Jumping in as new Grad

[nhelkhound]

I entered nursing school so that I could work in hospice. I'm about to graduate with a ADN and have been having some disappontments. Both in one interview and after resume submission I'm told to apply again after a year in med-surg. I HATE med-surg. I know that there are many potential benefits to doing a year in med-surg, but I have a moral conflict with nursing on med-surg units. I feel very strongly that patient autonomy is neglected and ignored. I do not believe in full-codes and do not want to resusitate.

I have years of experience in home hospice as a PCA and wanted to do more with my clients, thus entered RN program. My assessment skills are strong and I have letters of recommendation from my instructors attesting to such. How can I even get an interview if the potential employers don't look past the med-surg?

[Rnmomajmj]

You may not like med/surg but you can't beat the experience it will give you. As far as autonomy being neglected/ignored, maybe you could be the nurse to change that. I feel that it is the nurses job to protect the patient, if you see a fellow co-worker (nurse,cna) not respecting or protecting the patients autonomy you need to call them on it and educate them.

When you are a nurse, not believing in full codes or not wanting to resuscitate really isn't up to you, it is the patients decision. I have been in quite a few situations where I've had to put my personal feelings aside and go with what the patients wishes are. The hospice company that I work for doesn't require a patient to have a DNR so I could very well be involved in a code at some point, whether I believe it should be done or not.

I really hope you try med/surg for a while, all of the things you can learn from being there will certainly help you out in the future.

Good Luck!

[nhelkhound]

The problem that I have with full codes is that the patients that I've had during NSG school are listed as full codes but when you communicate with them they don't REALLy want to be but have given in to pressure from either their family or their doctor. I have spoken to some who have told me that they didn't know they had a choice!

BTW, it seems absolutely bizarre to me to have a patient on hospice without a DNR. To claim Medicare hospice benefit means that the patient only wants palliative care, not life-prolonging measures.

[Katillac, RN]

The problem that I have with full codes is that the patients that I've had during NSG school are listed as full codes but when you communicate with them they don't REALLy want to be but have given in to pressure from either their family or their doctor. I have spoken to some who have told me that they didn't know they had a choice!

BTW, it seems absolutely bizarre to me to have a patient on hospice without a DNR. To claim Medicare hospice benefit means that the patient only wants palliative care, not life-prolonging measures.

Actually, one only needs to have a six month prognosis in order to be eligible for hospice services from the Medicare perspective. Hospices often put conditions on admitting that include no chemo, no radiation, no transfusions, no vents, no dialysis, etc. but this is more a financial issue than anything else. Some hospices with Open Access programs put NO restrictions other than the six month prognosis on their patients and will provide all the above therapies and more. And in point of fact, a hospice can NOT require that a patient be a DNR in order to admit; it's in the regs.

I can understand that you don't like med/surg for a variety of reasons, but coming in to hospice with the perspective that every patient only wants and should get palliative care is a one size fits all approach that really doesn't.

There are MANY factors to considered around the issue of code status. If you believe as a nurse that your patient's desires are not represented in their code status, advocating for a discussion with the physician will be doing a terrific service for your patients.