Latest Comments by Flatlander

Flatlander 6,410 Views

Joined: Jul 21, '12; Posts: 258 (49% Liked) ; Likes: 275

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  • 1
    nursel56 likes this.

    I agree this seems to be the standard nursing practice.

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    I always have to fight my agency to supply enough gloves for home care. I recently researched this subject online and the recommendations vary site to site. However all were in agreement that it is important not to contaminate the new trach by allowing it to touch anything unsterile, presumably because it will remain in place for awhle and allow chance for contaminants to cause infection. The other agreement was using a new sterile suction catheter each time.

    I am still confused. Wish my agency had written protocols and standards. One option I've tried is to call the physician who prescribes the trach care and ask their staff for what they recommend and teach families. Sometimes they will send a copy of their home care instructions. By following doctor recommendations maybe then you are covered if there is a licensing/standards issue against you.

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    I recently started working in home care with a 14 month old with trach, g-tube, neuro deficits, etc. The family is very knowledgeable and willing to answer questions, demonstrate, train and so on. The agency has a case manager in charge of the case and a manager who will answer questions in the case manager's absence. I had no prior experience with peds and was very nervous about trying it out. It turns out that the care is not so different from adult care, and it's gratifying to be learning and developing confidence in this new arena.

    When in doubt call your supervisor/manager, the parent/caregiver, the doctor (pediatric nurses are very helpful). You may find this new experience very rewarding. Good luck!

    PS -- Thanks to OP and the rest. I've learned alot and tested my assumptions by reading your comments.

  • 2
    Kitiger and amoLucia like this.

    Quote from nekozuki
    When I quit or request to be taken off a case, I’m not shedding any tears over my agency being inconvenienced, but I do feel a tremendous amount of guilt for (some) patients. Sure, there are the wacky new assignments you never accept again (Mom running around the house naked talking to ghosts, one family decides to turn off the AC in July, maybe a case feels like a big fat lawsuit waiting to happen, etc), but what about the ones you’ve had for awhile?

    If I’m leaving a case because it’s gotten stale or because I feel like I’m being involuntarily sucked into the family dynamics, I usually never tell the family. The agency is informed well beforehand, but I feel like the family would take it as betrayal if they knew I was voluntarily leaving, and possibly retaliate in some way. So, I smile big, wave, and never come back.

    I’m torn because I’m having elective surgery (weight loss surgery) and will be out for six weeks. I’m agonizing over how to break the news to my patient's family, and whether I should say anything at all (or simply lie about it being some other surgery). I’ve been the only nurse staffing their case for almost two years, and given their rural location and complexity of the patient, I know they will have a hard time replacing me. I *have* to do this for myself, my health, and my future, but that doesn’t help the crushing sense of guilt I feel for “abandoning” my patient (whom I adore like my own niece). The family has received a series of devastating blows in terms of the patient’s health over these past few weeks, and I figured I’d drag my butt to the AN forums to commiserate.

    What is your MO for quitting a case? Do you tell the family, or do you high-tail it out of there without a word? Do you ever feel guilty for moving on? Anyone have any stories?
    Thanks for posting this, Nekozuki. I just left a case I was on for a year and 10 months. I had an injury that required me to be off work for 2 weeks following an almost 2 week vacation. When I asked to go back to work, my shifts had already been covered for the whole next month. At that point I had to request a new assignment, which fortunately looks like a "go." This agency pays no vacation or any other paid time off until after FIVE YEARS ! of service.
    Anyway, yes. I don't feel guilty, but I miss my client very much and worry that she will feel abandoned and confused about my unexplained and abrupt departure. I asked the agency to explain why I accepted another assignment, but I was discouraged by my supervisor from making contact myself.
    I have a master's in counseling psychology and one of the things always stressed in that program was the importance of preparing the client for termination. It was also considered important to recognize that after a long period of working together, both parties will have feelings about ending the relationship. The work at the end was to allow both parties to process and come to terms with issues and feelings that arise and the acceptance that it cannot continue as a friendship because of the professional boundaries. That is the reality.
    I believe it is okay to feel sad at the loss of that person. I believe it is okay to miss them. I think it is okay to tell them that you will miss them, and they may miss you, but they and you will move on and get over the missing in a fairly short time. I believe it is important to explain your leaving face to face, if possible, and if the reason would be hurtful, to not explain fully. It is always possible to find a grain of truth and to hold back anything that harms rather than helps.
    I don't feel guilty, because it is the agency's responsibility to get the shifts covered and find a good fit for the family.
    In my case, I think I'm going to send a brief note to my patient and another to the patient's family to briefly state that I enjoyed working with them, have made a change that will work out better for me, and hope they are well and remain so.
    I am interested in what you decide to do. Keep us posted. I relate to some of the issues others raised about agency differences in this area.

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    Home care private duty through agency, started out at $19/hr with two years' experience. No paid time off until 5 years' longevity. Raise of $1 (yes, you read that right) after one year. Jobs in home care are plentiful and hiring process is much quicker than hospitals'. Great way to start earning while continuing to look. Michigan licensing can take 4 to 6 weeks, with luck; in my case it was much longer, due to Board's clerical error which sent my application confirmation and info on completing fingerprinting, background check, etc, to someone with my maiden name in another state, so I had to keep calling the board to find why I'd received no response. To which they kept replying, "it must have been sent to your old address." Finally they sent another letter after about the fifth phone call. (Two months later, I received a nice note from someone in Ohio who had received my Board response, and was kind enough to send it, though a little late. I never lived in Ohio, and shared nothing with that person except my former last name!) But, hey! Good luck and, really, the state is great. Lake Michigan is a jewel and will make you forget about the ocean!

  • 2
    Rocknurse and Libby1987 like this.

    I need to lose 50- 60 lbs.Just read Gary Taubes' Why We Get Fat. Get your hands on it and follow the advice. This is the REAL science behind weight loss. Very full of latest research. When you're done, give it to your doctor! I'm starting the diet recommendations this week. Reply on this thread to compare progress. Will let you know how I do, too. Good luck!

  • 1
    Millionstars1 likes this.

    Quote from NorthernRN97
    Is 58 too old to start nursing school? No, however, finding a clinical position in a hospital will be extremely difficult. The cost of training a new nurse is simply too high for an HR department to make that kind of an investment in an older nurse.

    That being said, there are many other fields open to you where you could help people! Home health is booming, so being a caregiver may be an option. Best wishes in your future endeavors!!
    I find the above arguments objectionable, though they may indeed be true. First of all, no new hire of any age is required to make a guarantee on how many years they will work for a particular company. Ours is a very mobile society. People move and relocate for various reasons. Women get pregnant and decide to become stay at home moms. People decide they don't like the working conditions, the management, their co-workers and decide to look elsewhere for employment.

    The laws of this country are very clear on the illegality of basing hiring decisions solely on a person's age, ethnicity, etc. I hope this discussion prompts everyone to review your employee handbook and the trainings you undoubtedly had related to employment discrimination.

    Please do not perpetuate discriminatory beliefs and attitudes. I believe it is time for all of us on this thread to educate, or re-educate ourselves about ageism and then to revisit the discussion armed with accurate knowledge.

    Second of all, I object to someone desiring to be a nurse being told they "should become a 'caregiver' instead due to their being "so old" at 58, or 62, or whatever.

    Please examine your attitudes. I heard an excellent discussion on the Diane Rheam (sp?) Show on National Public Radio this morning between Diane Rheam and Arianna Huffington. Diane is 79, Arianna is 65 and head of one of the most successful internet news sites and author of many books. (Her new one on sleep sounds terrific.) Arianna talked about how she takes care of herself getting plenty of sleep, eating well, exercising, and feels better at 65 than she did in her 30's and 40's. It is obvious that her mental capacities have not faltered at all either.

    Do not be ashamed of your age or try to hide it. There are NO LIMITS if you want it badly enough.
    Thanks OP for bringing up this topic. You have definitely "hit a nerve."

  • 1
    Millionstars1 likes this.

    Wow. Where to start? I am 69 years old. I started an ADN program in a rural community college at age 62, graduating at age 64. It took me 9 months to find a job and I had some rough starts. I encountered rampant ageism in school and on the job, though not quite as blatant as I'm hearing on this thread. Frankly, many of the comments here disgust me, but I applaud the few who see through the ageism.

    There seems to be a badge of pride in working 12 hour shifts without a drink of water or nutritious meal and a breather. It's like saying "I'm so bad, I can go 12 hours without having to pee, eat, sip water, or clear my head and rest my feet for a minute." I call that a grade-A recipe for burnout, and yet nurses keep doing it and bragging about how tough they are. The really tough -- and smart ones -- know when to call BS and speak up. They demand to have coverage for meal breaks and breaks to take care of basic bodily functions -- to get a drink of water, sit down for a minute, have a moment of quiet to clear the head, and jot a note to get organized.

    Do not for a minute let anyone tell you that you are too old. Most of the candidates for US President this year are older than you are. Do you think they will have a "cake" job? Flying all over the world, managing conflicts and wars, dealing with disasters of every imaginable kind both day and night, plus the constant battering of the press and political opponents? Really. Come on, people. Get a grip and show a little respect for the knowledge, wisdom, and experience that aging brings. And have a little much-needed humility.

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    I've been researching this, too. I've found that Institute of Medicine (IOM) has new recommendations. Healthy men should have 3.7 liters fluid per day; healthy women should have 2.7 liters per day. Dietary recommendations often suggest the 30 - 35 mL/kg/day. It is common to deduct the free water (usually 80 - 85% of total liquid) in tube feeding formulas.

    My patient in home care is recommended to receive 1200 mL free water in addition to 1080 mL provided in her tube feeding. She has been getting 3600mL free water -- or more -- per 24 hours. Her urine output has been 3000 or more, and stool output via ileostomy has been 800 mL or more. I am concerned about overhydration or overworking her kidneys if that is possible.

    Any comments welcome.

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    Just hired in Michigan at $19 an hour, 32 hrs per week. My rent is $875 a month (includes all utilities, cable, and internet.) I have car payment and student loans together totaling $500; $130 car and rental insurance, gas and groceries of course, and 30 mile round trip commute. Benefits are minimal at best. Training hours are paid at minimum wage! But, hey, it's a job, and far less stressful than some!

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    What has happened in your career since your post in Feb. 2012? I find myself in the same pickle you describe above. It seems that success in nursing is all about being able to keep up the "fast pace." Is it really all about the money? I think we are expected to complete the job in 32 hours that used to take 40. (Consider it a privilege to run yourself ragged and ignore your patients for fewer hours and much less pay.) For me, as a relatively new nurse, it is dangerous. I start making mistakes, forgetting things, and then dwelling on the things I forgot -- all leading to stress and worry, which only compounds the problem. Maybe I'm ADHD, too. Orientation and training is a joke. If it's meant to weed out the tortoise in favor of the hare, it is working! And that lesson obviously has no relevance for nursing. (Sorry to be so negative.) I wonder if I'll ever find the nursing job where I can be successful and happy. I am close to giving up, too. Sure wish I'd known all this before I invested huge time and money in becoming an RN.

  • 2
    Squad51KMG365 and paujos like this.

    You'll be amazed how fast two years of school goes by. Study hard and learn as much as you can. A two year program crams an awful lot into a short time, but it is all necessary learning...there's no fluff. You've persevered this far and already have the makings of a damn good nurse!

    I admire all the people who persevere through adversity -- breast cancer and chemo have to be in a class of their own -- and that is truly inspiring. But the other things on this thread are, too. The years of doing things you don't love to pay the bills, the struggles to find funds for tuition and books and to carve out time for study as an adult.

    One hopes that it pays off in the end, but sometimes it's hard to find the job that fits. I'm still working on that one. The good part is that my nursing degree has made it easier to stay employed and when I'm earning a full paycheck, I can even put some into savings. I've tried the private duty home care nursing with one client in a family setting. It has had its reward and I often enjoy it a lot when the family, kids, grandkids, and helpers are all around and I'm juggling making supper, keeping my client comfortable, giving her treatments, charting, letting the dog in and out... I've tried a busy challenging floor job in the hospital with 12 hour shifts...also tough in its own way. I've been a flu clinic nurse and enjoyed working with kids, babies, moms and pops, business people and factory workers...especially liked the autonomy. I'd get my assignment, collect my large bin at the clinic, then head out to a school or place of business and start giving injections and nasal sprays. When I was out of nursing work for awhile I did medical records field tech work, earning enough to pay the bills each month. Also got that job on the strength of my nursing education.

    Of course, I'm still paying off the student loans. That's another drawback of late life education, unless you have the funds to pay without loans. I'll be paying them off till I croak, prob'ly.

  • 1
    paujos likes this.

    To paujos: I think your waitressing experience and the physical labor and truck driving will help you. Waitresses have to be fast, organized, and able to prioritize and delegate (you can use this in your job interviews!). And obviously you are not afraid of hard work and not overly concerned with "status-seeking." I had to get used to a lot of scut work. Goes with the territory.

    If nursing is what you want, do not let age stop you! No one ever told me out loud that I was too old, but my mother kept telling my sister I'd never find a job at my age. She grew up in the age when you were out of luck if you were over 40. But goodness, people are now often youthful into their 70's (60 is the new 40! I think so!)

    Good luck.

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    Squad51KMG365 likes this.

    Hi. Nice to hear from this thread. Yes, I completed the ADN, was hired after 9 months on a cardio/acute care floor and was let go at end of orientation. That's why I stress getting performance reviews very early on and specific areas for improvement if told you are not progressing as expected.

    I'm still working in complex home care (client with quadriplegia, G tube, trach, Cath, etc.) Was just hired on at a nursing home and start in a couple weeks, evenings, 8 hour shifts.

    What doesn't work for me is 12 hours shifts. Hate 'em. I get really tired, but some of the young do too. We're finding out through recent empirical research that long hours and night shifts actually impair health! I wonder how nursing field is going to solve that one!

    I've been told I'm slow and I believe that I am. That may or may not be due to age. I rather suspect it's that I'm very cautious, deliberate, and I think too much. However, it is critical thinking that I do and I follow up on every discrepancy and hunch that could prevent problems down the line.

    Yes, nursing is indeed hard work! Even for young folks. I believe it is imperative to stay in good physical condition, eat well, get enough sleep, and keep stress under control.

    Please continue to share experiences as an older worker. We can provide support on this forum! Thanks for connecting.

  • 1
    La'sBlueSky likes this.

    I've been working in a home care job for awhile now. I have one patient who is total care, quadriplegic, with trach, g- tube and suprapubic catheter, lots of meds, suctioning, feeding, etc. It's twelve hour shifts with a one hour commute each way and can get just as exhausting as the hospital job. I'm beginning to feel that 12 hour shifts are not for me. I found the hospital environment rather brutal in the attitudes toward new nurses and hours/workloads. Home health care comes with its own set of challenges, not least of which is some fuzziness in how things are done. Not the best place for an inexperienced nurse. On the plus side, there are patients who are in dire need of nurses for the reasons above (remote locations and tough care assignments.) I plan to apply for some clinic positions and see if I can get hired and have a more normal work schedule. I think I need more variety and a place where I can continue to learn and grow. How are the rest of you doing? Care to update on your experiences since firing? Thanks!