's been a while since I've had to have one of those", referring to the IV.

    I went in a half an hour later to check on him. He was curled up in a ball on the stretcher, his eyes closed and his long limbs tucked close to his body. His mom had fallen asleep in the visitor chair with her head on the counter.
    "Nurse, how long does it usually take to work?"

    He was living his life
    even as he was dying
    I went out to speak to the intern again. She ordered 2mg of Morphine. Ok a step up. I went back to him and gave him the morphine. I checked on him shortly after and he smiled and said he did feel better. He wasn't coughing as much so I'm sure that helped alleviate some pain at least temporarily. He thanked me politely and closed his eyes again.

    The CT showed mets to his spine including his shoulder where he had been having pain. I saw the doc go in and come out. He was discharged with a prescription for Dilaudid. I went in to remove his IV. It was almost 0500. I told him to go home and get some sleep.

    "Oh no, I can't sleep. I have a test today. And I have a dentist appointment later."

    "A test? What is your test for?"

    "I'm taking some college classes," he beamed.

    "Well, good luck on your test. I bet you can reschedule that dentist appointment though. It was really nice meeting you."

    "It was nice to meet you too. Thank you for all your help." I didn't notice his limp until he walked out of the ER, waving at us all.

    The lump in my throat has remained. This kid, this young man, was told he was going to die but his instinct was to still take care of himself, to still improve himself. College. Even the dentist. You can bet I'm not going to worry about seeing my dentist if I've got months to live. I am honestly not sure that my first thought would be to start going to college if I was told I was dying. I might be tempted to sit around and feel sorry for myself. To think of all the things I would be missing. But I also had immense respect for him. It might have been his dream to go to college and he was living his life even as he was dying, his body betraying his youth at a time when he should have been able to embark on a new part of his life.

    I'm sure he suspected his symptoms were related to his diagnosis. I'm sure it was on his mind even as he went to his class after a night in the ER. But it was never even an option to skip his test or even miss a dentist appointment. I never got the impression he used his diagnosis to make excuses. I was impressed with him as I interacted with him. Impressed by his maturity and coping. He impacted me more than a lot of adults ever have. But then he stunned me into a humble silence with those last sentences to me.

    What would you imagine doing with the knowledge that you were living your last few months? We pose this question a lot. But how do any of us know how we would react? We can speculate. Would you stop everything and be with family? Would you get that urge of motivation to do something you've always wanted to do? Would you cherish the mundane like going to the grocery store? I honestly don't know what I would do but this young man made me totally rethink what is possible.

  • Jan 31 '14

    ​Maybe we should have a panel for this thread to review posts prior to publishing them. We wouldn't want to offend anyone's sensibilities now, would we? (Yes, that was sarcasm.)

  • Jan 31 '14

    MarissaHu,

    I am aware that one cannot be sure of the tone a poster has when they comment online but some of your posts are coming across as argumentative and sarcastic. As it has been repeated MULTIPLE times, we are in a discussion forum speaking with our peers, not at Jahi's bedside, therefore we should be able to use any medically correct terminology that we choose to. I don't see the point of beating a dead horse on the politically correct terminology to use, and I don't want to see this thread closed because we can't just agree to disagree.
    As others have said, I would also not use the term corpse around the family, but when speaking in a nursing forum I should be able to say the things that I really feel and I do feel that she is a corpse, although I respect your position on the subject.
    For hopefully the last time, can we all just agree to disagree?

  • Nov 6 '12

    I find the comments on the daily mail to be offensive in the extreme. Comparing LCP to Auschwitz and hospital staff to Nazi SS members? Beyond offensive, and I will no longer give them the time of day or their sponsors an audience for their ads.

  • Jun 14 '12

    I, personally, think that many forget here that this is the LARGEST Nursing Community and we have nurses here from all over the world. I think we all forget to say what country we are posting from, if different from the US, or remember to ask the poster where are they....as in country. (AN is based in the US) All forums show up on the What's new, Daily linked/liked areas and many don't look/see what forum they are in or can't see as trhey are on their phones.

    I usually pick up on certain speech patterns for Ireland, England, and Australia .....there are common phrases or use of certain words that tip me off Like the "ward" or "Brilliant".

    While some of practice is very similar....some of it is vastly different. I think first and foremost we need to be respectful of each other and remember that each of us have different Practice acts that govern our practice.

    I think we need to remember that in the US.....the LPN/LVN practice has become extremely limited in all of the US States (for various reasons) and in the US every state has it's own Nurse Practice Act and then that practice is governed by individual facilities. Very confusing......The down side of non-centralized medicine.

    In the US we need to remember that there are other posters that are not from our country or work in the same facility that we work.

    We "can agree to disagree without being disagreeable". President Gerald Ford.

  • May 7 '12

    I know that you are venting and probably not looking for advice, but if you will allow me to offer a few suggestions:

    So many of us have been in your position. It is SO frustrating! If you feel up to it, try to change the culture of your workplace. Most of the time, people with attitudes feel "victimized" somehow. Rational people with a clear understanding of their job duties don't react with an attitude when asked to do something, do they? So why is this person being irrational? Does she feel unappreciated? Does she feel like she has too large of a workload? Is her personal life in shambles? (and the reason I ask the last question is because sometimes when employees don't have a balanced/stable home life, they act out at work-not that this is OK, but it may help you to understand their behavior.)

    I had this same challenge with a particular staff member for almost two years. I finally asked her, "Mary, it is clear to me that you are angry because you reacted to my request to help Ms. X up to the bathroom by rolling your eyes and sighing. Can you tell me why you are mad?" Mary replies, "Why do you think I am mad? I just have to do EVERYTHING while you just sit around and play on the computer!" I state, "It may look that way, but I am charting, and it takes a while to get through all of it. You said that you have to do EVERYTHING, and I don't want you to feel that way. I do want you to understand that you are a valuable team member on this unit. We need you and rely on you. Do you feel that your tasks are too numerous? What can I do to help you?"

    She finally opened up to me and said that she was taking care of her dying mother by herself while her 3 sisters came up with one excuse after another regarding why they can't help her, trying to keep her daughter out of trouble, and trying to keep up with her pre-nursing classes at the community college. I had no idea. She felt under appreciated at home and carried those feelings over to work; hence the comment "I have to do EVERYTHING". She was simply at the end of her rope.

    To change the culture of a work environment is difficult, no doubt. But you can do it. In collaboration with your NM, compile a list of duties in a checklist form for the CNAs on your unit. Involve them as well so they feel like they have a voice in their job duties. Staff members are more compliant when they have some sense of ownership in defining their duties. Expectations are then clear cut. Try to open up those lines of communication and do small things to make her feel appreciated. A candybar, a coffee, an email to the NM pointing out the things she did well during a shift...it's the small things that make people feel good. However, if the CNA continues to have an attitude after your efforts to communicate, then she should be written up for disruptive behavior. You have to document each occurrence as it happens.

    I hope this helps. I know it's frustrating, and not very pleasant. View yourself as a leader in this instance and reach out to her. You might be surprised at how her attitude turns around.

  • Apr 13 '12

    As Australia is an independent country from the USA it is impossible to transfer! as you say.Your best bet is to apply to AHPRA to be an RN then go from there

    It is impossible for someone to make decision for you on how to immigrate and were to go as one is not walking in your shoes and do you realise Australia is as big as the USA. What climates do you like? rural, remote, city, town?

    The only comment I can make and were to go now at THIS time, who knows in a few months, is Sydney appears to be employing International nurses but these jobs will be filled eventually.

    Btw. AHPRA assessments are taking many months to process, I, personally if, was thinking of going overseas to work would be making sure I was accepted by the nursing board of that said country first before making any other decisions and this would be the best place to start, ANMAC after registration/assessent if you want independent skilled assessment for immigration.


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