Sterling-RN 2,089 Views
Joined Jan 29, '05.
Posts: 40 (25% Liked)
I guess I would say, try not to compare yourself with people who have clearly destroyed their lives, and compare yourself with someone who is successful. We can all point to someone who has it worse than us, and to someone who has it better.
I just got accepted into the Adult-Geriatric NP program. May 6th is the start date! Hurray!
Honestly, I think I am in a similar sitation. RN (BSN), with roughly the same amount of time under my belt. Med-surg, LTC/psych, Hospice. I work in hospice admissions so it is also the job that a lot of people would want to have. I do very little hands on...save for a physical assessment, and occassional help with care...but mosly to see skin. Most of my job is paperwork/charting, phone calls, recommendatons, emotional support, and there is symptom management that normally requires new medications, or a transfer into an in-patient unit.
I drive between 100 and 150 mi/day. Pay is good, mileage is good, I get 10.3 hours of PTO with each pay check. I feel like I am getting fatter also! lol...but moreso, I just feel exhausted all the time, and am getting burned out. I recently applied for what I thought was an ADON position at a small facility, but turns out it wasn't what I was told the job was going to be, so I declined it.
I have people telling me that I am crazy. I work 2 -12s and 2-8s. I used to love the autonomy. I used to love the interaction with people. I used to love the income and perks. But now I feel like I am desperate for a change. Not necessarily from hospice, but a change from the day to day of not knowing where I am going to be from day to day or hour to hour sometimes. I need a break from all the driving. I take PTO. I request regular days off to allow for long weekends, but it doesn't seem to help. I feel like I am whining too much lol. And the kicker is that those who I am looking for advice from are telling me to be patient and count my blessings.
In all honesty, I love the work that I do. I just can't continue this way for much longer. I need to be centralized, and want to accomplish measurable goals, and have the follow through. It feels like a double-edged sword. I am looking for flexible-rigidity in my position lol.
So, no...I don't think you are crazy. I think there is something in you that is seeking a more appropriate siituation for your health, well-being, and maybe a new challange.
I don't think they missed the mark at all. I believe that the original post DOES sound "wounded, unhappy, and defensive." And, I'm sorry, but clearly the OP feels that there is no difference between an RN or an LPN besides a letter "R" or a difference in pay, and that is false. More noticeably, it sounds as if there is an attempt to belittle RNs in order to elevate his or her own self-esteem.
Isn't it just as insulting to RNs to make the claim that their education, responsibilities, and experiences are no different? Isn't there just as much lack of respect in that view that the OP is stating RNs show her?
It's okay to acknowledge different tiers in nursing or in the healthcare field in general, isnt it? Or should I post a rant about how there is no difference between me and a nurse practioner just because they have more education, and an "NP" in their title? After all, we are all nurses, right?
It's silly and insulting to assume that different means better or worse...whether it comes from an RN or an LPN. But pretending that there is no difference at all is just as silly and insulting, and shows disdain and dissatisfaction in the choices made.
When I was an On Call nurse for hospice, it was expected that when you heard the phone ring and got your assignment, you were to be on your way within 15 minutes. If it's 3am and you had been sleeping, that gives you almost no time to throw clothes on, deal with hair standing in all directions, jump into your shoes and fly out the door.
Our standard uniform was casual business with dress shirt with our agancy's logo on it. I always wore black dress pants and shiny black shoes.
The visit was a death/support visit at a facility. The death had been expected and the family seemed to be doing well: "grieving appropriately," as we call it. I have had a lot of experience providing emotional support to families at this time, and have learned that focussing on how the patient's comfort goals and persional wishes were acheived does give families a sense of comfort...usually.
This night, there was a large family in the room...standing room only for the hospice nurse. So I made my way to the patient, assessed vital signs, and recorded the time for the physician. I started talking to the family collectively and then individually, sometimes leaning forward to speak quietly and still be heard.
On occassion, family members would start smiling and turning their heads away. Then some were chuckling. I wasn't sure if they were upset, losing it, or if I had a booger in my nose or something. So, I did my best and circulated until I was sure everyone was okay.
When I left, I stopped in the men's room and caught a glimpse of myself in the mirror. That's when I noticed the large, orange smiley faces peeking out from behind my zipper! I died of embarassment, and thoughts about how I was trying to comfort and ease the tension in the room with my quiet, calm assurances came flooding in. I realized why they were chuckling and I stayed hidden in the bathroom until I was sure they left the building.
I guess it could have been worse...I think I still had a pair of Curious George boxers back then.
A good friend of my told me she has a male GYN, and said "Well I just wouldn't feel comfortable with a woman looking at me there." I don't think it's discrimination, it's a comfort issue. And what difference does it make? So long as it's individual choice and not a policy enforced by the facility itself.
Again...can't agree more with Tewdles. Also, if your patient has a history of chronic pain and is not being medicated with long acting pain medication for one reason or another, it is important to consider this in your pain assessment when giving prn SL doses. Getting a patient comfortable is one thing, maintaining that comfort is another--especially when she is unable to tell you, and appears comfortable at the moment. Continual assessment is so important.
We have a physician who has done research on using levisn and other drying agents with our patients and she is finding that these are often over used as a "standard in eol care." That many patients are becoming dry, creating a new discomfort in our patients for moisture deep in the lungs or when the "death rattle" is heard--which is often times a distress for family members and not for patient's themselves. So again, assessment and benefit vs "cost" to patients.
Our hospice uses a care team called: extended care. We are not supposed to use the term "continuous" because our regulations state that Continuous level of care requires a minimum of 8hrs presence in a 24 hr period. And rather than putting assumptions that all patients on that level of care will receive 24 hr care, we indicate that it is intermittent and short term. This seems to be a valuable option for both family and agency because visits can be broken up to allow for as much coverage as possible by various team members throughout the day and night. GIP or general inpatient should also be reviewed.
I agree with tewdles' post. I would also start discussions with the family that although the goal of keeping the patient at home is a high priority if that is the patient's and family's wishes, reaching comfort goals is something that may require consideration of placement into a controlled environment. You can do your best to keep a patient at home with the tools and support the family needs most of the time, but occasionally there comes a time when placement is the best option for the patient and the family.
First of all, I don't agree that the NRA isn't protecting the 2nd amendment, but even if that were true why are you assuming that an organization protecting "GUN MANUFACTURERS" is so horrible? We have unions that protect automobile manufacturing industry workers, government bailouts to the Auto and other industries, yet have you seen the data on automobile related deaths, vehicular homocide. drunk driving? You don't have to be mentally ill to kill someone behind the wheel, either. It seems odd to me that villianizing manufacturing is your answer to these mass shootings. If the shooter had a couple rifles or handguns, do you think the outcome would have been different?
So then shall we ban ALL guns? Or just the high capacity ones? It seems to me that even 1 handgun in the hands of a these school shooters would have a devistating impact. Where does it end?
Shall we ban alcohol again? There is plenty of data that links alcohol use to domesting violence, assault, rape, murder. Banning a thing because, in your enlightened view, it's something "AVERAGE, civilians don't need access to" does NOTHING to address the real issue. That if someone wants to kill a person or a group of people, he will not need to do it with a gun, and if he wants to, he will secure one (or more) REGARDLESS if bans are present or not. Furthermore, he doesn't need to have automatic or semi-automatic guns to terrorize a community.
So let's put your crusade into practice: How many deaths occur due to drunk driving? How many lives has Crack-Cocaine, heroine or Methamphetamine destroyed? Maybe another ban or law will help here? I think not. It's just more empty action that will do nothing...more nothing...more nothing.
Moving to support yet another ban on those who would be going through a normal, legal process to secure firearms is going to be as effective against gun related violence/homicide as moving to support yet another law against drunk driving or alcohol or drug abuse. The criminals will STILL get access.
I agree with the replies. I would also recommend that any time you question something, write it down and call your supervisor, or another nurse on your team who can help. If there general hospice questions, post them here, and that can also help.
Don't give up, you are allowed to be a new nurse, you are allowed to learn your role. Just make sure you are asking questions like crazy and continue to learn what you can by any continuing ed, forums, read journals, ask your work if there is anything else they can help provide you with (practical skills reviews, symptom management classes, etc.).
It normally takes quite a while to feel like you've gained some confidence...just keep at it.
Having been an admission nurse for 2 years for hospice, I would recommend that you start out in hospice doing primary or on-call nursing if the field before starting with the admissions team. There is so much knowledge from experience that you need...knowledge about hospice in general and how it works with your agency.
Going into an admission visit, it is vital that you can teach/reassure patients and familes what hospice actually is, what your agency can offer them, how the different teams will be involved in care, etc. It seems vital to know the philosophy and standards very well to handle all the questions throwns at you, and experience is the best way imo. You are normally by yourself on those visits, and although you can normally call supervisors with questions, it would be helpful if you can speak to concerns from experience and from a hospice/agency perspective.
You will need to be comfortable evaluating patients to see if they are appropriate for hospice by meeting eligibility criteria; knowing what kinds of aggressive treatments are acceptable to continue while with hospice (i.e. blood transfusions, radiation, etc.); understanding what the patient's and families goals of care are...and if those goals are in line with hospice philosophy; addressing symptoms present during your visit, and providing emotional support and reassurance to patients and families about what is going to happen next, and what hospice will do in a given emergency situation, etc.
The list goes on. Don't let this deter you from hospice though. All these things can be learned and integrated. I am just recommending you work on the inside for a while and it will help prepare you to better deal with whatever comes your way at each visit.
Hi...I spent 2 years as an on call nurse before I moved into a primary nursing role with hospice. It was also 7 on and 7 off. My hours were 4:30pm to 8a. My coverage area was huge, and I was responsible for symptom/death/admission visits. I was also called to confirm continuation of extended care presence.
It was a difficult transition from med/surg and ltc nursing. The travel, the elements, the critical thinking, emotional support needed while at the same time learning hospice philosophy and resources was very challenging. I learned a tremendous amount, but at the cost of dreading the sound of the ring tone on my cell phone. We rarely ever had a fully staffed team, but everyone went way beyond what was expected of them.
My advice is to be extremely organized. Make a list of common terminal diagnoses: CHF, COPD, CA, Dementia, ALS, Renal, Liver, etc., and review common symptoms and common symptom management. Become familiar with what is needed to get meds from a particular pharmacy, how to send patient to an inpatient unit (if that is advised and families are willing), how to initiate continuous care. how to provide non-pharmacological interventions, and providing emotional support/education. Review your practical skills: changing dressings, catheter placements, etc. Review caring for an actively dying patient. Much of this you probably already know, but it makes things somewhat smoother if you have some kind of a outline to guide you in your head.
I would often know the name, age, sex, dx, problem, doc, current medcations, and length of stay with hospice on my way to the home/facility. I would use my drive time to consider possible interventions before I walked in. Caution though...be open to nothing being what you necessarily expected when you get there =).
Hope this helps. I know this is just scratching the surface. If you have any specific questions feel free to message me. Following a year in primary nursing for hospice, I spent another 2 years on the Admission team, which is what I am doing now. So, I may be able to help if there is an admission piece to your role afterall.
I hesitate to use oxygen with patients in active/terminal decline as it dries the mucous membrane and the body's requirements for O2 is reduced. Evidence shows a gentle fan on low hitting the trigeminal nerve is more effective in maintaining comfort. Also, atropine is indicated for hypersalivation or TRS (terminal respiratory secretions) and will be more effective if used early as it will help reduce additional secretions, but will not clear up existing secretions/rhonchi. Atropine crosses the blood-brain barrier and can cause delirium, and can add to mucous membane dryness/discomfort.
In our state (not sure if this applies nationally), a physician now needs to perform a face to face assessment with the pt for certification. I don't know what your hospice criteria is, but if a physician refers a pt that the physician deems "likely to die within 6 months if the disease process progresses normally," then we admit. The RNs do an assessment for "appropriateness for hospice," but usually that involves a discussion with the physican, or otherwise finding signs of decline physically, or in lab results, etc.
If a pt has a terminal dx of Alzheimer's, it's extremely difficult to find hardcore signs of decline. Painting of picture of declining ability to perform ADLs, appetite, weight loss are sometimes all you have to support appropriateness. I have needed to visit pts with a referral dx of Debility Unspecified. In other words, it's not always possible to assess for appropriateness on the first visit.
So, If the doc feels the pt's will likely die in terms of months, rather than years, I believe it's better to start hospice, provide education and support to the pt/family/caregivers, and then if the pt remains stable, discussions about taking a pt off the benefit will be a lot easier to have with the family and pt. Predicting how long a person will live is not our job...but it is the role of hospice to initiate end of life care if death is LIKELY to occur within the time frame the doctor suggests.
Totally agree with all the posters. I am in a similar on call position that you are going into. I work 7 days on and then have 7 days off (16 hour nights). Starting salary for me was $50,800 + mileage + benefits. Mileage makes all the difference in the world right now, but when they start passing out cars again, I'll need to re-evaluate a few things.
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