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madwife2002, BSN, RN Guide 106,961 Views

Joined Jan 17, '05 - from 'Ohio'. madwife2002 is a Director of Nursing Services. She has '26' year(s) of experience and specializes in 'RN, BSN, CHDN'. Posts: 10,282 (21% Liked) Likes: 6,104

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  • Jun 18

    Moving from one state to another can be as easy as ABC, providing you plan and make it a nice smooth transition.

    There are certain variables which you are able to control and there are certain ones you can't.

    It is certainly easier to transition if you have a job to go to.

    After you have decided to move states, you have picked where you want to live, the first step should be to secure your nursing license for that state.

    It is important to remember that many jobs will not look at applications from RN's who are not licensed in the state they are applying for.

    So my advice is to obtain a license sooner rather than later. If you go to the State board of nursing sites you can find information which will give you an idea of how long it will take to obtain a license there. Remember this can take anything from a couple of weeks to a couple of months.

    At the bottom of every allnurses.com page, you will find a link to each state Boards of Nursing to obtain license endorsement information .

    Unless you do not need to work, I would not hand in my notice and leave my current job until you have the license you need for your new job.

    If you have a compact state license and want to work in another compact state, then the process is simpler. Go the NCSBN website to view which states recognize Nurse Licensure Compact At the moment 24 states are compact states, so only another 28 to go!

    When looking for a job in another state, there are some good web sites which you can go to, you can post your resume online and often recruiters will contact you.

    If you know where you would like to work then go to the hospital of choice web site and look under job opportunities.

    Often if you are coming from another state or live a long way from the hospital, they will do a series of telephone interviews.

    Some companies will fly you out for interviews. New technology such as video conferencing and webinars can make the interview process easier, and much more cost effective than paying for flights.

    Often companies will pay some of your relocation costs, especially if you have skills they want.

    Wages and relocation costs can be negotiated after a successful offer of employment.

    Just because you want to move for your own reasons doesn't mean companies aren't willing to reimburse some of your expenses. The worst thing they can say is no. Most companies have budgeted relocation costs but if they don't have to pay them, then they won't.

    If they do pay some of your relocation expenses prepare yourself for a sign on contract of about 1-2yrs. Normally money will have to be paid back if you do not stay the required period of time.

    When I moved across country from AZ to Oh it cost in excess of $9000, so do not sell yourself short!

    Even if you don't get any expenses paid, you can put it against your taxes.

    So now you have a license and a job, what next?

    You have to find somewhere to live; this is probably the hardest part of the whole
    process because unless you know the area you have absolutely no idea what you are getting yourself into.

    Do not rush into accommodation and sign yourself up for a long term lease, unless you or somebody you trust says it is a nice area to live.

    If you can fly out and view the areas then go and look around, if you can't then you will need to find storage for furniture and rent somewhere furnished on a week by week contract.

    The journey! Plan it well, are you travelling in 1 car or 2? Are you going get one of your cars transported? Or are you going to travel in convoy with your other family members?

    Take into account gas prices and hotel accommodation along the way.

    Estimate how long it will take you to get there, try to allow enough time to travel and recover from the travel before you start your new job.

    There are lots of options for getting your furniture from A-B, and all options come in a varied amount of cost.

    You can move yourself, look out for the hidden costs of one way moving. Many moving companies will charge mileage and they will charge for the cost of the removal van going one way and not being returned to place of pick up.

    Another option is to lease part of an 18 wheeler which can work out reasonable, as they will negotiate their empty space if they are going in your direction.

    Often if you lease part of an 18 wheeler, it doesn't cost you much more to have one of your cars put inside too, and think of the gas you will save plus the wear and tear on your vehicle.

    Lastly

    If your move depends on your job, then make sure you have an offer in writing!

    The travel expenses they are paying are normally paid up front, do not travel unless you have both.

    Good luck

  • Jun 4

    Continuing with the series of 'Top ten reasons we get fired' Number 4 comes in as "Poor Performance" at work.

    Problems with performance can result from any number of factors. Organizational change, new technology, inexperienced nurses, issues outside work or even a run of "bad luck" can all affect performance, even for the most assiduous of professionals.

    Managers should be able to say that they have the right person in the right job, sometimes they get it wrong.

    Everyday we hear about co-workers who have performance issues, some of the time we have already identified the co-worker who has performance issues.

    We know they have problems because the patient has informed you about something that has or hasn't been done. Or you have followed them onto the shift, found numerous issues or problems that have either not been identified or have not been dealt with correctly and you have to pick up the slack.

    I am going to hazard a guess and say that everybody on the floor has been discussing the problems with this staff members performance, we all have a story to tell

    What do we do about helping a co-worker improve their practice? Is this our job? or should we just leave it to management because that is what they are there for!

    Poor Performance

    So what constitutes a poor performance?

    • Poor time management
    • Insufficient attention to details
    • Inability to multitask
    • Missing orders in chart
    • Signing off but not completing orders
    • Completing wrong orders on patient
    • Med errors
    • Poor documentation
    • Judgment errors
    • Lack of timely interventions
    • Lack of knowledge and not seeking help
    • Not reporting changes in conditions
    • Not noticing changes in conditions
    • Not being able to self identify
    • Blame others

    What can organizations do to help?

    Numerous errors and mistakes add up to a dangerous nurse and if every thing possible has been done to help the individual including but not limited to:

    Support for manager to manage a poor performance

    Identify areas of concern

    Discuss issues with staff member in a clear concise way

    Improvement plans with clear outlines, realistic time to complete

    Ensure they understand what the expectations are

    Education

    Increased mentoring

    If everything has been done, then HR may have no other alternative but to terminate your employment, they have a duty to protect the patient, and if fear that harm could occur because of poor performance then there is normally no alternative.

    Patient safety is of the upmost importance and if it is compromised in any way, action has to occur. Now with this being said we need to identify quickly the near misses and work with a risk management team to ensure that this doesn't happen again.

    How to protect yourself and your patient

    Reflection of your shift and self-identification of areas of weakness could help the poor performer. We need to know when to ask questions, when to ask for help and when to go to your manager to discuss your education needs.

    Do not undertake, a task on a patient if you have never done it before, ask for supervision. No manager worth his or her salt would allow a procedure to be done on a patient if the staff member was very inexperienced.

    Don't bring outside issues into work, leave them at the front door and pick them up on the way out. You think this is not possible, well it is and you have a responsibility to your patient, if you cannot function in this capacity then you need to stay home.

    Learn from experienced nurses their good habits, not their bad ones
    Organize your day in a structured manner
    Know where the policy, procedure and protocols are, these are there to help and guide you.

    Learn from your mistakes and the mistakes of others

    For the experience nurse, help your co-worker you were new once! Offer to show them the right way to do something. Don't ignore their cry for help, spend 5 mins now with them, and avoid clearing up the mess later on.

  • May 23

    If you are sick you are sick I really dont want you round me
    but
    If you are calling off because you dont want to work I dont want to know, just say you are sick, why dont I want to know because if we do not find cover you are sticking it to your co-worker and I do not think it is fair.

    Instead why don't you ask for a PLB day off so plans can be made to cover you.

    I guess I will get grief for saying this but if everybody thought they would just take the day off because they cant be bothered to go into work then it would be a huge mess.

  • Apr 29

    Hands up, how many of you actually hate your boss? I can imagine a fair few will be nodding their head in agreement that they hate there boss.

    I search google with the words 'I hate my boss' and with that simple sentence I found 12,800,000 results.

    Change the wording to 'I hate my manager' and the results add up to 58,600,000.

    I am sure if I delve deeper I would be able to find more results, so what does this tell me? It tells me that we in the nursing profession are not alone in 'hating' our bosses, we are not the only profession who feels we employ idiots to 'run' business's

    Who do we define the term boss?

    Boss an individual that is usually the immediate supervisor of some number of employees and has certain capacities and responsibilities to make decisions. The term itself is not a formal title, and is sometimes used to refer to any higher level employee in a company, including a supervisor, manager, director, or the ceo.

    But did you know that a boss can also be defined as...

    Boss 3 (bs) n.A cow or calf. [perhaps ultimately from latin bs; see bovine.]

    There are books on...

    • How to manage your boss
    • How to kill your boss
    • Get back at your boss

    There are over 10,000,000 I hate my boss jokes!

    Bosses are also being blamed on causing marital problems too!

    That bad marriage – it could be the fault of your abusive boss

    So there is lots of information on hating your boss. Does this make me feel better? No!

    It is also laughable that if you do further education past your bsn in management or business and throw in a msn for good measure you are now eligible to go for middle or upper management! Doesn't really matter if you are good at it, have any people skills, or even a lot of hands on nursing care, you are now considered to be management material.

    I have nothing against further education but some of the strangest people have msn, I do not think that having a masters in anything means you have common sense.
    Most people who go onto obtain further education have access to money! We know it is not cheap to get further education.

    You have to have good credit scores and have to be dedicated to working extremely hard in your studies and normally at the cost of other parts of your life.

    My boss has every known degree known to mankind yet I still question her decisions, I feel her hands on experience is minimum and I wonder if she ever worked as a frustrated staff nurse.

    I think doing time spent as a frustrated staff nurse makes you understand the problems and issues that everybody experiences first hand on a busy floor.

    This in turn helps you have a human approach to management, that is what I believe is missing these days. You have to know how to turn things around in a crisis. You have to have very good understand how your specialty works. How to troubleshoot.

    You cannot tell by watching staff how busy they are! Most rn's aren't running around like headless chickens, they are calm, confident and have excellent time management skills, so they make it look easy!

    That doesn't mean to say they are having an easy day, eventually after a certain amount of experience on the floor you grow to realize running around like a headless chicken serves no purpose. You use up energy and brain power you actually need to be effective.

    A lot of management staff in health care have stood still for very little time before they have climbed the ladder very quickly.

    I am sure if you ask your bosses how long they worked as an basic rn on a unit, they will barely have 5 years or less!

    Most of them have planned their career very carefully and always seem to find themselves in the right place at the right time.

    These days I have seen advertisements for charge nurse positions with only a minimum of 1 year post grad experience under their belt. This concerns me because 1 yr is barely enough time to get your feet wet let alone have the experience and know how of managing staff and the unit.

    When I was a newby staff nurse I could turn to my charge nurses and managers and they knew everything. It always amazed me.

    I bet in some cases this is not true anymore.

    I still hate my boss and I have to learn how to channel this emotion towards something more positive as the negativity is 'killing' me.

    I have got to the stage that I worry about every single interaction between us, I suspect she is 'out to get me', I imagine she has a different agenda to me and if I don't agree she 'is out to get me'.

    I have become paranoid and this emotion bothers me! I ask myself why do I really think she is out to get me?

    It is a personality clash? Or is it simply 'i dont like being told'

    Remember, it takes two to tango.

  • Apr 28

    After 20 years I have worked on a lot of different types of floors and some of the easiest bored me senseless.

    I have to say for me personnally the best places I have worked are the place where there is a good working atmosphere where you feel supported by staff who are educated and informed.

    Where there are students who keep you on your toes, and keep you up to date with the latest research.

    Where 'the open door' is really open and you can bounce idea's off your manager and feel supported and encouraged.

    Where you get up in the morning and are actually looking forward to going into work and not feel sick at the thought.

    and lastly a place where you feel valued, respected.

  • Apr 13

    Quote from FransBevy
    I have never worked so hard in my life! Repetition? What repetition? I'd LOVE some repetition. I love it but no two minutes are ever the same here and you have to be A&OX3.
    I agree it is hard work in a Chronic Unit, I dont think all RN's are prepared for the amount of work involved.

  • Mar 29

    PS keep your own notes on this incident-Time and dates etc

  • Mar 13

    Sleeping while on duty is the number 3 in my top ten of reasons nurses get fired.

    In 1910, we slept for an average of 9 hours; by 2002, the average dropped to 6.9 hours per night. Early studies indicate that those Individuals who work nights and rotating shifts rarely obtain optimal amounts of sleep; they may have 1-4 hours less sleep.
    This could all add up to a sleep deprived night worker, which could cause a night nurse to nod off while on duty! Or even fall asleep while driving home.

    Complications of sleep deprivation

    Sleep deprivation can have serious consequences for both the nurse and their patient's safety.

    Impaired decision-making, slower reflexes and motor skills, and heightened stress levels are all potential side effects of too little sleep.

    Health issues such are diabetes and heart disease could be more prevalent, depression and mood alteration issues are well documented for night shift workers.

    Patients could suffer serious consequences from sleep-deprived nurses for example medication errors, slower responses to critical incidents, and even death.

    Consequences of sleeping while on duty

    For some nurses no matter how much sleep they get during the day, they are unable to stop themselves from 'nodding off' during their night shift.

    This causes many co-workers to feel angry and upset, they feel the need to report the napping co-worker to management. In some health care facilities even nodding off on your break time can be considered grounds for termination, the expectation is you should be alert and available to be called upon at any time.

    Some will argue that nodding off on your unpaid break should be allowed, unfortunately this argument maybe something your management team will not tolerate.

    Suspension, termination and being reported to the Board of Nursing, may occur if you sleep on duty. In some occasions where sleeping or nodding off have caused harm to patients, nurses may end up in court.

    Tips to help you stay awake

    Caffeine is probably the number one crutch night workers use to stay away. Coffee, diet coke and the 5-hour energy drinks: Be careful you don't become addicted to too much caffeine, try and use it moderately and sensibly.

    Get up stretch, walk briskly around, sprint 100 yards if you can which will refresh you immediately.

    Drink plenty of water.

    Don't remain seated when you feel that overwhelming tiredness, find yourself physical work to do. Computer charting can increase the desire to close your eyes

    Eat healthy food; reduce the carbs and high sugar food, which can make you feel sleepy. Try to have small frequent meals if possible rather than one large heavy meal.

    Talk to your co-workers, have interesting lively debates.

    Sit in an area which is brightly lit.

    Try to get as much sleep in the day as possible, use black out curtains and eye masks to reduce the light in the room.

    Turn off your phone during the day

    If you struggle on night duty, you may need to find a day job.

    Current research for night duty nurses

    Newer studies support 20 min napping on your break could prevent some of these errors and revitalize the night nurse.

    Hospitals around the world are starting supporting this research, although it may be years if ever before U.S. hospitals will set up sleep rooms for nurses!

    "Several studies support positive outcomes for on-duty napping for health professionals," noted a 2011 study in Critical Care Nurse, the journal of the American Association of Critical-Care Nurses.


    Further suggested Reading

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
    Chapter 40. The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety Ann E. Rogers

    Sleep Rooms can Benefit Nurses on the Night Shift

  • Feb 24

    How can they take money from your bank account I would have thought that was illegal?

  • Jan 27

    We have learnt on our floor you talk to nobody not even those you think you can trust because it all gets back to the one you had hoped wouldnt get to hear about it.
    Some hospitals really do not want to hear about problems and you have to have a new way to look at things and a new approach something like
    'it is all good' Negativity even justified is not acceptable any more. Managers are using the financial crisis to make nurses fear for their jobs, I honestly believe they are using it to their advantage.
    I feel for the nurses and hospital workers who are being 'bullied' at this time by unscrupilous bosses, with no morales and will use anything to get their way.

  • Jan 8

    Death came to visit Friday, it was not kind, and it was not peaceful for my friend’s mom-it was hard, she struggled so much, her mind was ready, but her body fought her to the bitter end; causing trauma to her loved ones who stayed by her side so she did not die alone. The family had discussed end of life choices, and treatment was stopped on Tuesday, with the only intervention being pain medication.

    Death is still a taboo subject that many of us prefer not to discuss. Why is this? Unless you work as a healthcare professional, the clergy and funeral directors, many people are not able to talk about it freely.

    As a nurse who has been with many patients as the end of their life, I know you cannot prepare their loved ones for the final end. You cannot say that it will be peaceful, you cannot give a timeline and you cannot promise how it will be because you really don’t know. There are relatives who have no clue about what their loved one wanted. There is often no discussion about end of live choices.

    I have been fortunate to be with my sister and my mom when they breathed their last breath and it was peaceful, calm and a relief that their struggle was over. I have been with patients who have passed away peacefully without pain, without struggle and without suffering. I have also been with patients who have fought to the bitter end, every last breath being a struggle for them. It was like something from a horror movie only it was real life.

    My question is why? Why do some people have horrible deaths and some people go quietly. It certainly doesn’t pertain to how they lived their life; I can vouch for that with my own eyes, experience and knowledge. My mother was a feisty firecracker of a woman who fought for everything in life, never gave in to anybody and would never hold her tongue. Yet her death was one of the most calm, peaceful I have ever experienced.

    When somebody passes what determines if it is peaceful? What would determine if death is going to be horrible? Is planning important, should patients and relatives make known what they want near the end of life? You still cannot guarantee that death will be peaceful, however everybody involved knows what their loved ones want.

    Is it the environment they pass in? Can we choose where to die?

    Hospice is a wonderful environment, where the nurses, aides and doctors are amazing. I have never seen such caring individuals. When my mom passed many years ago they were amazing, I will never ever forget the kindness my mom received and how supportive they were to my husband and myself. The atmosphere was incredible in a hospice where everything is available for support. Nothing was too much trouble; nobody seemed rushed or didn’t have the time to spend with her.

    Hospital can be a frightening place for many people, yet many will die in the hospital this year. Some expected deaths and some unexpected deaths. Relatives can add peace or trauma when their loved one is dying. The circumstances of impending death play a huge role for end of life decisions.

    Is the hospital environment a good one for a peaceful death? Yes it can be. It can also be a very traumatic experience. How many things can contribute to peaceful versus traumatic-who or what determines the definition?

    Hands up! How many of us nurses have witnessed needless interventions, pain and suffering? How many of us have experienced relatives prolonging life as long as they possibly can? Does this add to the trauma of their dying?

    End of life discussions can be very difficult; but it shouldn’t be; as it is something we are all going to experience as our only guarantee in life. Many people do not have a living will. Many people do not even understand the terminology ‘Living Will’. It makes no sense to them, although we as healthcare professionals are much better at promoting living wills.

    Even with a living will there can be struggles to make sure your wishes are followed, but without one relatives can fight and disagree with each other about what they want. Clear precise instructions can at least highlight your choices helping relatives to make better decisions on your behalf.

    In 2007 only 41% of the population in the United States had a living will.

    In 2009 President Obama made it more popular by publically talking about his living will, saying it is a sensible choice.

    In 2013 only 1 in 3 people had a living will, 32%, Findlaw.com

    In March 2016 “American College of Emergency Physicians’ stated that two thirds of Americans don’t have a living will!

    The sad fact is that even with an advance directive, your designated decision-maker may still face a fight in trying to follow your instructions. It’s not uncommon for doctors to disagree with a family about what should be done; it’s not uncommon for family members to disagree — sharply and painfully — with one another. But, as Mr. Kottkamp said, “It’s an uglier fight if you don’t have the documents.”

    Question of the day-Do you have a living will?

    Or are you part of the 2/3rd's that don't have one

    Less Than One in Three Americans Have a Living Will, Says New FindLaw.com Survey

    http://newsroom.acep.org/2016-03-21-...ving-Wills-Do-

    The living will needs resuscitation

    For young and old, it’s wise to have a living will to state health-care wishes - The Washington Post

  • Jan 4

    This is a fantastic story, the ending however was so sad

  • Dec 27 '16

    Emotional Intelligence or EQ

    Emotional intelligence (EI) or emotional quotient (EQ) is the capability of individuals to recognize their own, and other people's emotions, to discriminate between different feelings and label them appropriately, to use emotional information to guide thinking and behavior, and to manage and/or adjust emotions to adapt-Wikipedia
    Emotional Intelligence (EQ or EI) is a term created by two researchers – Peter Salavoy and John Mayer – and popularized by Dan Goleman in his 1996 book of the same name.

    In the recent past it was always considered that IQ was what got you employed in most jobs especially healthcare.

    Today Emotional Intelligence or otherwise known as EQ is considered far more important than your IQ. Years ago IQ was the focus and tended to be what employees looked for when employing a RN, when interviewed a lot of questions revolved round responses which may have required you to be an expert on the subject matter and your ability to perform the job.

    Today it is believed whilst IQ is important it really only counts for 25% with the other 75% being your emotional intelligence. Interview questions will ask you how you respond in certain situations, they can include question about relations with co-workers and previous managers. Interviewers want to know how do you work under pressure, with emphasis on conflict management.

    EQ is not measurable in the same way that IQ can be measured because EQ is subjective, it is emotions and emotions can depend on the moment, the situation, your stability in life, to name a few.

    EQ is your ability to handle stressful situations, your emotions, and your responses to a trigger in your everyday life.

    So what it a trigger? A trigger maybe somebody who you do not have a great working relationship with, suddenly pushing your button and you respond in an emotional way. They may be late on a report, they may be late or don’t complete a certain task. Triggers could cause you to be very negative towards a certain situation or a certain person.

    An example of a trigger in my life-My boss questions me on every single cent on my expense report, every month without exception. Every month I wait for her to question and I am fired up, angry, indignant, upset and ready for a disagreement with her. I am immediately on the defensive, even if there is nothing to defend. This leaves me feeling stressed, upset, negative and feeling of inadequacy. It has an impact on physical health and well-being. I have included co-workers in my rants, which has caused them to feel miserable.

    A better way to handle this situation would be to just answer her questions and move on. Not telling myself a story about how she is out to get me, or how she only picks on me.

    The higher your EQ the better you are able to put things into perspective and manage your emotions. Disagreements with co-workers, patients, and family members can always be handled in a different way.

    The big question is how do you plan to change your behavior and your response in situations.

    The most important step you can make in your journey is to identify your triggers, this could be something that always makes you angry, it could be something out of the blue and you respond immediately:

    For example you are in a line and somebody pushes in front of you or you may be cut off in your car-your immediate response is anger and indignation. You may or may not respond verbally, body language and facial expressions will be evident. Your BP may rise, your fight or flight responses will be initiated you whole body will respond in a negative way.

    Do you always make the right decision when ‘confronting’ this sort of situation?

    At work a patient is rude to you and you respond inappropriately then this situation doesn’t rest easy with you for the rest of the day, so you seek affirmation from your co-workers, which then has the ongoing effect of dragging down the mood of the team.

    You may have conflict with Doctor, I am sure most of you can identify with this situation-This can quickly affect your mood, your indignation and affect the mood of the floor and day. EQ is learning how to manage that situation so there is a positive outcome, managing your own responses to the situation, managing the outcome and managing the Dr.

    You have to review how you behave when you are triggered; you need to evaluate how you are making other people around you feel when you are triggered. Could you have handled the situation differently?

    Then you make an action plan of how to respond better to triggers, do you have any indication that you are triggered?

    Role-play conversations with somebody who you consider ‘safe’ a mentor or a life coach. Mentors do not cost anything apart from time and investment from both of you. There is a commitment that you talk weekly; it can be formal or informal, in person or via the phone. You have to trust this person, make ground rules especially the ‘Vegas” rule!

    Life coaches can be expensive but a great alternative if you want somebody outside work who is not tied to your company. There are literally 1000’s out there you will need to do research as with everything there are good and bad life coaches.

    Do reflection, start noticing your responses to certain people in your life, this doesn’t just apply to work, it could be in your family or any outside activity.

    Start a journal initially twice a week, or when you have identified that you have been in a situation you could have handled differently.

    Reflect on what you could have done differently, thinking about how the situation made you feel, the person who you were dealing with felt and also the people around you.

    Once you start evaluating your behaviors, triggers, your responses to situations and start changing. You will start to recognize when you acted or spoke appropriately and can alter how you manage certain situations. On occasions you even recognize that the way you behaved which you thought was positive could be improved.

    EQ is going to be life long learning, are you going to always handle situations appropriately-No of course not life is unpredictable and can change in an instant. You cannot predict how somebody else is going to behave; you can only change how you respond and how you manage others especially when under pressure.

    You can however learn to manage your EQ so unlike IQ, which is, pretty fixed-EQ can be modified.

    Further study is recommended-there are literally 1000’s books out there devoted to EQ. Live courses, WebEx’s, journaling and life coaches are the way forward.


    Recommended reading

    'Emotional Intelligence 2.0' by Travis Bradbury and Jean Greaves-includes a EQ test to give you a base line to start from.

  • Dec 3 '16

    Death came to visit Friday, it was not kind, and it was not peaceful for my friend’s mom-it was hard, she struggled so much, her mind was ready, but her body fought her to the bitter end; causing trauma to her loved ones who stayed by her side so she did not die alone. The family had discussed end of life choices, and treatment was stopped on Tuesday, with the only intervention being pain medication.

    Death is still a taboo subject that many of us prefer not to discuss. Why is this? Unless you work as a healthcare professional, the clergy and funeral directors, many people are not able to talk about it freely.

    As a nurse who has been with many patients as the end of their life, I know you cannot prepare their loved ones for the final end. You cannot say that it will be peaceful, you cannot give a timeline and you cannot promise how it will be because you really don’t know. There are relatives who have no clue about what their loved one wanted. There is often no discussion about end of live choices.

    I have been fortunate to be with my sister and my mom when they breathed their last breath and it was peaceful, calm and a relief that their struggle was over. I have been with patients who have passed away peacefully without pain, without struggle and without suffering. I have also been with patients who have fought to the bitter end, every last breath being a struggle for them. It was like something from a horror movie only it was real life.

    My question is why? Why do some people have horrible deaths and some people go quietly. It certainly doesn’t pertain to how they lived their life; I can vouch for that with my own eyes, experience and knowledge. My mother was a feisty firecracker of a woman who fought for everything in life, never gave in to anybody and would never hold her tongue. Yet her death was one of the most calm, peaceful I have ever experienced.

    When somebody passes what determines if it is peaceful? What would determine if death is going to be horrible? Is planning important, should patients and relatives make known what they want near the end of life? You still cannot guarantee that death will be peaceful, however everybody involved knows what their loved ones want.

    Is it the environment they pass in? Can we choose where to die?

    Hospice is a wonderful environment, where the nurses, aides and doctors are amazing. I have never seen such caring individuals. When my mom passed many years ago they were amazing, I will never ever forget the kindness my mom received and how supportive they were to my husband and myself. The atmosphere was incredible in a hospice where everything is available for support. Nothing was too much trouble; nobody seemed rushed or didn’t have the time to spend with her.

    Hospital can be a frightening place for many people, yet many will die in the hospital this year. Some expected deaths and some unexpected deaths. Relatives can add peace or trauma when their loved one is dying. The circumstances of impending death play a huge role for end of life decisions.

    Is the hospital environment a good one for a peaceful death? Yes it can be. It can also be a very traumatic experience. How many things can contribute to peaceful versus traumatic-who or what determines the definition?

    Hands up! How many of us nurses have witnessed needless interventions, pain and suffering? How many of us have experienced relatives prolonging life as long as they possibly can? Does this add to the trauma of their dying?

    End of life discussions can be very difficult; but it shouldn’t be; as it is something we are all going to experience as our only guarantee in life. Many people do not have a living will. Many people do not even understand the terminology ‘Living Will’. It makes no sense to them, although we as healthcare professionals are much better at promoting living wills.

    Even with a living will there can be struggles to make sure your wishes are followed, but without one relatives can fight and disagree with each other about what they want. Clear precise instructions can at least highlight your choices helping relatives to make better decisions on your behalf.

    In 2007 only 41% of the population in the United States had a living will.

    In 2009 President Obama made it more popular by publically talking about his living will, saying it is a sensible choice.

    In 2013 only 1 in 3 people had a living will, 32%, Findlaw.com

    In March 2016 “American College of Emergency Physicians’ stated that two thirds of Americans don’t have a living will!

    The sad fact is that even with an advance directive, your designated decision-maker may still face a fight in trying to follow your instructions. It’s not uncommon for doctors to disagree with a family about what should be done; it’s not uncommon for family members to disagree — sharply and painfully — with one another. But, as Mr. Kottkamp said, “It’s an uglier fight if you don’t have the documents.”

    Question of the day-Do you have a living will?

    Or are you part of the 2/3rd's that don't have one

    Less Than One in Three Americans Have a Living Will, Says New FindLaw.com Survey

    http://newsroom.acep.org/2016-03-21-...ving-Wills-Do-

    The living will needs resuscitation

    For young and old, it’s wise to have a living will to state health-care wishes - The Washington Post

  • Dec 3 '16

    Death came to visit Friday, it was not kind, and it was not peaceful for my friend’s mom-it was hard, she struggled so much, her mind was ready, but her body fought her to the bitter end; causing trauma to her loved ones who stayed by her side so she did not die alone. The family had discussed end of life choices, and treatment was stopped on Tuesday, with the only intervention being pain medication.

    Death is still a taboo subject that many of us prefer not to discuss. Why is this? Unless you work as a healthcare professional, the clergy and funeral directors, many people are not able to talk about it freely.

    As a nurse who has been with many patients as the end of their life, I know you cannot prepare their loved ones for the final end. You cannot say that it will be peaceful, you cannot give a timeline and you cannot promise how it will be because you really don’t know. There are relatives who have no clue about what their loved one wanted. There is often no discussion about end of live choices.

    I have been fortunate to be with my sister and my mom when they breathed their last breath and it was peaceful, calm and a relief that their struggle was over. I have been with patients who have passed away peacefully without pain, without struggle and without suffering. I have also been with patients who have fought to the bitter end, every last breath being a struggle for them. It was like something from a horror movie only it was real life.

    My question is why? Why do some people have horrible deaths and some people go quietly. It certainly doesn’t pertain to how they lived their life; I can vouch for that with my own eyes, experience and knowledge. My mother was a feisty firecracker of a woman who fought for everything in life, never gave in to anybody and would never hold her tongue. Yet her death was one of the most calm, peaceful I have ever experienced.

    When somebody passes what determines if it is peaceful? What would determine if death is going to be horrible? Is planning important, should patients and relatives make known what they want near the end of life? You still cannot guarantee that death will be peaceful, however everybody involved knows what their loved ones want.

    Is it the environment they pass in? Can we choose where to die?

    Hospice is a wonderful environment, where the nurses, aides and doctors are amazing. I have never seen such caring individuals. When my mom passed many years ago they were amazing, I will never ever forget the kindness my mom received and how supportive they were to my husband and myself. The atmosphere was incredible in a hospice where everything is available for support. Nothing was too much trouble; nobody seemed rushed or didn’t have the time to spend with her.

    Hospital can be a frightening place for many people, yet many will die in the hospital this year. Some expected deaths and some unexpected deaths. Relatives can add peace or trauma when their loved one is dying. The circumstances of impending death play a huge role for end of life decisions.

    Is the hospital environment a good one for a peaceful death? Yes it can be. It can also be a very traumatic experience. How many things can contribute to peaceful versus traumatic-who or what determines the definition?

    Hands up! How many of us nurses have witnessed needless interventions, pain and suffering? How many of us have experienced relatives prolonging life as long as they possibly can? Does this add to the trauma of their dying?

    End of life discussions can be very difficult; but it shouldn’t be; as it is something we are all going to experience as our only guarantee in life. Many people do not have a living will. Many people do not even understand the terminology ‘Living Will’. It makes no sense to them, although we as healthcare professionals are much better at promoting living wills.

    Even with a living will there can be struggles to make sure your wishes are followed, but without one relatives can fight and disagree with each other about what they want. Clear precise instructions can at least highlight your choices helping relatives to make better decisions on your behalf.

    In 2007 only 41% of the population in the United States had a living will.

    In 2009 President Obama made it more popular by publically talking about his living will, saying it is a sensible choice.

    In 2013 only 1 in 3 people had a living will, 32%, Findlaw.com

    In March 2016 “American College of Emergency Physicians’ stated that two thirds of Americans don’t have a living will!

    The sad fact is that even with an advance directive, your designated decision-maker may still face a fight in trying to follow your instructions. It’s not uncommon for doctors to disagree with a family about what should be done; it’s not uncommon for family members to disagree — sharply and painfully — with one another. But, as Mr. Kottkamp said, “It’s an uglier fight if you don’t have the documents.”

    Question of the day-Do you have a living will?

    Or are you part of the 2/3rd's that don't have one

    Less Than One in Three Americans Have a Living Will, Says New FindLaw.com Survey

    http://newsroom.acep.org/2016-03-21-...ving-Wills-Do-

    The living will needs resuscitation

    For young and old, it’s wise to have a living will to state health-care wishes - The Washington Post


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