Leesha 2,584 Views
Joined Aug 8, '07.
Posts: 74 (30% Liked)
I'm now sure what specifically is stresses me out. I'll have to think about that a little.
Don't forget the placebo effect is a very well-documented thing. I don't believe aromatherapy, for example, is terribly scientific - but if you can convince a patient to believe lavender will help him calm down, and you have him smell some lavender, he might just calm down. Certain treatments/interventions can absolutely be useful and work even if they don't have hard science backing them up because of the placebo effect.
You can call me an oddball if you wish, but I like to know about patients with behavioral issues before I meet them. I also appreciate heads-up warnings regarding bizarre family dynamics or tendencies toward crazy-making.
It sounds like the patient should have been set up as a continuous care case or inpatient for symptom management??
The fact that you really get to know your pts and family (depending on their prognosis)
Being able to support families and pts at EOL
Being able to feel like you successfully helped a pt pass with dignity and comfort
meetings about meetings about meetings
Being respected and appreciated by colleagues, medical and allied staff (and reciprocating that feeling). That might include bringing in a silly joke gift that is part of an inside joke on the unit; being thanked for doing a good job; receiving informative feedback or education when you've missed something.
1) We don't do your homework for you. Even if it isn't nursing homework. It's in the terms of service.
2) It's not a very good idea --it's actually a pretty bad idea-- to post your real name and email on an anonymous internet forum.
3) Nobody is going to give you a real name, position, and employer. See "anonymous," supra.
What I recommend, as a nurse writer and editor, is that you go to the library and check out some of the many, many nursing journals. Almost all of the better ones give you contact information for the article authors. You can also contact or Google some past and present nursing editors, like Diana J. Mason, the Editor Emerita of the American Journal of Nursing; I think there's a very good chance that she would answer your questions. The rest of us are on the mastheads.
That way you will increase your chances of finding real writers (although I hasten to add that there are some truly excellent ones on AN), and you will know to whom you are speaking. On an anonymous forum like this, well, we could be lots of different people and not even nurses.
Hope that helps! At very least it will give you a leg up on learning how to do research on a writing topic beyond hitting "send."
We need good writers, so I hope you choose nursing over journalism. You can always be a nurse who writes well, but you can't be a journalist with a nursing hobby.
(oh, and a good writer doesn't call her correspondents "you guys.")
My nursing career has spread over several hospitals and units, and in all my years I have never been more ashamed and frustrated to be a nurse as I am nowadays.
Between hospitals lack of money and the constant fear of being sued I have noticed a shift from caring about the patient to caring about proper documentation and "saving your own butt".
I am seeing a lack of comraderie between staffmembers, as they no longer have eachothers backs, but now overlook one another and write eachother up numerous times.
We are expected to document in both the paper and computer flowsheets, and are immediatly written up if something is charted in only once.
Animosity now exists between the ER and the floor, rolling their eyes.. refusing report and patient.
Management once had our backs and supported us when accusations were made from families or other staffmembers, but now they merely make a note in our file of the incidence, not wanting to cause waves as their own positions of middle management are unsteady.
Management now does 'quality assurance' everyday double checking our charting and making daily notations on how to improve our written word.
We have checklists for everything.. checklists to monitor the chescklists.. it really has become quite ridiculous.
I personally once was in the middle of moving a trached patient on a vent from stretcher to bed, and the nurse manager came in mid movement to ask about the MedReconciliation.. never once looking or asking about the status of the critical patient.
In defense everyone is acting out in fear of their job, fear of the DOH, CME, or Joint Commission showing up... all suits who do not understand the medical profession nor have realisitc expectations. I would truly like to see anyone of the Commissions work a full 12 hour shift in a busy ER without being allowed to have their bottle of water at the nurses station.
Nursing is no longer the "art and science" we were taught in school.. it is now "charting and fending for oneself". I have seen many incredible nurses leave the bedside practice because they can no longer deal with the micro-management of insignificatnt daily tediousness. Make no mistake,
I am no bitter nurse that is tongue-lashing after getting in trouble, and I am making a realistic observation of how the nursing profession has quickly moved its focus off of caring for a patient. I really wish nursing could go back to what it was years ago when we had a a sense of pride and comraderie... I fear what the future holds.
Welcome. Your experience will depend upon where geographically you are practicing, whether or not you are visiting patients in the hospice inpatient unit or in the field. You may travel with different disciplines in order to give you an idea of the interdisciplinary approach. You may be invited to attend the IDT meeting (InterDisciplinary Team meeting).
If you visit in the home with the case manager you should expect that the RN will introduce you and say why you are there. (He/she may have already notified the patients and families to expect a student ride-a-long). H/she will enter the home, appropriately stow their bag, and proceed with their visit process.
During the visit certain things are common;
~The RN CM will greet the patient and family, often warmly, and may have chit chat about social things that have gone on.
~H/she will look at the med POC and the medications available in the home
~h/she will assess how the meds are being given, if they are effective, if the goals for the medication POC are being met and why or why not.
~the nurse will order any meds that are on short supply to insure that the patient has an adequate supply
~some level of a physical exam will occur. however, dependent upon the POC that may appear very cursory to you and may not include things that you consider standard, like recording VS.
~sometimes the RN will do things like change or irrigate a foley, draw blood, empty a pleura vac, assess and redress wounds, suction or clean the trach, complete ilieostomy or colostomy care, administer medicastions, apply compression stockings or lymphedema wraps (if trained), etc. Basically any skilled need the patient may have.
~the nurse may phone and speak to the MD, or may order an intervention from the signed Standing Orders without speaking to the MD. The CM may contact other disciplines at that time if there is any need identified during the visit.
~the nurse will assess the overall needs of the patient and family, determine if the current POC is working and if there are additional problems, interventions, or goals that should be added, changed, or discontinued.
The visit may be brief or quite long...it depends upon the patient, family, and nurse. Most try to complete the visit and their documentation in about an hour.
You can find the job if you look. I came right out of nursing school got my license and the first place to hire me was a hospice. I absolutely love it and could never see myself doing anything else. I leave work feeling good about the difference I have made to my pt and the family. The comfort and love that I have given to them means the world to me.
So, you have a job you hate and a useless husband and your world is falling apart at a brisk clip. Time for some major soul-searching. You have the wrong career and the wrong spouse. Does your current job have an employee assistance program? Find someone professional to talk to, help you clarify your values and goals and come up with a realistic game plan.
We nurses are notorious for getting latched onto by useless partners and relatives. Time to ditch the ballast and go into survival mode for yourself and your children. Good luck to you.
In your second post you explain how your husband is a drain on you. Suggest you develop a mind set of "no husband". Start thinking and acting as if he was not in the picture. If you want to earn more money and not give it to him to waste, do so. If you want to spend your check on this instead of that, do so. Start a savings account in your name only, even if all you do is put $5 in it every two months. Make your decisions as if he were dead, or just plain gone. In other words, do what YOU need to do to survive and stop wasting energy on him. If you don't let him drag you down, that is one less thing to depress you and maybe you could handle things a little easier. Just a thought.
I have an acer netbook that I really love and have found to be very helpful in my classes. I got it because I do most of my studying and schoolwork at the library and in study groups and wanted the convenience of a smaller laptop to easily take with me. If you do most of your schoolwork at home, a laptop might not be necessary. I do not use my netbook in class though....pen and paper is much easier for me there.
I personally prefer a laptop because I can take it anywhere with me -- the library, coffee shop, vacation, etc.
I've found having my little netbook to be an invaluable resource during nursing school. All of our classes are taught with pdf slides, I can type out my notes right on top of them and then print them later if I want. It's smaller than the average textbook and only 2 pounds, so very easy to take with me everywhere I go. It's especially valuable when I go to the hospital to gather information on my patients for our care plans / mini preps.
So I'd be much less effective at my studies if I didn't have my laptop. It might not be the same for you of course. I type WAAY faster than I write, so that really helps me get enough information.
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