HMP83

Thanks, yes this hospital was in a big city, in the midwest where I grew up. I don't have a negative opinion of hospice, in fact I was really at peace when I recieved the phone call from my dad saying that she would be going to hospice. I just wanted her comfortable and taken care of well, just like she had done all her life for everyone else. Instead, the whole experience made me feel horrible. I felt as if she would have gotten better care not going hospice, atleast she would have gotten basic nursing care such as emptying of her bladder, adjusting pain management per her symptoms, being changed regularly to be sure she is clean, and being turned atleast once every few hours. I think it is unacceptable to not be turned once in a 30 hr period, ICU or hospice. Like I said, I just wanted to thank all of you hospice nurses who are so wonderful, you really do make all the difference in the way the family and patient experience this very different time. I'm left feeling guilty that she didn't get the care she deserved.

Thanks for your responses. I guess looking back and wondering what if doesn't help anything, but it's hard to see your loved one not get the care you would have hoped for. I also thought there were other alternatives other than central access to go home hospice. But the ICU nurse and the women that came to talk to my family from the hospice company said she would need a PICC, this only after sticking her 6 times to finally get her a second peripheral, because originally the ICU nurse said she would be able to go home for hospice but would need to be sure to have atleast 2 peripherals so they would always have one available if one went bad. I thought there were SL med options. Yes, and once she discovered the distended bladder, she put a foley in, my grandmother died an hour and a half later. She was in the ICU for 6 days, the last 48 hrs she was "hospice". Thank God it was relatively quick and she lived a full and active life up to that point.

Also, when the nurse scanned my grandmother's bladder and it had 820 mls, she said "that must have been so uncomfortable." how uncomfortable is that for someone on a morphine gtt at 6 mg/hr and ativan gtt at 6mg/hr? it is so upsetting to think she was so uncomfortable.

Hello all. I'm a relatively new RN and currently work in the NICU, so I don't know that much about end of life care. 3 weeks ago my very active, cognitively intact grandmother had a stroke. When I say active, I mean paddling a paddle boat daily, taking long walks with her dog every day, so this was very unexpected. To make a long story short: She actually was in the hospital for some dehydration issues and the doctor said they were going to rehydrate and probably send her home. The next morning however, as the doctor was about to discharge her, my aunt came to visit her and she was having obvious stroke symptoms (left side face droop, speech garbled, and couldn't raise left arm). Each day for 4 days it progressively got worse, failed the swallow study and the family had to decide to do a gtube or not. She was having a lot of pain all of the sudden and the doctor put her on a morphine and ativan gtt, she never woke back up after that. She was made hospice, for as the doctor said she would not come back from this and my family knew she wouldn't have wanted to live like this with a feeding tube and whatnot. My question is about hospice care. When my grandma was made hospice, she was in an ICU. We wanted home hospice the nurses said that she would require a procedure to put a PICC line in and they didn't think she was stable enough survive the procedure, so we were unable to take her home since she only had peripheral access. We asked to be moved to a hospice/oncology floor, but no beds were available. So we stayed on the ICU floor for the next 2 days. On the ICU floor, my grandmother wasn't turned for 2 days, no vitals taken, no assessments, didn't even scan her bladder (she did not have a foley in---why????) Almost two hours before my grandmother passed away, I asked if the nurse would take her vitals and scan her bladder just to have an idea of where she was. She had 820 mls!!!! :crying2:The nurse couldn't believe it, i couldn't believe it and i was so upset. I had to travel far in order to get home, and I only got to spend the last 8 hrs or so with her and i couldn't believe she wasn't being made as comfortable as possible. The only time we saw the nurse was when she would pop her head in and say "does anyone need anything?" Is this the normal practice for hospice care in the ICU, does all patient care stop? Are you kept on 4.5L of oxygen, because that is what she was kept on, i thought anything about 2L was therapeutic. I honestly don't have much experience with this but am just looking for some other perspective. I wasn't aware that when you go hospice in the hospital (ICU especially) that even your basic nursing care ended. The whole experience was emotionally draining and horrible enough, but it left such a bad taste in mouth for "hospice" care. This was not the wonderful experience I had always heard about hospice, maybe the problem was we didn't have a hospice nurse taking care of her. Everytime my family would ask something about the dying process, we would get the response "well i'm not sure, we aren't hospice nurses". Sorry so long, just venting and looking for some insight and understanding. Thank you to all you hospice nurses that are wonderful and truly are angels to your patients and their families. Your job is so important to the family and I wish my grandmother could have recieved great hospice care like she deserved. Thanks.

I'm not sure about whether the "dr" title should be in legal documents, however I know where i work if a physician or dentist is a patient then their chart says: Smith, Dr. John. physicians, dentists, veterinarians are all doctors and get the Dr. in the front of their name. PhD's are usually not called doctors...though they do have a doctorate degree, just the same as pharmacists usually don't introduce themselves as "Dr. John Smith though they have a PharmD. Here is a link that I think brings up some good points...not sure that it is exactly the standard but i think most of society tends to agree to extent. http://www.medhunters.com/articles/misuseOfTitleDoctor.html

Yeah, I took a peek myself and was disgusted at how arrogant many of them are, just an example: Originally Posted by johankriek I wouldnt go to nursing school because of the mentality of nurses and its not even academic. They have small minds. they are protocol followers.. they are unable to bring common sense to high places. and they cant see the forest for the trees and they will never be able to. Then another of them replied: "Well, I would mostly agree with this. Nurses are great at advanced pattern recognition. They see a situation and, through repetition, know what has worked in the past and what is likely to work again. Anyone can gain this by simply doing something enough. What they may not understand is why or how a particular intervention works, or what is the appropriate next step if the "standard" intervention fails. Unfortunately, a lot of (lazy) physicians also practice this way. What separates a physician from an advanced-level nurse is knowing what to do next if a treatment fails, making decisions based upon a deeper understanding of physiology, biochemistry, anatomy, etc. that puts together a bigger picture of understanding of the human disease state. Not to say that some nurses aren't capable of doing this, but most I've encountered and worked with simply aren't. They typically know what to do, just not exactly why they are doing it. This is the difference between being a consultant and just simply a highly-trained technician." :angryfire

I've worked on oncology at st. v's and loved it!! the people are wonderful and ratios are pretty good most of the time...it has a great nurse retention. Unfortunately I had to move away or else i'd definately still be there.

Hello Everyone, i'm getting married this summer and will be moving to philly from indiana in august. my fiance goes to school at temple, so i'm somewhat familiar with that area. i currently am about to finish up my first yr of nursing in oncology. does anyone have any suggestions of hospitals to work? I really would love to work in L&D...anything OB, psych, or even a clinic or office setting. What is the job market like in philly? is there just a lot of med/surg openings? did it take you a long time to find a job you wanted? any suggestions or insight would be greatly appreciated! thanks in advance!

Hello, welcome! your job sounds very interesting. Eating disorders and psych issues have always been very interesting to me. I've searched for jobs similar to yours but have not been able to find any. I'm an RN with less than a year of experience behind me. I've been working since June 06 on a onc/hematology unit. What kind of experience are they looking for in a job like yours? Do you work with other nurses? is it stressful? I think I'm just not cut out for hospital nursing and am hoping to find my niche. Thanks for sharing your experience.

Thanks for your responses. I see your point that starting a new job will just add to the stress, but I dont think I can be anymore stressed. I can't sleep, i'm constantly preoccupied and have held back tears several times as I walk in and out of the hospital before and after my shift. I'm so unhappy and it is making me contemplate being a nurse altogether. It simply is not worth this unhappiness to me and the stress in my life. i'm afraid if i stick it out for the next 7-8months, i'll turn away from nursing altogether bc of burnout. Sorry to vent.

Hello all!! after reading so many posts, I see a lot of people are in a similar boat. I currently work in a med-surg/onc area for about 3 months. I had a good orientation, great coworkers, my preceptors were good and I had support from management if I needed it so I can't complain there. My problem is that I'm 100% sure that onc/med-surg are not my niche. I went into nursing for OB (L&D especially) and did an externship in it and absolutely loved it, however I wanted to get that "1 yr of med-surg experience". However I'm disliking it more than I thought I would, I dread going to work every night, can't sleep, constantly counting down the days until I can leave it, just completely stressed out. I'm moving away in about 7 months bc i'm getting married. just looking for some advice: do I just stick it out 7 more months even though i dislike it so much (just to put my time in) or do i look for something else to do for the next 7 months knowing i'm going to be leaving a few months off of orientation? i just worry about how this will look on my resume. sorry so long just looking for some advice :) best of luck to everyone!

Yeah, I know how working night shift makes you like an insomniac. Orientation is about 2 months, but I asked for an extra few days (so i'll be on my own next week), even though my preceptor doesn't share any of the load (i do it all) but it is nice to know she is there if I need her. Yeah, the first month of my orientation was on day shift, so i was happy to go to nights, it gives me a little more time to get organized. So I've had 2 different preceptors: one for days and one for nights, they both have been very helpful, one more than the other but I guess i can't complain too much. I just wish i would have gotten more education and inservices on working with cancer pts and chemo and the blood disorders instead of just assuming I know it all. I thought i belonged in oncology also, but I think it more that I am interested in hospice, I guess a yr in onc will make me more marketable in hospice if that is what I decide to do. I know it is a bit early to decide but i dont see myself doing oncology for more than a yr. I'm already getting burned out and that's not a good sign. Oncology pts have a lot of psychosocial needs but d/t to the stress and the overwhelming pt to nurse ratio I feel like the needs are ignored many times, esp since i'm a new grad and this is a lot to handle. I'm hoping this all gets better but until then i guess i'll just keep at it and get this experience under my belt. Atleast look at it this way we will come out with great IV starting experience, pain management, death/dying experience, chemo/rad knowledge, port-a-cath and central line exposure, etc. Let me know if you ever need to just vent, it feels better to know someone else is feeling the same anxiety and doubt. Good luck to u!!

Hello, I'm also a new grad RN working on an oncology floor...also feeling very overwhelmed. I work night shift and am responsible for usually 4 patients (could be up to 5) plus cover 1-2 LPN's patients, basically sign off their orders, write orders, call docs, sign off assessments etc). Just trying to get time management down is difficult but when you have such complex pts that need blood products, their labs always seem to be all out of whack, managing their symptoms from chemo/rad, and of course the whole psychosocial component of cancer is just overwhelming. Also my floor is a hematology floor that has hemophiliacs and sickle cell crisis pts, that have horrible pain and need their narcotic pushes and phenergan and benadryl every chance they can have it (usually q 2 hrs). I feel like i'm just tryin to stay afloat all night and am exhausted. I'm still trying to figure out how to juggle it all, but sadly it is already starting to burn me out and i've only been in it a few months. I'll let you know if it gets any better for me, just know that you aren't alone!!! good luck!

Hello! I worked as a SNE at Clarian and was offered a position there as an RN. I know at Clarian, as a SNE you are basically assured a job on that unit upon graduation. I have friends who were SNEs at St Vincent and were offered positions there upon graduation. So i'd say your chances are pretty high, as long as you dont mess it up. Good luck, u'll enjoy the externship, I did!!!

Hello, I graduate in May. I have been offered a job as a graduate nurse on a SICU unit. The hospital provides a 3 month orientation for the position. I just can't imagine feeling prepared after 3 months of orientation since I have very very little experience in critical care. Anyone else who is a new grad RN working in a sicu or micu, do you feel like 3 months of orientation prepared you sufficiently? I also have been oftered a position in the NICU with a 6 month orientation. It seems wierd that the orientation is cut essentially in half for the sicu. Is the NICU more complex? Any thoughts are greatly appreciated! thanks