mjamesRN

Had to comment here as a GAY male nurse -- never had a problem until I tried to re-enter the job market..."Faith-based" organizations immediately rejected me (no, I have no proof, but I know); any hard up recruiter, gay/ man-hating, resentful women at the helm, despite my excellent references, passively juried and denied me positions for which I have applied. As far as male nurses being assumed as gay: I worked in a large community hospital and I would say few of the male nurses were gay. Thankfully, the straight male nurses, and as attested to on this thread and in life, don't give a rat's ass if their male colleague is gay. It's not why were here or on the job. As far as someone's callous comment on the floor: go to your manager, then her manager then her manager then her's....personally, I would confront and put the ***** in her place.

Drug-seekers on a Med-Surg floor can be a difficult endeavor -- one you really shouldn't have to manage alone. Most hospitals have a Pain Management team that can help. Hospice is an entirely different animal. I had a guy with endstage pancreatic cancer who had been on pain killers and was an alcoholic all his life and, by the time I received him, had a port and a Dilaudid pump that was delivering 180 mg/ hour PLUS q15 minute 30 mg boluses for breathrough. (These high doses apparently aren't uncommon with oncology patients), however, He was beginning to have myoclonic twitching -- was verging on fullblown seizures and possibly a stroke -- from the high doses of Dilaudid. If we even pulled back a little, his pain would skyrocket. In otherwords, there was really nothing more we could give him. He was already on Oxycontin as well and morphine or methadone wouldn't even touch his pain. He died in pain. One good thing was he kept a sense of humor right until the end and his wife was wonderfully supoortive and caring.

I did a double take to see that there are actual ads promoting the Bush Agenda and selling pro-Bush novelty items. This is really quite inappropriate for a forum that is supposed to be unbiased and nonpartisan. MODERATORS??

I've been in Hospice nursing for just under a year now and find the most difficult patients, physically and emotionally, are ALS (Amyotropic Lateral Sclerosis or Lou Gehrigs Disease or Motor Neuron Degeneration) patients. The common prognosis from diagnosis is 5 years. People know from the beginning that it is terminal. They are faced with having their entire world close in on them, becoming completely paralyzed with loss of communication and respiratory ability but their minds remain active. I would like to hear any comments, suggestions, stories etc...on how other hospice nurses deal with this frightening disease process in their patients who have it.

Let's not forget the stages of dying which affect the family members often moreso than the patient. Depression and Denial seem to be most prevalent. I spend alot of time talking family members off of emotional ledges; they of course, are an important part of your care. The most difficult scenario is when family members insist that their loved ones stay "alert" until the end, which is ridiculous: sometimes there's an underlying inheritance issue, or an unresolved reconciliation....eesh! Very emotionally-exhausting. I often wonder why I'm so tired at the end of the day when all I did was sit and listen. One of the best lines for families, patients and for yourself is "No one has control here" meaning the disease will control the destiny of everyone from that point on. Hospice nursing has a lot of rewards, however, you find you're in a constant state of facing your own mortality, which if anyone has a suggestion for me on this -- as I'm approaching a place in my head where I need to see more life and healing rather than (to quote Scarlett OHara) " all this death and rot and death!" LOL ---.

If I may echo a previous post: Give them WHATEVER they WANT. If you have a problem with drug-seeking patients, hospice isn't where you should be. If you were dying of a terminal painful illness, I think you would want to be as stoned as possible. Get it?

If being HIV+ required disclosure, we would all be tested for it as a mandatory requirement to employment. It's nobody's business. And if you do disclose it, say, to your employer and there are negative repercussions, they would be in violation of discrimination and the privacy act. I agree with the previous post that you should be more concerned with the pathogens YOU may be subjected to if your counts are low.

One our newly-appointed Clinical Directors stepped out of school into hospice 7 years ago. She never worked the floor. I guess if you want to jump right in, go for it and learn as you go -- however, I agree with some of the other nurses' posts here, a good solid year or more of Med-Surg or Oncology will prepare you. You still need to utilize alot of basic skills in hospice and you'll sharpen these and not have to second-guess yourself when working hands-on with hospice patients.

I agree with Canoehead on this one. Haldol is for violent agitation (if it occurs) in the active dying stage. Any nurse who has given it knows that Haldol will zonk someone for long periods of time and many elderly patients are senstivie to it: hallucinations, etc...however, at near death these can also be common symptoms. And in the case of this thread, mets to the liver: increasing ammonia levels may have contributed to the agitation as well, but overall, Ativan and Morphine should have done the job, not multiple doses of Haldol. I would question this seriously.

Been hospice nursing for four months now and it really is a special field. I love the flexibility of it job-wise. In the nursing end of it (no pun intended), teaching and encouraging and reassuring families and patients, and dispelling the misconceptions about dying is wonderfully rewarding. The pay isn't so great, documentation is immense, but seeing someone through is a great gift you can give as a nurse.

I've never felt subordinate to doctors. I give them the respect they deserve and expect the same from them, and usually get that respect without asking for it. Healthcare today is a "Corroboration" -- nobody is above anybody. Nurses who suggest doctors "know more than we do" are only slighting themselves and are representing themselves as the very thing nurses have been trying to dispel throughout this century: that we are pawns. Doctors treat organisms; nurses treat human beings. Afterall, we see responses to treatment firsthand. This makes us first defense in healing and this should also be a continual learning mechanism for nurses. In a way, we fill in the guesswork of doctors and are indeed the checks and balances of the field, and because we are this we have right to put a physician in their place if they disrespect you. Admittedly, the hospital industry is falling on its *** more and more with every passing day because they are being run by money people rather than caring people; hence the nurses are being driven out by the bureaucracy who cannot possibly truly understand the stress of our work but continue to expect us to perform to their business-driven guidelines. Unfortunately many physicians have been falling into this money-wheel for many years now. There is a great joke that was going around before I left the hospital: What's the difference between a doctor and God? God doesn't think he's a doctor. And as far as residents go, a wonderful nurse I worked with had the best line for a snotty-nosed resident who was pushing her buttons: "Excuse me...doctor? I'm done school."

I'm in hospice training right now and for full time case managers, they "believe" that 16 is adequate. HA! I'm amazed at the paperwork. There are like 40 different documents I'm responsible for! Why is it that every nursing job seems like I'm just a pawn to keep the healthcare agency out of court? I'm very dismayed. All I want to do is assist patients and family through the dying process, but the paperwork requirements are really turning me off.

Diversity isn't JUST cultural. Sexual diversity is included. And gay and transgender are two completely different diversities.

More judgement among us. Talk about physical limitations: I suppose being pregnant is different?? or being so fat you can't get out of your chair?? Ladies, C'mon!

I guess NURSE CATHY who started this thread bowed out. Frankly she should bow out of being a nurse educator. You're supposed to teach and support diversity. Transgender people are perfectly capable of advocating a patient. Get a grip.