sharlyb

This is a philosophy you are describing, namely that anyone who has unresolved issues will have a conscious death if and only if those issues are resolved. Based upon the stories you shared this appears primarily to be patients who have been involved somehow in the death of another or others. It raises certain questions. Do you believe that only if a patient is conscious when they die can they have experienced a good death? Are we to teach families that their loved one did not have a good death and must have had some unresolved issues related to terrible things they did if they do not die conscious? Are only people who did terrible things but then who resolved those issues capable of experiencing a good death in the end? What exactly is your interpretation of the prisoner's remark about not dying? That was unclear to me. He did, after all, die. Are you saying he died but didn't die? Please explain.

You took initiative to improve the flow of things. That's a good thing. Anyone using the packets you made up should rightly be appreciative of the ease of knowing everything is together in one place. Any reasonable person would be all too happy to see things improve. It seems that co-workers like this prefer to keep other people in the dark to bolster their own underlying incompetency. If I were that patient I would want things to move as efficiently as possible. What effective nurse would want things to remain disorganized? One that wants to feed their own ego?

I wish you well. I've been in hospice nursing for over three years now. It is the most rewarding nursing I've done in 27 years having worked in many different areas of nursing. One thing I would caution you about is "for profit" hospice agencies. I worked for one for a few months, knew I loved hospice but also knew that I could not live with the "profit" focus that led to corporate policies that were not acceptable to me because the patients and families were ill served. Not that the staff were not great- they were. Almost all of the people I worked with at that "for profit" agency have left there now. The non-profit agency I work for now provides me with many opportunities for professional growth. They nurture it. We get free CEUs. Most of the nurses have their CHPN. Rather than being run by a business adminstrator who knows nothing about clincial issues and thinks only in dollars and cents we have an RN director who understands the issues related to patient care.

Officially we're supposed to get the order first. In reality, when it comes to things like duoderm, we just apply it and then send in the order. Most of our docs do not want to be called for this and, in any event. we are fortunate to have a medical director who is sane and who is always behind us for things that clearly are appropriate and necessary. We can always count on her signing for things if the attending balks but for the most part we have not had any problem with the attending physicians.

We have two full time on call nurses. Each works two weeknights from 4PM-8AM the next morning and every other weekend from 8 am Sat. to 8 am Mon. That makes for a 56 hour week for the on call nurse. Case managers take turns covering on call for Friday nights, the only night not covered by the on call nurses. They get paid beeper time of $5.25/hour. They also get mileage paid minus travel distance equal to what it would take to drive to the office and home again. If they go out to see someone they get paid $45 per visit. If they do an admission they get paid $75 for the admission in addition to beeper time. Our census is 42.

Consider looking for an in patient hospice unit. We have one and about two years ago we hired a new graduate who is doing a great job and is still with us. That will allow you the chance to work in hospice and still have the necessary support from seasoned nurses.

As I read these posts about patient surveys I am left to conclude that the average patient is: a. a griper and whiner just waiting to get a nurse in trouble about something b. never satisfied with anything we do c. intent on asking the impossible and expecting to receive it On the other hand, the average nurse: a. only ever does their job flawlessley b. is always unfairly assessed by patients Having worked as a nurse in direct patient care across three states for 27 years I can say that I have discovered for myself that: a. there are difficult patients and there are incompetent nurses b. there are unreasonable families and there are unreasonable administrators c. there are moments that make me want to continue in nursing despite all of that

There are two possibilities here regarding the potential black listing. A. they are serious about it. B. they are not. Given the current nursing shortage and given the fact that you are choosing to leave rather than that you were fired, I rather doubt they would stick to their guns if three years from now you went there and asked for a job. However, to be safe, if you want to be certain of being eligible for rehire at this facility it seems you would be better off giving them the three weeks. Just make sure you do get sufficient sleep so you are not at risk of having an accident on the way home. I did when I tried working the night shift as a new nurse and fell asleep behind the wheel on my 20 minute commute home. Thankfully neither I nor anyone else was injured. No other car was involved but I ran my car off the road. That was the end of the night shift for me.

Hi Slurgee, First of all, congratulations on your accomplishment! Welcome to the world of nursing and all it has to offer. I have been a nurse for 27 years and have worked in many different areas of nursing. You are right in thinking that home care is not generally the easiest to get into as a new graduate. You're out there in homes by yourself and there's no colleague to readily come to your aid. It takes a bit of independence as well as creativity in finding solutions to things you don't encounter in the clincial setting. However, it is quite rewarding. I enjoy home care and am doing hospice nursing right now. Our hospice agency is affiliated with one in Ocean county that has a new in patient unit as well as a home care census. We have the same in Monmouth County and I know we hired a new graduate who has been with us for two years on our in patient unit. If you tried that you could move to home care and not lose the time put into getting vested. (The Ocean County home care agency has a large non-hospice census as well as some hospice patients. The company offers good benefits. I'm not sure of the pay in Ocean County. If you would like more information or the name of the person to contact (the director of the in patient unit in Ocean County) let me know.

This is an interesting topic and one that will not likely go away. As someone else already pointed out, patient surveys are here to stay whether Press Ganey or other forms of polling patients post admission. Scripting is nonsense. How silly I would think the staff if, as a patient, every nurse who entered my room said the same thing. As another pointed out, it is the Walmart syndrome. The first time you walk into a Walmart it's OK, by the second and third time it becomes rather annoying. On the other hand, I don't fault administrative staff for wanting to assure that patients' needs are addressed, particularly comfort issues. I worked in acute care settings for a long time, floating to all the units of two differerent hospitals in two different states, working everywhere from the ICU units to the ER, med-surg, pediatrics and new born nursery. I have also been a patient myself a number of times. It is no secret that some basic comfort issues are not always given the attention they deserve. Small gestures can mean a lot and can in fact make a difference in the way a hospital stay is perceived regardless of the top notch care the staff has given when viewed from a clinical perspective. That is what administration is getting at and rightly so, even if their approach is rather silly. Nurses who care about patient comfort will find a way to show the patient they are interested in their needs without having to use some ridiculous scripted phrase. Our agency sends out Press Ganey surveys and we get consistently high ratings. I see it as a positive reinforcement that we are doing a good job not because we asked some silly question but because we are all finding ways to make sure we are paying attention to the details. Every nurse I work with has their own style of doing that. If the fact that those surveys go out makes each of us sit up and pay attention to the fact that we are, after all taking care of human beings who are often scared, hungry, cold, in pain or distressed and who need some basic human kindness in the middle of all the machines and tests, poking and prodding, then that is, I think, a good thing.

You have my sympathies for this challenging situation. Having done a fair bit of home care and private duty nursing over the past 27 years as a nurse as well as presently working in home care hospice I can relate well to the dynamic you have described. There are two key issues in this situation that I think you would do well to focus on: A. The agency told you that it was OK to leave. B. The state board of nursing told you that it was ok to leave. That would be sufficient for me. The way I see it, this family is manipulating you. They are playing on the fact that, unlike them, you feel a sense of commitment and caring. My suggestion is that you (calmly and politely) tell the patient and family that you will leave when you are scheduled to leave. Then do it. If the family acts enraged, let them rant. Refuse to allow yourself to be pulled into their negative dynamic. Do not let yourself become entangled in the net of negative dialog. Repeat the basic message if necessary i.e. I will leave when my shift is over. You don't need to explain anything or make excuses. If you do you will only be treated with disdain and viewed as weak and manipulatable. What the family or patient choose to do about the situation is their responsibility. They clearly have resources that they can tap into. You have been assured that it is not patient abandonment to leave. You have a responsibility toward your own family. Let the patient and family say what they will. You will only be manipulated if and when you allow yourself be drawn into their dysfunctional dynamic. People like this will not find it easy to keep any nurse. If you allow your sense of needing this job to dominate, you have given them full control over you. In the end you will most likely keep the job and your sanity if you stand your ground.

There are definitely jobs in nursing for LPN/LVN's that are not direct patient care. One LPN I know works at a fitness and wellness center. Another works in an MD's office. There are definitely a variety of options out there. You just need to look for them.

I have worked for two different hospices and I can tell you there is a vast difference between the two of them in terms of skill in management and knowledge of how to deliver quality hospice care effectively. To answer your specific question as to reasonable caseloads, geographical and demographical issues must be taken into consideration. So too acuity levels of patients, degree of neediness of patient caregivers, and location of patients i.e. managing five patients all located on the same floor of a long term care facility is quite different than managing five home care patients who are scattered 20-30 minutes apart from one another. Home care patients generally need a lot more time and attention than a nursing home patient because of the fact that the family are the primary care givers and there is no 24 hour nursing care available to the patient. A skilled team leader will understand these issues. My first team leader did not. It was purely a numbers issue with her- how many patients did each case manager have.