Palliative Care, DNP 16,459 Views
Joined: Jun 28, '11;
Posts: 779 (56% Liked)
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DNP, FNP; from
Family Nurse Practitioner
Planning to relocate to SC. Reading through requirements for the state. Am I understanding correctly in SC that you must have a supervising physician before you can obtain prescriptive authority? I thought I would ask here but will follow up with call to SC Board. Thanks!
The hospital system that I work for will hire ADNs but they stipulate a date by when that nurse must complete the BSN. Our ICU only has BSNs who are also certified in critical care.
The interesting thing to consider is that both parties seem to consider the other snowflakes. Thus, would everyone not then be a snowflake? Basically, no one is special.
My suggestion is learn as much as you can from everyone you can. There is something to learn from every person from the environmental services folks through management. Take what you learned in school and intermix what you learn on the job. Create your way of providing safe, efficient, and timely care. Most importantly, make friends with the CNAs and ER techs. They can make or break a shift. Always ask questions when you aren't sure.
We work in a team at my facility. We have a MD, 2 NPs, & a PCSW. We provide symptom management for chronic & life-limiting illnesses, have family meetings to determine goals of care, assist with advanced care planning, offer support, and assist with connecting families with hospice when appropriate.
Then keep in mind that people are different, and just because this discussion has worked for you and your family, it doesn't work for everyone. People are individuals, and should be supported as such.
Have you personally been in the position of talking to a close family member of yours about a DNR or hospice? Or is that still out in the future somewhere, so you can easily take theoretical positions? Perhaps you will have a close family member of yours who initiates discussion about these subjects, or wants to discuss them, in which case your situation is much easier. People frequently write on this forum how different it is when they are the patient or the family member, and how much harder it is then. End of life situations can be very difficult, painful (physically and emotionally), and complicated, and fraught with much pain and fear for patients and family members, and many people simply choose not to talk about this subject. Instead of being amazed, put that energy into trying to understand the emotions that people are dealing with, and then you may find yourself more tolerant of these situations and better able to support your patients and their families.
When I worked with adults I remember loving those shifts where I got to provide palliative care, making someone comfortable and comforting their family in the last moments. They were some of my most rewarding experiences.
In the NICU we're generally pretty bad at this...as no matter how severe the babies' case is and even if nothing can be done - parents want everything and anything done (and I don't blame them). Even a 23 weeker, or an infant with a syndrome or genetic abnormality that means they will likely be severely disabled or a vegetable for the rest of their life - they almost always want to do everything. Lots of ethics in the NICU.
Floor nursing was not for me at all. I knew it would not be sustainable for me. I went back to school and I have found that I very much prefer being a provider.
We have to provide daily education to physicians where I work. Many equate us with hospice. We are not the God Squad going room to room celestially discharging patients. Palliative Care provides symptom management and support to patients with life-limiting or chronic illnesses. We also assist with Advanced Care planning, Goals of Care discussions, and terminal extubations. We are able to assist with the coordination of hospice for patients who choose to go in that directions prior to discharge. In my area Palliative Care only exists inpatient and hospice would be the closest thing to us outpatient.
In my experience, oncologists are the worst with being truthful on prognosis with patients. We are often the first people who advise them that their disease is terminal. Oncologists like to use the words "palliative chemo or treatment" without explaining to the patient that means we can not cure this but may be able to prolong your life some. There are also those patients and families who are advised but believe in miracles. So far, I have yet to come across one miraculous recovery in a terminal cancer patient.
I currently work with a pulmonology and critical care physician who smokes. He says the stress of running the ICU makes it next to impossible for him to quit. When I was still a floor RN, I worked with an RT that had lung cancer and he was still smoking. My own husband had stopped smoking for 17 years but picked it back up when he opened his own pharmacy 5 years ago I can't get him to stop either.
I never worked as a CNA during my program. I did make friends and assist every CNA that I ever worked with though. CNAs make or break a shift. They are underpaid and overworked. My parents taught us "that you can learn something from everyone you meet." I learn something daily.
In Palliative Care at the facility I am employed we do not deep suction comfort patients. All are given Robinul, scopolamine patches, & sometimes Atropine. We consider deep suctioning to be against comfort. We may suction the mouth but that is it. We do provide family with education on end of life changes as well.
I have been at my first job for a year now. I am in Palliative Care so we provide symptom management for life-limiting and chronic illnesses, have family meetings for goals of care, assist with Advanced Care Planning, and can coordinate with hospice for patients. Most of the time I like my job but some days are pretty emotionally taxing. The worst part of my job is when we are utilized as pain management for patients that are admitted for surgery or chronic pain patients.
Every patient that I order opioids for also has a Narcan order placed. Unless, they are comfort transitioning to hospice.
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