Latest Comments by jaf0066

jaf0066 872 Views

Joined: Mar 7, '09; Posts: 9 (22% Liked) ; Likes: 3

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    anyone provide care to bariatric hospice patients? i have a bariatric patient for whom I am providing care. any input would be appreciated.


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    Critical thinking is to thought process as running is to crawling.

    It is based on drawing from disparate bits of information from which one may infer a supposition and then thoughtfully apply one's thinking process to predict outcomes and evaluate accordingly.

    Allow yourself to crawl, walk and then run. There is a natural order to things. The nursing process is based on this natural order. It is comprised of assessment, problem identification, outcome identification, intervention (that, which one will do to elicit the desired outcome) , evaluation and ultimately, reassessment. It is a big circle. Information is power and like any powerful tool, you must learn to master it.

    Finally, as one other writer posted, everyone has a basis of thought and critical thinking. Each is blessed according to his gifts in this regard. Some will have more work to do to hone this skill, than others.

    I bid you good travels on your journey, and as the Irish say, may the road rise to meet your feet along the way.


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    Whispera and leslie :-D like this.

    hi all.
    the week before last was a difficult one, if you recall. This week was no different in the challenges I faced culminating in a truly "one for the books" weekend involving a few "worst case scenario" situations. I really felt challenged and under seige. It was very intense, this feeling. Like a 8 or 9 on a 1-10 pain scale. If it had a smell, it would be the brim and fire stone old time train engineers must have smelled as their stokers stoke the firey furnace that is the source of the engine's power. the color would be a bright gold, like the sun at high noon on a clear day. In nature it would have been as though I took flight on the wings of eagles. Truly, for the first time in my life, I was really proud of my self and able to declare that aloud, to myself, my family and my coworkers.

    My boss told me one time, in an attempt to keep my humble (I need that sometimes, but that is another post in itself), that passing boards at the base of it all, is just passing a test. And, of course, that is true. For me, in my heart, I was afraid i did not fit, and that I would not measure up to the role of hospice nurse. I was mainly afraid that even though I graduated, passed boards and was fortunate enought to find a job, I would cut muster. The critical thinking and staying calm under pressure parts were of most concern to me. Would I be able to be cool and collected and be able to problem solve.

    I know now the answer is yes. I have passed my own test and met my fears with courage and dignity. Today, I am a hospice nurse and I know where I belong.

    Thank you for all of your support, and prayers.

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    sage words from kindred souls. thank you both.

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    sage words from a kindred soul. Thank you.

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    Good afternoon one and all,

    I am new to nursing (grad '08, boards '09) and new to hospice though I have had three clinical rotations with the organization with which I am associated. Like all new persons coming into a new role and a new culture, I am clumsily feeling my way, trying to fit in, not come off as an idiot and forge relationships with my team members. Unfortunately, I am a month into the game, and this last week was especially trying, and have had several unpleasant experiences in offending the sensitivities of an LPN, a NP and my boss (a certified hospice nurse) to boot. I am male, early 40's, with hospital experience in cardiac telemetry working with persons living with chronic conditions such as heart disease, lung disease, and so on. I do not, however, have any direct long term care experience, nor have I worked as an LPN or CNA. My position was that of an operations technician, which is a marriage between these two positions, only med admin was outside of my scope. What I am hearing from from the LPN via my boss, is that I am stepping on her toes by not consulting with her in my decisions and choices. I have addressed this and accepted my naivete with her and move beyond that. Second, in my apology and commitment to her to do better, I used the phrase ancillary care provider at some point. I was made aware, again via my boss, that this term was upsetting and left my LPN team member feeling hurt and diminished. Second, my interactions with NPs of late has been equally unpleasant. I am finding some like to be updated, some dont, some like to be faxed, some like to be called, etc.

    I am very aware of the hard work, knowledge, experience and intuition that each LPN with whom i work brings to the table. I am grateful to have them as a resource. I admire them, look up to them and can only work to emulate them as I begin my profession. As for the NPs/MDs, school does not provide etiquette and politics lessons on when to call them, or how to speak with them.

    I am hopeful some of you can offer some pointers on how to work on improving relationships in my new role. Thanks for your time and your suggestions.

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    NHCVTturnedLPN likes this.

    Whether or not you need to find new job remains to be seen. I also think you are overwhelmed in your new position. My advice is let yourself be scared, sad and uncertain. When those emotions pass, if they havent already, set about getting what you need. Talk to your boss about the possibility of working with him on a one to one basis at regular intervals on an individual development plan that you both hammer out. And, find someone whom you trust and can be honest with and who will be honest with you and ask them to mentor you.

    Im a new RN in my first nursing job in hospice. I am the case manager. While I have not made a med error, not to say its beyond me however, I have unwittingly and unintentionally, offended NPs, LPNs and my boss who is a certified hospice nurse with my words and or deeds. I too, am overwhelmed in my environment and feeling unsafe and second guessing my choice of profession.

    I empathize with you and am sorry for your pain. Do the best you can and work to grow from this experience.

    you will be in my thoughts and prayers.

    Good luck!

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    no argument here. i am a new nurse, new to hospice, rn case manager. i am very grateful for the work and support i get from my lpn team members. they are a wealth of knowledge and intuition that i can only hope to emulate in my practice as i grow. that being said, i need some help in building stronger relationships with these team members. being a new nurse, i am filled with the rights and wrongs of delegation and documentation and scopes of practice and have on occassion offended, hurt or diminished persons without intending to do so or knowing that I have harmed someone. any words of wisdom regarding how to build better alliances would be much appreciated.

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    I have found the first month of my career as an hospice RN to be rife with conflict between the reality of nursing and what is taught about nursing. Probably the most glaring conflict is the reality of working as a team member. I mean how does one actually fit and how does one begin to synergize with the team members? Between trying to understand when and how to contact MDs and NPs and how to relate to other nurses of different education backgrounds without stepping on toes or offending people, I am feeling very discouraged. I know I am in the right place because intellectually I know I am capable of the task and feel at home caring for pt and family as they wish. I guess for team member, I feel awfully alone.