Content That Chaya Likes

Content That Chaya Likes

Chaya 6,667 Views

Joined Mar 5, '03 - from 'Bosstown metro area'. He has '15' year(s) of experience and specializes in 'Rehab, Med Surg, Home Care'. Posts: 1,116 (19% Liked) Likes: 474

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  • Jul 23

    I don't agree. Soon patient's family members see you fill a new one and they filling used ones.

  • Jul 23

    A Day in the Life of a Hospice Nurse

    I slung my computer bag over my shoulder and pondered the question one of my nurse colleagues who worked at the hospital asked me. She wondered what my typical day was like. I wanted to laugh because “typical day” and “nursing” probably don’t fit in the same sentence. As I headed around to the back door of Mrs. J’s house, the familiar gravel path crunched under my shoes. I knocked on the screen door and heard Mrs. J’s daughter calling me to come on in. Mrs. J was in the den in the hospital bed, a real change from my previous visits when she had been able to get to the kitchen table and sip on her coffee while we talked.

    “How was the yard sale?” I smiled at her as I took her hand in mine, feeling for her pulse. She had planned for weeks to have a big sale “so my kids won’t have to do it.” She smiled weakly at me, and said, “It went good. Got rid of a bunch of junk. I feel better about that.” Then her expression changed to one of determination as she said, “I’m all set to go now.”

    I had been visiting Mrs. J for several months as she experienced a slow decline from her metastatic breast cancer. With her pain well managed, she had been able to continue to do many things she wanted to do: attend a family reunion, take her granddaughter back to school shopping, and watch her youngest daughter’s pregnancy blossom. Her weakness, fatigue and shortness of breath had gradually become worse and now it was apparent that the final days were near. I tended to her needs, talked at length with her daughter and made sure everyone’s questions were addressed.

    When I got back to my car and finished up charting my visit, I looked ahead at the rest of the day—I had four more patients to see to try to wrap things up by my 4:30. I made some mental calculations about distance and priorities—always seeing the most needy first and those in institutions later in the day. I thought some more about my friend’s question. How could I tell her what a hospice nurse really does? Some of it might really surprise her!

    Hospice nurses don’t generally go from one actively dying patient to another.


    Often, a hospice nurse, (also known as a Hospice Case Manager) spends her day seeing a series of patients that she knows, some of them for several months and in different stages of their disease. When a decline is gradual, patients meet the criteria of having a six month life expectancy but some of them live a little longer than that and some much less. Many hospice patients stay in the home setting the entire time they are in hospice. If there are symptom management issues they may have to go to a facility, such as a hospice house or a nursing home for a short period of time, always with the goal of going back to the home setting.

    Hospice nurses focuses heavily and teaching and providing emotional and spiritual support.

    While there can be many technical interventions in the home: pain pumps, pleur-x catheters, dressing changes, wound management—these are not the focus of care but instead are tools to help promote comfort while dying. More interventional monitoring such as blood work, X-rays, scans, IVs and even pulse oximetry loose the center stage presence they occupy during the treatment phase of the disease process.

    In the home, families and patients are a lot more in control
    .

    As hospice nurses we learn that we are there to provide the tools and the education but we do not force our way on the patient. From the very beginning, even during the admission visit, we tell patients that we are there to serve them; we want to help them have what they need in the home; we want them to know how they can call us and that we will come; but we spend much time teaching them how to respond to a variety of problems that might potentially come up. Being in our patient’s home also puts a responsibility on them and the family in terms of agreeing to use their medications as prescribed. In these days of prescription medication abuse, we lay out clearly how the medications are to be given and then we explain that we will count meds at each visit to ensure they have an adequate supply.

    Home hospice nurses visit patients at home wherever home might be

    That can include nursing homes, assisted living facilities, group homes, retirement centers, apartments and regular homes that run the gambit from very modest to thoroughly grand.

    A regular skilled nursing visit can take less than an hour
    ....

    Or continue for several hours, depending on patient need. If there are serious symptom management issues then the nurse will often stay to make sure the patient is more comfortable and that proper interventions are put in place.

    All the “other stuff” takes up lots of time
    .

    As in other nursing work, hospice nursing is heavily dependent on careful documentation, communication and one other factor—travel. In these days of bluetooth hands free cell phones, some of the talking to doctor’s offices and home base can get done in the car, but making sure everyone is on the same page can take up a good part of each day.Knowing who to call and when to call are integral parts of becoming an expert in the field. In addition to daily communication, each week hospice nurses participate in Interdisciplinary Team meetings (IDT), a time when social workers, chaplains, administration, doctors and even families share information and work together to coordinate care. And of course, there is on call time. Most full time hospice nurses take some call, often scheduled once a week, an addition to a full schedule that can sometimes be difficult to cope with.

    As I backed down Mrs. J’s driveway, I carried some sadness with me. But I also felt a sense of accomplishment and peace because I knew that our team had done what we could to help Mrs. J and her family cope with and be prepared for this time of transition.

  • Jul 20

    ***Some things are specific to the speciality but I want a general nurse reply as it can happened anywhere! Thanks.***

    Please tell me I'm not the crazy one!

    I work have worked in the NICU for about 3 years. Over the years, I have noticed some nurses on the opposing shift are a bit feisty but I have gotten over it for the most part. BUT, this small stupid thing has put me in a tizzy (sp?), and I more so need to vent than anything, but all are welcome to input your little "over-the-edge" incidences and what you do in response/to get over it.

    So to the point. I was having a really fantastic day; all my babies were cooperative, all quietly snuggled back in, parents all had a good (as good as it can get) day. It was not crazy admit day or let's make a bunch of changes day - IT WAS A GOOD DAY! It was nearing the end of my shift and as I almost always do unless we are slammed, I made the haul to restock all of my patients' supplies, any and everything they would need for the next 2 shifts.

    Shift change happens and I give report on my first two babies and I come to my third who is a different nurse taking them. I start my report as always, name, parents, etc. After the whole introduction, I casually skipped to the respiratory support. In the middle of saying, "I have only titrated my Os between 24% an--" the nurse butts in, holds up her hand and says, "Please,... (*hand to a fist now*) what's the patient's history?" Me: Uhhhh, PTL.

    THAT WAS IT... PTL. You know, I thought about it, and yea, maybe I should have said PTL before jumping right into the whole gaggle. Maybe I should have also added the 3 weeks old apgar scores and the whole resuscitation efforts. Maybe I should have gone through the whole pregnancy timeline.

    I know, I'm going too far but it kinda irked me. Yes, if there is a significant amount of history, I will start with that. But seeing as it was such a short and kinda insignificant history, it slipped my mind this time. (Serious on the apgar scores, I'm not telling you 3 week old apgar scores unless it's like 0,0,2,4,5,7)

    And to be honest, I would not even mind to have stopped right there to say the history had it not been asked of me in a completely ******* rude way and tone. Honestly, I would have even given an, "Opps, sorry."

    I just don't get it. What makes people behave like this after not even being somewhere for 5 minutes. I get you have a life, but don't treat people like scum of the earth just because your mind cannot get over having respiratory before history. Like, MY GOD, sorry I ruined your day...



    Sorry, I know I took a mole hill and turned it into a mountain. I get that. What I don't get is how people lack a decent sense of manners.

    Thanks for reading. But please do leave your experiences NICU and non-NICU. These situations happen everywhere, so even if you have them, say your non-nursing related stories too. I like to read on your guys experiences which far outweigh mine!

  • Jul 11

    I can understand that we shouldn't pine for the "good old days" because they weren't always so good. However, this is about respecting older nurses. They are a source of wisdom, strength and critical thinking. Listen to them, learn from them.

    Older nurses...respect the younger generation, they are good hard workers and they are eager to learn. Be the mentor to them.

    I've now reached the point where at 57 I'm one of two older nurses on my unit. I try hard to listen and learn from my younger colleagues, but I know they look to me to help them answer their questions. It's not easy being the mentor, but I embrace it.

  • Jul 11

    Sorry for your loss. She is not really lost.. if you still remember her.

    When this COB crosses over .. I will still be rattling chains on AN.

  • Jul 11

    I've heard of a wonderful tradition some of our local hospitals have. When one of these older nurses pass, they have a 'nursing honor guard' come to the funeral or viewing wearing caps, white dresses and the like. They do a little ceremony that includes the Nightingale Pledge.

    I want that when it's my time.....

  • Jul 11

    The new, young ones are coming up. Just got the news today about a neat old nurse who died suddenly. We always kept in touch, our paths crossed in life on a medical unit years ago.

    She went to nursing school when it was run by the nuns. I always liked looking for her picture in the old building. Now a for profit owns the hospital, healthcare isn't what it used to be.

    She was a strong, vital, kind, hard-working woman, wholesome and dependable.

    The world is changing. Some changes are okay, but a lot has been lost to us, never to be regained. A bit of valiant, strong goodness died this week.

    It's up to the younger men and women to keep these values alive now.

  • Jul 11

    I think that we all go through emotions like you describe, when we get involved. You need to sort out (I think) what touched you so much. The age of your patient (similar to your age, I assume). Getting close to the grieving family and feeling their grief. The organ donation. Not being able to save a young person and watching him or her die. What was difficult for you? Talk to a another nurse about it, maybe you can find someone who tried the same thing. Sharing is a way of getting through it. If you feel that you did well throughout and those people were glad that you were there - tell yourself that you made a difference for somebody. If something went wrong along the way, reflect on how it could be done in a different way. Ask other nurses how they go about it.

    I work as a palliative nurse and sometimes I know my patients for a very long time and get close to the families and friends. I do allow myself to get involved sometimes deeply, and when it is over I am emotinally drained. When my patient die I find a quiet time and place in nature for myself, and I think about the time I have spent with this family and my patient. I quietly say goodbye and mentally store everything in a box that I put on my shelf along with other boxes that I can pull out later on if I am in a similar situation.

    I am in Denmark, so unfortunately I cannot refer you to a book written Danish, but it is a book that helped me a lot. It basically talks about being touched, hit or all shook up. If you are touched by a situation, you can get by talking to other nurses or other professionals. If you feel hit, you may need some councelling, because you may have been too involved and cannot let go. If you are all shook up, you definitely need professional help to get through. I hope that this makes some sense to you, and good luck in your nursing career. You are a caring person and you also have to learn how to take care of yourself, which is necessary to survive in this world.

  • Jul 11

    I never did figure that one out. I routinely "brought" pt's and/or their family home with me (in my heart), even worrying about them on off days sometimes.

    One thing that did seem to help was talking on the phone to other nurses I had become close to. Obviously they had needed to decompress too, so it's not quite as isolated as you would think.

    If you have a couple - or even one - fellow nurse who is a close friend to talk to that may help. You may find they need it as much as you do - especially if they are a coworker, and know the pt/family personally that is weighing on your mind.

    Spending some quality time with a family - especially the really nice, thoughtful ones (you know - the one's who buy lunch for the unit, send thoughtful gifts, or who are just really kind people … they do exist!) can touch your heart in unexpected ways no matter how well you try to shield yourself. They get in - boy howdy do they get in, and some of them burrow in deep down to take up residency there permenently, to be remembered years later. After all, we're only human.

  • Jul 11

    I am stunned at the power and honesty of your article. I am so very sorry for what happened to you, and at the same time, I am glad you used the incident as a springboard for personal growth and positive changes.

    Thank you for sharing. (((((hugs)))))

  • Jul 11

    Quote from AutumnApple
    Thank you to everyone who are praising me and this article.

    I want to take a moment to stress a very important point: I am not the hero in this story.

    That title is reserved solely for my peers who took it upon themselves to support me even though I probably didn't deserve it.

    They treated me as if I had been a best friend to them the whole time. I learned much about grace, teamwork and being humble by watching their example.

    In order to return to nursing successfully, I needed to change on a professional and personal level. I am confident in saying I could not have done that on my own. They stood up and were my example of how things should be done.
    Yes, they were very gracious. My bet, it probably wasn't a stretch for them to be gracious because for whatever reason that's who they are. Which makes them absolutely amazing but at the same time doesn't minimize your effort.

    The thing is, it takes a special type of courage to recognize yourself as the problem. And fortitiude to turn that train around. You landed on your feet, that's always a victory.

  • Jul 9

    Mary stewart, age 62, has worked as a registered nurse on the postpartum unit for the past quarter century. She began her long career in nursing in 1972, with her graduation from a nursing diploma program. Mary is capable, knowledgeable, experienced, and possesses well-developed interpersonal skills. She is adept in assisting mothers and newborns with their physical and emotional needs immediately after delivery. As a preceptor and mentor, she passes on her wisdom and knowledge to the younger nurses and new graduates on the unit. Over the years, mary has consistently received outstanding performance evaluations.

    Due to dire economic conditions, her small community hospital was recently sold to a large hospital chain and the postpartum unit is now under new management. The new nurse manager does not value mary's vast experience, skill, and knowledge. Much to the contrary, mary senses increasing workplace hostility as she is singled out and undermined. During a six month period, mary is written up four or five times by the new nurse manager for petty, trivial things, such as not writing her name on the board in a patient's room. For the last write-up, she is suspended for three days. Mary believes that she is being targeted solely because of her age, as the younger nurses on the unit are not receiving such harsh criticism, nor are they being micromanaged. Eventually, she is fired for "poor performance." heartbroken, mary opts to retire from nursing altogether.

    Mary's case, unfortunately, is not atypical. Cases based on age discrimination are not new, nor are they rare. Ageism is defined as negative attitudes, stereotypes, and discrimination against people based sheerly on age. Since we live in a culture that is youth-driven and youth-obsessed, ageism is pervasive throughout our society. This pervasive ageist attitude has profound implications for nurses, because the nursing population is aging more rapidly than the workforce as a whole. Ageism spawns a stubborn cache of harmful and hurtful negative stereotypes concerning older nurses that can result in unfair treatment directed towards them.

    Common negative stereotypes concerning the older nurse:

    • older nurses cost more. they have more illnesses, use more health care benefits, and use more sick time than younger nurses.
    • older nurses are unable to fully meet staff nursing job requirements. they no longer have the physical strength to meet the demands of the job.
    • older nurses are less flexible and adaptable and therefore, are difficult to train or teach.
    • older nurses are slow. they exhibit reduced speed and efficiency.
    • older nurses are resistant to change.
    • older nurses are unable to learn new technology, such as computer charting.
    • older nurses lack enthusiasm. they are less motivated or creative than their younger counterparts.

    Stereotypes are unfair, as they are based on sweeping misperceptions and prejudice, but do not take into consideration the actual facts that define the individual person. For instance, i know some practicing nurses in their 60s who can run circles around nurses half their age.

    Legislation that prohibits age discrimination in employment:


    Not only is ageism harmful and destructive, but it is illegal as well. Both federal and state laws prohibit discrimination based on age and protect employees from age-discrimination. Age is one of 10 protected classifications in u.s. Anti-discrimination law, such as race, gender, and disability.

    The age discrimination in employment act (adea) prohibits, in general, discrimination against employees, or individuals seeking employment, starting at age 40 or older. Discriminatory actions based on age can take place within the following job functions: recruitment and hiring, promotion, transfer, wages and benefits, work assignments, leave requests, training and apprenticeship programs, discipline, layoff, and termination.

    Grievances concerning age discrimination can be filed with the following federal agencies:

    • U.S. Equal Employment Opportunity commission (EEOC)
    • U.S. Department of Labor
    • Office of Federal Contract Compliance Programs (OFCCP)

    As the nursing workforce continues to age, it is imperative that age discrimination, such as the unfair treatment that mary endured, becomes a relic of the past. Performance evaluations should be based on the individual's ability to perform essential job functions without consideration of age. We must retain our older and most expert nurses. Their skills and contributions should be valued and celebrated.

  • Jul 2

    We all start somewhere not knowing a whole lot. I find the vast majority of the 1's eager to learn and the attendings in my facility encourage them to listen to the nurses. I have forged a lot of good working relationships and in some cases friendships with the residents.

  • Jul 2

    So, granddaughter #2 turns out to have some fairly significant food allergies. Daughter goes to purchase prescribed EpiPens. Four of them. You must have 2 in order to give a second dose if EMS is slow to arrive. A daycare situation requires 2 more EpiPens.

    Walmart Pharmacy calls to inform daughter that the charge for 4 pens is $1200. Daughter says "oh no, I have Aetna insurance." Pharmacy says "that figure includes Aetna's payment of (drumrolll, please) of $2.62." A discount card found on the internet takes another $200 off. Daughter is left to pay $1,000 for a drug she hopes she will never need and which expires in 10-12 months. One of my OR sources quotes the amount of epinephrine in 1 pen as having the base cost of $.03.

    Turns out that the maker of EpiPen has a virtual corner on the market on adrenaline pens. Every year, they increase the price because, well, because they can. They have also been accused of artificially decreasing the expiration date in order to require an annual purchase. Making money hand over fist on the backs of sick babies and adults.

    There is so much wrong with our healthcare delivery system.

  • Jun 27

    Quote from NurseGirl525
    But why call CPS? What did the mother do wrong? She didn't have anyone to take her kids and was obviously seriously ill. If she had to be on fall and seizure precautions was it better to send her out in a car? If you are thinking legality issues, that's honestly a big time legality issue. Can you see my point?
    CPS isn't just for neglect. It's an emergent social worker that has greater resources than a hospital worker to locate kin and can assist in getting family to the child or child to family and secure temporary guardianship for non-immediate family until the parent recovers. It's not to file a complaint against the ill parent. It's to secure emergent social work services and safe placement.


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