grbrico

I LOVE being a night nurse.... not having to "deal" with administration except through email, or doctors unless I call them... our worlds maybe be different... but I will never work day time... I have done it once.. and never again. A motto I picked up years ago... "Night Nurses.... keeping them alive till 0705." I love my day shift coworkers... but I think it takes a special kind of person to put up with THAT kind of hell. There is a special kind of person to work our shift as well... I work a ICE/CCU and Step down unit in Kentucky... and all kinds of holy hell comes unglued at night... I just don't need admins mucking up my job when it does... you admin... I will nurse. There is however that special hour... between 2 and three... when all the ativan and ambien craziness is slowing down for about 45 min... lol and no meds to pass till 3... that the quiet happens.. and if we are lucky... we may get to eat dinner during that time... however if your a Friday or Sunday night.. not gonna happen.. cause Admissions will come and take your dinner away...LOL I love my night shift as well as my partners in crime! some of the best nurses I know...

I am 5'1. ahem... Im not going to give my weight..LOL... but I have never had a problem working in ICU. I have rheumatoid arthritis and fibromyalga as well. Never once had I a problem with working with my co-workers in moving patients and preforming my duties... as a matter of fact... my current co workers are very protective of me due to my RA, however.. no one here.. is left on their own trying to move patients.... do not try to hinder yourself due to height issues... if this is what you want to do... then do it!

We use atropine gtts for emergencies and keep those in a comfort box. But Scop patches work even better. We use the Atropine gtts (typically opthalmic gtts) under the tounge... 2 gtts every 4 hours as needed. We get the scop patches as soon as we can... 1-3 patches every 72 hours.

I agree with Irish there.... it does sound like a bad case of terminal agitation... and I had one of those about a three months ago.. it still haunts me... no matter what we did, we could not ease this man's agitation... and pain... no amount of medication, and he was a very good man.... Never be afraid to ask pointed questions that is how you learn... dont ever hold back your questions... they may have been doing all they could.. and didn't have it right yet... I dont know.. I wasn't there.... but if you didn't feel right about something... ask... then ask why they are doing what they are doing and why can't they do more... if a preceptor avoids you or doesn't answer your question.... then ask your supervisor... someone will have an answer for you... or... something will get done. It comes with time... just never be afraid to ask... that is how you learn.... Hugs

Howdy... Graduated gosh.. going on 6 years ago.. dang the time flies.... Not so competitive in the spring.. because... I imagine... you dont walk graduation.. I mean you can... I started spring... and graduated in December... we had our own pinning ceremony it was better than any graduation... not sure if thats why they dont start then.. or just decide that starting in the fall is better for them... go figure.. My background is ICU/CCU Im now in Hospice and loving it.. however... Both hospitals have great units either one you decide on going with you will get well educated after you graduate.. they both have wonderful training programs.... I learned so much from going into ICU/CCU as a new grad. Good Luck and look out for Connie in Psych Semester if she is still teaching... she is a hoot!

Well, what don't you like about it... it does take some getting used to its a different nursing entirely. I mean there is still the bedside but in the field, you are on your own most of the time, that is when your team comes in and you work together. Are you in a hospice facility or out in the field? I am sorta new to hospice as well, I have been here nearly 8.5 months.... Im getting the hang of things, in the field I am alright, it was just learning the medications and the different ways they use them, what is and isn't allowed with medicare/medicaid (insurance stuff I never paid attention to while in the hospital.. we staff nurses didn't get to look over bills and billing....) So that was hard... I still have questions. I guess you would have to ask yourself.... do you believe in what you are doing... have you helped someone ease into death with their dignity intact, abiding by their wishes, do you feel a sense of peace and accomplishment when you look back at the end of the day, no matter how difficult it has been or how few hairs you have left on your head. Can you look into the mirror and say. "I helped ease someone's pain today. I did a good thing" If you can say, even if the person you helped was a distraught, controlling, manical family member come to peace with their loved one's disease process, then my dear.... you are a hospice nurse. If you can't accept those things in your heart, and you feel better working with others to fight disease and get better, and you feel the same things that I described above, then maybe you are on the wrong bus... maybe, just maybe you haven't found the exact place you fit yet.... But you know what? Your time isn't wasted in what you are doing... you are learning each day, you are learning a side of nursing that many do not see. Im not going to say that your heart wont ache, and that its hard not to become attached to your patients.... There was a few weeks ago.. I literally was falling apart... there was a lot of stuff going on with our hospice and with our personnel and at home. What it did do for me after I vented here..... number one was bring me back to this forum that I do miss, and I learn quite a bit from lurking. I was told by a very warm and gracious nurse educator with hospice that it takes a year to finally get it... and maybe even then some. You trip you fall, you get back up and ride that horse again and again. Whether it's with hospice or whatever field that intrigues you and fuels your passion with nursing..explore it, but do give the area you chose some time. Blessings to you

Where I come from our medical directors are pretty quick to take our judgement when it comes to a patient out of pain control. We would have them on a gtt at home before going inpatient. There have even been times we have done continous care with a pt out of pain control and with terminal agitation issues. Yes, in some of our patients we do use methadone, some dilaudid, most though and our main pain medication has been morphine. Mainly because its one of the only drugs of its kind that assist the respiratory system rather than to depress it. We use it quite frequently for shortness of air, chest pain and any other pain... its good for agitation as well, however we generally add ativan with it for agitation and with psychosis halodol.

Thanks for the input.. I have always carried extra insurance since the day I received my nursing license... thank you for suggesting that.. hopefully someone who read this who didn't have it... will get it. Im in a much better frame of mind right now.... did talk with my managers.... Im back to seeing 6-7 patients daily our call has dropped to one night a week with a weekend coverage every 9 weeks. It wasn't just me then... It was all the nurses were stretched as far as they could go. During thier "crisis" they lost 5 nurses in the process... they all quit... I believe it hit em harder than they expected.

Its wonderful that you feel this way now. I too would have to worry for you in the field being new grad. This is no reflection on being a new grad whatsoever... we all were at one time. However. Right now.. you are paired with a nurse who probably has all the answers.. and can see what is happening with a patient and knows why it is happening. Sooner than you think you will be on your own making your own judgement calls, having to explain sometimes in rather graphic detail what is happening to the patient.... some times not. Families will question you and question you. When we say you need at least (minimum) two years on the floor its because your not only dealing with the patients... your dealing with the families... your learning the doctors.... and they in turn start to learn you. You are mostly on your own in the home...and for whatever reason.. Doctors seem to trust Hospice nurses more than do nurses in the hospital. Typically we call them with what we want and the dosages but only because I am familiar with which drugs are within our hospice formulary and which are not. I would suggest you study up on end stages of diseases, in our hopsice its a lot of lung ca, breast ca, parkinson's, colon ca, failure to thrive, demensia, alzheimers, it goes on and on. And to be prepared for small babies, children and teen's as well. We definately do need more hospice nurses... but in this job you experience serial grief, your patients sometimes drop like flies...and you can't help but to get attached to them. Always remember to take time at least once a month and do something good for yourself..... take time to grieve for your patients... if you dont.... it will sneak up on you like it did me my first 6monts in Hospice... I ended up taking two days off work and cried like a baby. I have a healthier respect for this job now... and I am thankful that I had my years in ICU/CCU I even did a year as a charge nurse on a pulmonary/tele floor to get the experience of having more than 3 patients at a time... because ICU/CCU is different than floor nursing... Just remember study study study and take time for yourself.... Best of luck in your new position!

Even though I do not have mine... I do plan to get it. Monetary reimbursement is great and all of that... but just think of the knowledge base you will have... and the good you can do for all of your future patients.

lol... Im reading this post because I am a hospice nurse.. and quite frankly... I write a lot of orders.... but in my defence... the orders I write are from standing orders in which we have a ton of them. However... if a doctor hasn't signed off on the standing orders... I am the first one to call them... and I dont really care if they get upset... and as they are ranting and raving at me whether it be in the wee hours of the morning or during their very busy day..... I always add... Dr... So and So.. we do have standing orders for hospice, can I send those to you again so we can reduce the number of calls? Generally that midmorning call and the gentle reminder to sign and fax us the standing orders.... does the trick.... If they get to particulary nasty.... I remind them that they are the physician and only they can make this call.... if they still yell and scream and hang up on me without the order given.... I call them back ( I am always pleasant and never lose my temper nor raise my voice... and my response when they answer the phone again is.. " so by your actions... your telling me you are refusing to treat our hospice pt?" That generally dampens their fire... they know me well enough to know.. that it WILL be charted. So far.. the docs that I know are very quick to give us what we need when we need it.. its the New "God Syndrome" out of Medical school that give us the most problems... but they catch on rather quickly.... We even have one doc... who is notorious crappy to nurses in the hospital... I mean.. down right hateful to where they cringe and even pay others to call him.... He hated me.... LOL.... I wern't scared of hi m....LOL now that I am a hospice nurse... all of a sudden... I somehow grew a brain..LMAO LOL.. but yeah... darlin.. call em... they put their pants on one leg at a time.. and if they didn't want the calls.. they shouldn't have become a Doctor... and I never apologize for calling them either. Its their job... if they dont like... they need to move on. HUGS.... and just to keep yourself safe and out of the legal drama's... call the doc... even if it is trivial.... if they tell you its trivial and you shouldn't be calling... them tell them to give you some standing orders for common ailments.... and you will happily leave them alone...LOL

In our agency, we use quickcrete concrete, not sure of the resource... but from what I understand we are no longer to flush meds down the toliet or rinse down the drain due to chemical residue that cannot be filtered out during water treatment processes. We discard of all narcs this way add to a baggie half filled with quickcrete, put in meds.. if the liquid meds are not enough moisture to activate the concrete then we add a wee bit of water.. squishy squishy and then throw in the trash.... We do the disposal infront of a family member witness that then signs the discard sheet stating that we destroyed the medications in front of them. It has both the nurses signature and that of a family member.

Hi.. its me again.. the nurse falling apart. I talked with a manager today... explained feeling so stressed and that I am crying all the time... "Well sometimes Hospice is not for everyone" Let me put it straight.... I love Hospice... I love seeing and taking care of my patients. I feel right now that they are pushing all of us beyond what we can handle. I dont want to leave.... but I think I should.... I think the management need to be realistic in how to run it. We have some knock down best nurses in the area... that would give everything for this job... problem is.. they are giving everything and have nothing left for themselves or for their family. Right... now... I am just looking for ideas on what y'all do to destress what thing do you do daily. I am very spiritual... and even my devotional meditations are not enough Im a big ball of nerves and and tightened muscles..lol I never was that before.... Husband says to leave... do something else.... but I do love this work so... I feel like I am letting this beat me... I can do this... .

LOL... sure... I can give this a whirl. Call report line from home.. because I dont have time to sit at the office... because I just a call that my pt has died. jump into my clothes I laid out the night before, my hair is wringing wet... grab the phone, the laptop the portable computer, oh yes... dont forget my meds. Pop in the car.. plug in the rear jack... the computer in the front jack the GPS system that will not freakin hold a charge. tether blackberry phone to computer upload the pt from the computer data base.. because it wasn't my pt... I forogot.. Im on call.. and it was my partners pt...lol Call the family.. tell them I am on my way. When I hang up... I call my PCC and tell her that I am headed to a death, but could she pick up the green script from the doctors office for me. Since this death I am heading to is at the same facility that I will be seeing another pt I scan my previous visit notes and get them ready to print because my printer only works in the car with radio going my arm hanging outside the window... chewing bubblegum... and humming... work dammit work... or your roadkill" Afterseveral tries... I get one note printed. Arrive at the house 1 our later (yes we live out in the boon docks.... our response times sucks... and we can't tell them where we are coming from..LOL but I will be there... the corpse might walk out on his own... but we will be there. I get there, the family is now half drunk and crying. I locate the body do the assessment and do the pronouncement. There is usually one person at this point who didn't think that the blue color that granny was, was actually death, so she faints while boyfreind catches her. Get the body bathed with the help of NO ONE and dress her in a 4 piece suit.. because they do not understand the process of embalming at this point. We have a conversation about sending pt in pajamas or hospital gown so the facility can access her more easily. Nope... Granny isn't going out of the house without panties, girdle, bra, slip frilly shirt, too tight skirt and buckled shoes that no one thought to do slippers or let her go barefoot since her feet are contractured.. and can't wear the shoes... However... the shoes go anyway... Get the Funeral Home there... which you have time since Billy BoBo had to go pick up his Auntie Maude and bring her to the dyin. At this time, I gather meds with the family to destroy, and to finish up the death report. There are arguments as to what Granny HaHa will be named on the death certificate, and then an all out brawl breaks out as to who will sign the death certificate as if they were getting the last will and testament read to them. The funeral home comes, I call the doc, talk with the family some more, decline the ash topped cake Ms. Flo made while I was there and head back to my car to document and move on to my next patient. Get to next pt, Granny poo poo has been sippin on hubby's Lactolose, and now can't quit pooping and she can't get off the toiliet to help her own hubby to the toliet and he is mad at her cause he had a boo boo with the poopoo in the bed. His pain is fine, but his wife's bootie isn't. I go get her some of her own metamucil to take instead of the pt medication. Off to the next patient who has just pulled out his foley. Replace it, also replace the nasal cannula he is using like a lasoo to grab things off the kitchen counter when his wife isn't looking. He has a nice stash of little debbie snack cakes hid in the couch and wife wondered why his blood sugar was 442 today. Teach on diabetes and the importance of keeping healthy snacks available for the patient and not having little debbie influence him any more. Call results into Dr. New Orders, call the pharmacy profile meds, and call other pharmacy to have medications waiting to be picked up. and deliver back out to them. Receive a call from the PCC, could I go (1 hour away) and see another pt they had fallen and gotten a skin tear and their nurse is tied up in a death right now... Sure thing... teather up the blackberry pull in the pt drive 1.3 hours yep... skin tear... just enough for one bandaid. Nero's intact no other problems note... but wait.... they needs meds refilled. Call those in and get them filled ask if family can pick them up... but no.. we can't leave poppy.... so off we go pick up meds and take them back. My day is gone... no time to go back to office for paperwork and still didn't get to see two of my patients today. Call directly to nurse oncall because I have missed my call in report time... tell her about 2 routine visits that need to be made today... because... I wont be able to push them later in the week.. because I am already seeing 8 pts a day. I typcially drive.... 2-300 miles a day I get a whopper of a mileage check but wait... Im still oncall tonight... dear lord... I will never sleep again...... I didn't put in the drug diversion, the name calling, the crying on my partners arms, and falling fast asleep in my husbands arms... oops... I forgot to see my kids today... Well... I can push that to tomorrow.... I know... it sounded a bit crazy... and I am not burnt out... honestly most of my days are lke that but we have to throw management into it, and a few staff meetings once a week which is two towns over from where I live... and OH NO.... They are changing the documentation system from PTCT to McKesson.... go live in 5 days... did you get your training in? Well... do the best you can. OMG.... Renee.... did your brain fall out of your head... but that back in your head... and get back in the car woman.....lol

Hi all, I moved to Hospice from the ICU last year, mainly because I feel I have had a calling to this field. And quite frankly I do. (When things go right...LMAO) Our Hospice has been hit pretty hard, and Im the new baby on the block. My very first day out on my own, was in a stand off in a drug diversion issue with a bilateral amputee who was beating this tis poor paralplegic man for his meds. I wouldn;t leave to have him hit again. Got him out after staying nearly 8 hours drug task force in... (must say...the police in that county are the BOMB) heck do they sey that anymore? When first hired... they explained that I would have two nights on call a month. We then went to a full week on call 24/7 where I nearly killed my self working, and now we are down to a night a week but now... even though we take call ... we still get 16 hour calls on top of working 40 hours, and then take weekend calls which last from Friday night at 4:30pm until 8 am on monday morning. Our staff have had accidents and needed sugeries and leaving the rest of us to hold up the fort till they get back and now they are tying to teach us McKesson in 2 days with a launch for the 1st. I am crying between drives in the car, I have a crazt strung out drug person stalking me over her mother we put in respite to keep the c/g calm and I feel like smashing my head against the wall. I love this job... I love what I do... I love my patients and I feel like I belong no where else...... why do I feel so stressed out all of the time. Any free time I have had... believe it or not I have been sleeping.. because I can't any other time. I have had a belly wash of pt die on me, and I know you shouldn't get close, but this one lady I was very close to I adored her to death. Im seeing her now in my dreams and when I am driving her smiling face pops into my mind, and I know she isn't hurting... anymore... I know... but WE have a great team. Wonderful nurses and social workers, and our bossess are just as strung out as they are... and If I hear one more time... Do what you have to do to see them, well... quite frankly... they have been getting in and out visits because I end up with 12-14 visits a day to make in a huge 4 county area. They want to spend a great deal of money on a triage call service which doesn't make any sense to the nurses because swe still go out anyway. There is no more help coming. And just when you feel like you can't take anymore.. and ask for a day off, some of the managers make you feel like crap for asking. Starting to think that going back to the hospita to do my three square 12's and I am done is looking pretty good right about now. But I would hate... I would miss the driving and visiting with my babies . I asked for a time when we nurses could get together and uplift each other and comfort each other, teach other what each of us know... The answer today was not now... Anyone feel like cloning me? sniffs sniffs...