Latest Comments by rngolfer53

Latest Comments by rngolfer53

rngolfer53 3,401 Views

Joined Sep 13, '08. Posts: 687 (53% Liked) Likes: 975

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  • 1
    Race Mom likes this.

    My experience is that, more often than not, the patient knows, or has a pretty darn good idea of what's going on.

    When it's not a cultural issue, I've often seen a daughter or son, who was mommy's or daddy's little prince or princess (and has not managed to become anyone else's prince or princess) who can't face what's manifestly happening.

    Witholding information does indeed cheat the dying person of the opportunity to close their life out as they wish.

    One case I had: A man came in directly from a hospital to the IPU where I worked. A couple family members were in complete denial, insisting on IV heart meds, fluids, etc, because the cardiologists were all wrong. We got him settled, cleaned up, and comfortable.

    When his family came in, the patient turned to me--he'd known me for about 20 minutes--and asked if he told me his last wishes, would I see they were carried out. I told him I would do everything I could to make sure they were.

    There was really nothing special about me. He just used me to get the message across to those family members who wouldn't face facts. That's desperation, eh? Even then, one of the deniers said "That's just his sense of humor."

    Fortunately, other family members prevailed, he got to belatedly tell his loved ones what he wanted, and died peacefully three days later.

  • 0

    Quote from VANurse2010
    Why do you think the company has no responsibility for training its own employees? Would you prefer the employee pay you during their own orientation? Perfect example of how this is an employers' market - but that won't last forever.

    OP - you are going to have to have BLS as a requirement for your clinicals. That's a non-issue.
    Training and orientation are different things. Orientation is to familiarize the new employee with the particulars of the agency, not train them in intrinsic requirements of the job.

    If you were building a house, would you hire an electrician who wanted you to pay for his learning to install, say, 220 volt wiring? Or would you prefer to hire someone with those skills already?

    Or course, as you say, the employers' market won't last forever. But you'd best have sufficient savings to buy groceries while you're waiting for the turnaround.

  • 3

    If I read your post correctly, you're about one year out of school. With your limited hospital experience, that may be "new grad" in terms of experience if not exactly time.

    I wouldn't hesitate to apply for "new grad" jobs, making it plain the particular facts of your situation.

    This question comes out a bit harsh, which is not my intent, but what in your life has changed to make you think that this time around in the hospital will be different as far as the things that made it untenable for you a year ago? Most hospitals still use 12 hours shifts and weekends are normal.

    If I were in HR, that's the first thing I'd ask, and hopefully, you have a well-prepared answer ready.

  • 0

    An axiom of used car dealers is "there's a 'posterior' for every seat."

    The many roles and setting nurses work in approximates the fit of "seats" in seats. There is no such thing as a perfect job or perfect employer. All have their strong points and weaknesses. Much is in the eye of the beholder.

    Thank goodness people have different perceptions, desires and goals. Not surprisingly, those may change over a working lifetime as kids come along, go to school, etc. Trade offs in life are frequent.

    I've always thought it makes sense to follow your gut as far as what feels good about where you work. I work hospice and love it. I talk to nurses who are family to some of my patients and many tell me they couldn't possibly do what I do......and I know I couldn't possibly do what many of them do.

    Nursing gives one a better chance than many disciplines to follow interests and needs of the time of life one is in.

  • 0

    Quote from WeepingAngel
    Finder of TV channels! For sure!
    I recently had a confused gentleman whose normal home routine was watching a couple old TV programs and a game show. He knew the channel numbers on his cable at home....but ours was naturally different, and with fewer channels.

    Anyway my first morning with him, I managed to find his game show just as it was starting. He gave a big smile....then promptly fell asleep for the whole show. That's nursing for you.

    He was one of the patients I had a chance to get to know a bit, and I really enjoyed him.

  • 0

    Quote from calivianya
    You nailed it with the bad economy and tight job market comment. The media has been hyping up this imaginary nursing shortage, so highly paid professionals who lose their jobs and can't find anything else think that at least they'd get a job as an RN and it would let them put food on the table. It's pretty sad.
    The general media is little but a repeater of press releases and other sculpted messages put out by institutions such as schools. They typically rely on the same few "experts" for their analysis, and never seem to bother to check whether the expert knows what he/she is talking about.

    Still, there's a good number of corporate type folks who want to do something very different, and more rewarding. Not all get to nursing out of desperation.

  • 0

    I work 12 hour days in a hospice IPU. I will, with a late call-out or some other emergency stay an extra six hours but only if I don't work the next day. I live close to work, so I run home to feed the dog and let him out at shift change (I don't have to give report to myself) so it works out OK.

    But I do sleep late that next morning. If I lived in the place mentioned in another thread that calls 911 for any resident who didn't get up for breakfast, I'd be in the ER after every 18 hour shift.....and quite a few 12s too.

    Of course the staff of that place would be with me in the ER....with wounds from me kicking and biting them as they tried to get me out of bed.

  • 3
    tewdles, Nurse_Diane, and OCNRN63 like this.

    Quote from Tait
    In the hospital is the last place I would want someone to be unclear with me. If I want to know if my patient is having pain, then I ask them if they are having pain and then use the appropriate pain scale to determine what the appropriate nursing intervention is. It is not my place to try and deter a subjective measurement by attempting to skirt around the subject of pain, and I definitely do not want my patient to be undertreated for pain.
    As a hospice nurse, I always think that un/undercontrolled pain is a cardinal sin.

  • 1
    Altra likes this.

    Quote from tewdles
    I find that hospitalized people(patients) often respond better to the "pain" questions and the 1-10 scale than do patients in their homes, and the very elderly.

    Too often elderly people don't count their aches as pain.

    Our language can affect how people answer us, especially if there are cultural issues at play. An Athabaskan indian may answer about pain quite differently than say an Irishman.

    In my view, as nurses, it is our obligation to have a GOOD appreciation for the comfort needs of the patients under our care. For some that can be determined easily and quickly, for others we must dig a bit.
    I work inpatient hospice, and I get a good % of people who will respond with "uncomfortable" when I ask about pain, and I ask directly. Without getting into a lexicography debate, I try to dig to get at what they're communicating. I alway ask if I can bring these people something for pain. If I have a range of dosing, usual where I work, I'll tell them I'll give them the lowest dose if they are reluctant.

    If they don't want any meds, I obviously don't give them, but I do provide education on not letting pain get out of control and I follow up with them often.

  • 0

    Quote from chare
    Why wouldn't you just ask them if they are in pain?

    Why are you concerned about "planting in their minds the the idea that they're actually feeling pain?"
    I agree with this. What is the downside of asking a post-op Pt if they're having pain?

    If they say "yes" and there are orders for meds, then you give the meds. In some small number of people, I may end up feeding their addiction. (OK, so be it. That is their responsibility. I have no powers that allow me to unerringly determine who's lying.)

    That's the better outcome than having a patient in pain that could and should be controlled. The number of people helped swamps the number of people harmed.

  • 4
    nrsang97, canoehead, RetRN77, and 1 other like this.

    Was this person A&O? Competent?

    If so, what ever happened to autonomy?

    I'm getting to be old and perhaps crotchety (depending on who you talk to ), but if someone tried to send me to a hospital because sleep seemed like a better idea than breakfast....well, there might be another 911 call soon.

  • 1
    bagface likes this.

    Job descriptions should never be confused with the actual job assignment, in nursing or anywhere else for that matter.

    I'm pretty convinced that job descriptions are written as broadly as possible so HR folks don't have to trouble themselves with writing accurate ones for the many different kinds of positions, or having to update them more than once every century or so.

  • 7
    al586, Ir15hd4nc3r_RN, psu_213, and 4 others like this.

    Why add complexity to a word when the addition provides no benefit?

    "Orientated" and similar constructs are often used by bureaucrats trying to sound important. A pox on all their houses.

  • 2
    goalienrse and madwife2002 like this.

    Quote from goalienrse
    I have a mixed reaction to this post.

    I left my first nursing job on good terms, filled out my notice happily and thanked HR for the oppurtunity and did everything right. But was leaving bc I had what I thought was my dream job waiting for me. So when I found out it wasn't, were 8 months later, they accpted me back with open arms.

    My 2nd job, the one I left for, was a horrible exp I will never forget and would leave nrsg and eat dog food before working for them again. I gave my 2 wks after 6 months. I gave it my all, even stayed over completeing my work 45 mins after my shift on my last day. Did me no goood! I went on 5 interviews before having too crawl back to first job. I don't know what HR said or did, but I have my suspicions, bc how would I know what there saying?

    So basically I'm saying the article is right, but it still may or may not do you any good.
    Certainly, there are not guarantees, but it pays to do what you can to put the odds in your favor, as you say.

    The majority of people will not chose to do what is wrong unless you give them a plausible reason. Leaving with a lousy attitude and poor performance in the notice period can be that reason.

    Some people will incline to do what is wrong, unless you make it hard for them to. Following the advice of the article does make it harder to justify dumping on someone who's been a good nurse right up thru the last shift.

  • 1
    LTCNS likes this.

    Quote from LTCNS
    When it comes time to put in my notice at my current job I am going to choke. I've only been there for 3 months and they have been good to me. I was thinking of just saying "I have enjoyed working with the staff here and appreciate the opportunity and experience, but feel this job is just not for me. Thank you for giving me the chance to be part of a great company and a good group of people."
    That sound okay?
    The only thing I'd add is that you really found how much you miss LTC when you weren't around it.


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