Race Mom, ADN 9,869 Views
Joined Jul 2, '05 - from 'Exactly where I want to be!'.
He has '8' year(s) of experience and specializes in 'NICU/L&D, Hospice, and back to Mom/baby!'.
Posts: 812 (10% Liked)
I scored a 124. I used the study guide by MacDonald. Excellent book--uses old test questions. My advice is to keep track of time. I ran out of time on the 1st section and had to quickly mark "C" all the way to the end (to not leave any blank and possibly pick up a few "right" answers. This was the reading portion, the one I scored the lowest on. Still ended up with a 124! We had to have a composite of at least 100 in order to be considered.
My unit director told me that a fellow RN had gone to the CNO to lodge a "few" complaints about me. First one: You spend too much time with your patients. (I was a L&D nurse and we almost always were 1 to 1 care). I told her that I don't just run in and run back out. I talk to them, I chart in their room, and I do all these things because they're IN LABOR and have come to the hospital so that we can monitor their labor/delivery! She said the nurse's complaint was that if there were an emergency, they wouldn't know where I was. Really? I thought you just told me where I was...in my pt's room! If I have one labor and I'm not sitting in the nurses station...you can probably guess where I am.
Second one: She complained that you go into the nursery and close the door. Hmmmm.... I thought we were SUPPOSED to do that! You know...infant security? She said...well, yes, you are.
Third one: She said that you act like you know it all (not the exact words she told me, but meant the same thing...just can't remember how she phrased it to me). Well, yes, I am the only NICU trained nurse here and everyone still does care as though it is 1975. I told her "I thought you wanted me to help with evidence based practice" and she said, yes, but that the RN was complaining about me trying to "teach" her (basically she didn't want the help to be up-to-date with her nursing knowledge). I said "fine. I won't bring anymore of my knowledge to this hospital since it is bringing complaints." She then IMMEDIATELY asked me if I knew how to do the Ballard Score". I told her yes and she asked if I would teach it to the RN's. UMMMMMMM......NOPE! Thank you for wasting my time though with this ridiculousness!
I ditto the field of foot care! Although I do not use a dremel drill (I use podiatric drills) so my start up costs were just under $10K, but that includes everything, right down to my business cards and bandages. You definitely can start out at less than that but $10K will get you all the tools and training you need to provide up-to-date care and the best tools for the job. Foot care needs will never go away and the more we get out there as nurses, the better our odds are of being a big provider in this awesome field!
Visiting the newborn in L&D, as the nursery nurse, I was happy to comply with the family's request of waiting 2 hours from birth for bonding. I arrived a few minutes prior to 2 hours (parents were accepting of vitK but not erythromycin) to give the VitK in our standard 2 hour time frame, as well as newborn assessment/Ballard/etc. I had prepped the VitK, ready to give, and the doula walked in between me and the infant (on the warmer) and coo'd over the infant for at least 2 mintues while I stood there with an exposed needle. The warmer is in a confined area in the room, so I could only feel that it was intentional. The rest of the family did the same thing repeatedly during my assessment. I was hoping to get it all done quickly so they could continue with the bonding, but my assessment ended up taking about 45 minutes with all the "stand in front of the RN while she is working". It was frustrating. In the end, the family thanked me for not taking the baby off the breast and allowing for bonding. No harm, no foul, but my interest is that the baby is transitioning well and I need to assess that. That is what we do in a hospital environment. The baby is just as important as the mother.
Two days before she passed, she had a seizure (only time she ever did). At that point, she transitioned to active dying. When we got her into bed, after calling hospice (which took multiple tries...getting voicemail but it didn't allow you to leave a message) I made the quick decision to open the kit. Her seizure was at 3am and it was about 6 am before the OC nurse arrived. He said "who opened this kit?" I told him I did (although I didn't use anything, just got it ready and looked to see was in there). He said "well, I don't know if there could be any legal ramifications for you since there isn't an order for those meds." I told him I didn't care. I couldn't get ahold of them and she was non-responsive. He was a really nice RN, but that just hit me weird. Then next night, when she was in a large pain crisis, I called the oncall (this is after her CM wouldn't come and open her kit). I asked her, when she called before making the visit), if I had permission to open the kit. I was told no. It took over 3 hours for them to arrive. So, while waiting the 3 hours, I opened the kit. If they weren't going to take care of their hospice patient, I certainly was. I pulled out enough morphine for 3 doses, giving her one, and fridging the other syringes. Taped the box back up, and put it in the fridge. I made this decision after I was told the OC nurse was in a town 1.5 hours away and wasn't done with that visit yet. So unacceptable.
I really did see my sister's death as being something more peaceful and spiritual, but it was the opposite. I will struggle with this for a long time, I'm sure. This went against everything hospice was supposed to be.
Sorry for the confusing way I typed this. As you can tell I was a little angry. I have been a hospice RNCM and have worked for two really good hospices. Unfortunately, my young sister went on hospice (in another state) and this is the story of her death. No one would open the dang kit! I was so mad! It would take 3-5 hours to get the oncall RN there for a crisis at nighttime. Her CM refused to come over and open the crisis kit when I called and asked her to please come and do this. Her response was to crush what can be crushed and give her MsContin rectally (they don't supply gloves or lube, even though they supplied suppositories PRN).
So, in a nutshell, my intent was to ask if any of these situations were ok and I was just being out of line by requesting them. The whole hospice experience for my sister's death was a horror story. (They wrote on FMLA paperwork that her hospice dx was brain cancer, and CM verified it with me when I questioned it, only to tell me a week later she didn't have it but offered not one glimpse of an apology for what that did to our family. She discussed her "next pt visit" with the SW while sitting at our table during the visit, mentioning how difficult the pt was.) There is SO much more that is even worse than these examples, but I'm not going to mention all of it, cause it would just be a rant. Thanks for your reply. It is greatly appreciated
When I was an L&D nurse, I would always advocate for my pt. Docs would come in and want to AROM the pt and up the Pitocin. The pt would just nod in agreement. When the doc would leave, I would tell my pt "you don't have to have your water broken. You can let this go more natural. All you have to do is tell the doc that you want to wait for interventions." The pts always expressed gratitude but allowed the doc to AROM them. Nurses need to really be strong and not worry about what the doc thinks. I always advocated for my pts. After that, it was their decision. Of course, this means that I have gone head to head with a few docs. I don't care if they don't like me. I have seen too many poor outcomes from wanting to deliver in the 9-5 world.
My mother-in-law died from a brainstem glioblasoma multiforme. She was on hospice for almost 3 days. She taught me how to be a hospice nurse. I was an L&D nurse at the time, but quickly educated myself on hospice (it was a weekend admission and not very much support for us, unfortunately). She never lost her wit, or her mental ability. She just faded quickly that last week. Her last day was spent with her eyes closed (she said the day before that the earth was spinning and it made her nauseous so she kept her eyes closed). I had a true heart-to-heart with her, about 2 hours of me talking and crying and laughing and forgiving and telling her we would all be ok. At that moment, she transitioned. She began Cheyne-stokes breathing. She was also having the "death rattle". It was so unforgiving and difficult to listen to. She blessed me with teaching me "textbook dying". I was grateful to have researched what to expect. It really taught me how to educate my families. Perhaps this family was witnessing "death rattle" and Cheyne-stokes breathing. It is a normal process that is believed to cause no distress to the patient. God bless
Sadly, this will just keep skilled foot care nurses from getting their certification. I do not have a BSN but I am MORE than capable of performing this wonderful skill. Even started my own business. Why do the colleges even offer the ASN if we aren't "good enough" anymore to provide excellent care? I receive compliments all the time as a nurse!
My response was along the lines of "I'm sorry but given my scope of practice and the responsibilities you have stated for your nurse, I would not be able to accept less than $20/hr". The doctor wanted someone with experience and desire to work very independently with lab results and adjusting plan of care based on results (and protocols in place). The doc was very understanding but I really would be shocked if their office will be able to find someone with the qualifications they want for the money they're offering.
Congratulations on staying in hospice for so long! I just left my most recent hospice RN Case Management position for the same reason you are looking to leave. I am tired of death. I loved caring for my patients and their family but in hospice, you are never quite "off" shift. Your life becomes about death. Your perspective on life changes and you can forget to live in the "here and now".
I didn't work in hospice nearly as long as you have. I have experience in NICU, L&D, and postpartum so my abilities to get a position at the local hospital were somewhat easier than you might have. I did highlight my hospice nursing skills and discuss how they are a wonderful asset for a unit that, on occasion, needs that excellent nursing skill. Before hospice, I had one newborn death at delivery and I didn't quite know how to handle it. I now would be honored to have that mom on my assignment. You need to look at all the positives of your hospice career and how they can benefit you in this area. (time management, stressful situations, difficult family members and your ability to bring them together, etc) Look into all the improvements in processes that you have contributed to and put them on your resume for each company you are listing.
Good luck to you in your search and keep trying!
NICU position offered before graduation. Only stayed there 5 months (orientation completion). It was NOT a good fit at the time. Hit the streets and visited local hospitals. One LDRP was not locked down and I was nervous to enter the unit so I was turning around to go home and submit my app when one unit nurse asked if I needed help finding someone. I told her I was an RN looking into hospitals for a position in L&D. She gladly toured me around the unit and gave my name to the Director. The Director called me, interviewed me, and secretly told me that she was going to pass me onto HR for a formal offer. I worked there for 4 years, as well as returning to the NICU during that time (working both hospitals at the same time). I then wanted a change from hospital life and night shift and went into hospice nursing. I am now exhausted in hospice nursing and began to appreciate the 12 hour shifts and my continued love for mother/baby (reason for having my interest in Nursing). I start back at the hospital in a few weeks and I am excited! It has been a long time since I could say that.
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