neonatal3

Hello all! Enjoyed reading your comments about work options for us older nurses. Each situation about working as an older nurse seems to be different. Other factors to consider in going back to nursing work at age 62 are individual health, energy, and stamina. For example, I recently worked in a private duty home health job thinking that the slower pace of the work might match my older age and less energy. I learned some hard lessons about the energy demands in care of patient's who are elibigle for insurance to pay for private duty R.N. home care---examples of the physical energy demands include turning very heavy patients often to change their diapers, bathing and dressing big patients who are paralyzed due to spinal cord injury,and constantly calming very confused combative patients who have Alzheimer's Disease--plus there are the mental energy demands of even getting to work such as waking at 4:30 A.M. to work a case requiring 6A to 6P hours, or driving 60 miles round trip to a patient's home, and hunting to find the location of the patient assignment homes. Most older nurses I know including myself have worked as nurses all our adult lives and now have less energy and less stamina. For this reason, we are very thankful for the option to start receiving Social Security pension payments at age 62! But maybe you feel you have more energy for work since it seems you have not worked outside of your home in a long time. Best wishes in your decision about work! Peace to you.

Hello all, Another factor in decisions about whether to share personal info is what is the current "norm" for conduct of nursing professionals. For example, the expected "norm" of conduct when I first started working as a registered nurse in the 70's was to focus only on the patient---zero personal info was to be shared. At that time if a supervisor observed a nurse answering questions from his/her patient about personal life, the supervisor gave a quick, serious verbal warning to the nurse to focus ONLY on the patient--if a nurse continued to share personal info with a patient the result might be to lose one's job! So we nurses learned to have a nice response to patient's questions saying "thank you for asking, but we are required to focus only on medical care for you". To be fair, this required nursing approach to restrict sharing personal info was probably also to PROTECT nurses from awkward situations with patients. For example, a fellow nursing pal told me this week that one of her nurse co-workers at a short term rehab unit within a nursing home had given her personal phone number to a patient who said he was feeling depressed---then even after discharge to home this patient was calling often to this nurse with requests to talk for long periods of time about his depression feelings!--now this nurse says she is trying to figure out a smooth way to get out of this situation! Best wishes to all of you!

Hello fellow private duty nurses! Can relate to comments by mamato3 about whether to "tough it out with agency" or switch jobs to some other work with "for sure hours"! I have worked private duty home health nursing at an agency for three months now, and I still do not have ANY permanent case with "for sure hours". When I interviewed for this gig, the staff said that most nurses have a regular patient assignment within the first two months of working. Hah! After reading many helpful comments by fellow agency nurses, I am learning that maybe the unpredictable hours and frequent changes of patient assignments are just part of the "nature of the beast" of agency work. The brave nurses who write that they are ok with agency work may be at a point in their lives when they ride well with unpredictable job situations. Good for them! Your idea to maybe reduce your hours of committment with the agency may be a good temporary plan until you decide if you quitting is best for you. In my work situation, a friend suggested a similar temporary work plan. She suggested that I delay my urge to "jump ship", and just kindly tell agency that I will not be available for assignments for a few weeks. During that few weeks I could use part of my savings for expenses and explore other "for sure hours" job options. Best wishes in your decision! Your fellow tired warrior in agency nursing

Hello all, Appreciated reading your comments about getting cancelled on agency assignments. I am a retirement age RN working private duty home health for an agency. Yesterday I received a call from the agency saying "sorry but we will need to find another assignment for you....the parents of your patient(19 years old) have requested that we arrange for a nurse who is CLOSER TO THE PATIENT'S AGE....". Bummer! Any of you have this experience? Best wishes to all. Your fellow agency nurse

Hello all, Sincerely appreciate reading all your compassionate comments about nursing care of teens with profound developmental disabilities. One of the challenges for me is to try to give positive responses to the parents of these disabled teens when (probably as a coping mechanism) they sometimes express unrealistic goals for their dear children. For example,the parents of my current home health 19 year old patient ask me if we nurses and special education teachers are helping their daughter at school with "hand over hand writing"(patient has severe cerebral palsy and very profound developmental delay)---when I asked the special education teachers about this writing assistance, they kindly responded saying they no longer attempt this task because the outcome is that the student displays no recognition of the task and no ability to help with any of the writing(mental age is approximately one year)---so I kindly respond to the parents saying I mentioned to the teachers that they are interested in more efforts at "hand over hand writing" and leave it at that. At school, this patient does have a simple "communication board" attached to her wheelchair,but she does not display the ability to use this communication board--there are four big buttons she can push for these recordings to be heard--the four options are "hello","my name is ", "I need help", and "I need to be changed"---many times she does not push the buttons at all---other times she pushes the same button over and over and over with no apparent association with circumstance) Peace to all of you fellow nurses who care for patients with developmental delay!

Hello all, How very cool to read this mix of your comments about living and working as a nurse in Florida! I have long been wondering how it might be to relocate in Florida! In past years I have been on many wonderful family vacations to coastal cities in Florida. Long ago my husband and I seriously considered moving to Daytona Beach,Florida. And this past January I was seriously considering a pre-retirement plan of moving from my current location in Tennessee to Panama City Beach,Florida. Florida seems to "call to me". I even persuaded a fellow retirement aged nurse to ride in my car with me for a weekend "scouting" trip to explore living options and employment options in the Pananma City Beach area in January. Hats off to those of you who are true explorers and have relocated to different cities! After my "scouting trip" to Panama City Beach, I realized that I cannot make myself move a long way from my current city where my dear son and his family are located. Good luck in all your nursing work adventures in Florida Land!

Hello all, I agree with a comment on this thread saying that "there is no shame in not persuing something that doesn't resonate with you". Years ago I used to teach nursing in an assoicate degree program, and sometimes students would discover that nursing just was not their "thing". Have you considered changing your major and transferring as many as possible of your hard earned college credits toward completion of a different college program? To me, nursing work has long been sort of a "personal calling". I have worked as a nurse for over 35 years. Over time I have experienced "burn out" feelings about nursing work, and my solution was to transfer to a different hospital unit or to change jobs to different fields of nursing such as teaching nursing at a university or working with the state health department doing patient education. Best wishes in your decisions!

Hello all, My favorite cousin has had a very positive experience of earning his associate degree in nursing at age 50 and working as an R.N. for 13 years now. He made a bold career change from being a policeman for many years to becoming a professional nurse. Then he combined his skills and worked as an R.N. in a prison hospital for several years. Now, at age 63 he works as an R.N. earning high pay per hour doing PRN work(as needed work shifts) at a general hospital to supplement his Social Security Pension and his police work pension. Though I sincerely welcome you to join the world of nursing, it seems wise to share some challenging factors for you to consider in your decision. One factor to consider at "mid-life" age is the physical demands of much nursing work---for example,being on your feet for all of 12 hour shifts,lifting and pulling patients as needed,working some night shift hours. Another factor to consider at "mid-life" is that the ability to do fast multi-tasking is a must in many nursing jobs. If you have never done any medical type work, a general but grass roots question to ask yourself before applying for nursing school is "am I ok with switching to work which involves handling patients' body fluids even with gloves on such as blood, drainage from wounds,urine,stool,sputum,vomit?" (Years ago I taught nursing in an associate degree program and saw many students drop out of nursing when they learned that they could not cope with real blood situations for their student assignment patients.) Best wishes in your decision!

Hello all, I am RN who just started working for a home health agency three months ago. (have decades of nursing experience but new to home health)It is great moral support to read words written by txnursingqt about how agency work is "always unknown and can change minute to minute"! It is also encouraging to read that you other agency nurses are experiencing requirements to be extremely flexible! Yes!! One of my challenges regarding flexibility has to do with driving time to assignments. When I was first applying for this agency job I specifically asked if there would be enough work for me to drive only to homes within my county. The staff responded positively saying, "no problem--most of our cases are in this county". Then during my first three months of work the office staff has called asking me to work a mix of in county and out of county patient assignments!--with each out of county request I kindly remind the office staff that I initially agreed to do only in county patients--then the office staff still tries to persuade me to take the out of county case--so I am trying to be what I call "medium level of flexible" about the out of county requests (for example turned down one hour drive cases and accepted a few 30 minute drive cases--yesterday office requested 40 minute drive "permanent" case and offered me one dollar more per hour for gas expense--I reluctantly accepted case--reason for me even keeping this job is the appeal of slower pace work of private duty cases for this older nurse and because of great perk of group health insurance) Ah, lessons is learning to be more flexible!! Best wishes in all of your agency adventures.

Hello all, Your comments about various guidelines for bath care of rehab. patients are very interesting and helpful. My current private duty home health patient is a "rehab type" patient in that he is only 18 years old and is a quad due to a car accident one year ago. This patient lives in the home of his parents. This patient's Mother has said that her plan of care for bathing him is for the nurses to give him a shower once per week(using Hoyer lift and special waterproof sling), and give bed baths on all the other days. Each shift I work, I always offer to give the patient a bath--if the patient refuses a bath(which did happen to me one work day this week), I document the offer of bath and the patient decline and kindly share this patient response with the patient's Mother. (Hey, when I am off work sometimes I take a shower every other day---in my humble opinion, bath every other day with cleaning of diaper area at every diaper change is very reasonable patient care) In closing, will "vent" that as retirement aged nurse have just three months ago started working again by taking this job with home health "rehab. type" patients and am finding this EXTREMELY depressing work!(my current plan is to look at this job as another learning experience in life, do my very best to care for these gloomy patients, and kindly exit at the one year of service point)---hats off to all of you who work with rehab. patients!--take a bow! Peace to all of you.

Hello all! Yesterday I had with a tough job while working only one rare day with a home health Alzheimer patient! Since this 99 year old,blind,and bedfast patient was not my regular assignment, she was not familiar with my voice --- she became very agitated and combative as I kindly and gently tried to give her care. As joyflnoyz wrote on this site, I tried to "enter her world" and tried to understand that a new nurse which she could not see might be scary to her. As other nurses wrote, I just started kindly responding to her shouting by frequently saying "OK, Ms. Smith" and turned on her TV to a simple garden tip program and that seemed to gradually calm her part of the time. This patient had a PRN order for Ativan but the son chose not to give her this medication because he said she would sleep the rest of the day and then be up all night. The only time I lost my cool and had to step out of the patient's room to regroup was when this frail little lady suddenly grabbed my finger and strongly jerked my finger---so I pulled back before she could do any damage to my finger!!! I sincerely salute any of you who have the courage to work long term with any Alzheimer's patients! Take a bow! (Most of my many years of nursing have been in maternal/child health---unfortunately, geriatrics is just not my thing.) Peace to all of you.

Hello caliotter3 ! BIG thanks for your oh so helpful reinforcement about calls to involve resource people when one encounters major negative home environment issues!(Reading your kind messages is wonderful moral support because this unfortunate patient situation has been causing me to feel super depressed!) After reading your kind suggestions, in addition to previous call to involve case manager, I also called my nursing supervisor with more update info and made a request yesterday for her to work on speed up of nursing home placement for this patient. Update On Patient Situation--another learning experience!--this morning I arrived at my patient's residence and knocked on the exterior doors for ten minutes with no response---then, I called my agency concerned that this paralyzed patient might be in bed alone with no ability to open door--agency staff person was apologetic to me and said that patient had just called him from a hospital to notify that he would not need an agency nurse today!(cause for admission was not given)---this unfortunate patient development will probably speed up the goal for admission of this patient to a nursing home--maybe new development is a "win/win" situation---a "win" for this patient to be more safe in a nursing home and a "win" for me to get the heck out of one messy patient assignment! Would appreciate any stories others may have about negative home health patient environment "challenges". Thanks again caliotter3 for your helpful message! Peace to you.

Hello! Wondering if any of you encounter home health situations where the patient's home environment is a progressive disaster situation with apparent need to move to a nursing home? I am currently working as a private duty home health nurse for an agency--patient is a quadriplegic from chest down and requires help with meds,pressure ulcer dressings, and all activities of daily living. The environment and care of my current patient has slowly deteriorated in the last couple of weeks to a very low quality due to a mix of decrease of nurse coverage associated with recent change of Tenncare Insurance rules(Medicaid--used to have 24 hour nurse coverage, now has only day shift nurse coverage) , a decrease in patient support by his friends, and unfortunate choices by patient to use social security disability payments for entertainment items instead of for basic care items(such as food, rent,utility bills) Evidence Of Disaster: facts: (1)inadequate heat--only working heat system for patient's duplex apartment is turning on oven and opening the oven door(because he is behind in his rent and landlord has refused to repair heat system--outside temp. here this morning was 29 degrees); (2)notice to move--- two days ago patient's landlord brought him a written notice that he must move as soon as possible because he has not paid his rent;(3)inadequate help--- friend patient arranged to help at night bailed out yesterday Potential Solution To Environment Disaster---I encouraged patient to call his case manager today to help with arrangements for him to move as soon possible to either a government subsidized apartment or a nursing home--patient made some calls today Question---in working as home health care nurses, do you find that it is common to encouner such sad patient environment situations? Is this just part of the "home health world"? (have worked as nurse for decades but am new to home health type work) Your input would be appreciated!

Hello all! I can relate to your comments about frustrations with problems in the home health environment of some patients. My current private duty home health patient is a quadraplegic and the heating system in his duplex apartment does not work. The only current heat source in his apartment is to turn on the oven and open the oven door. This patient states that his landlord will not repair the heat system because he is behind on his rent payment. (I have observed that this patient has made unwise choices to spend money from his social security disability checks on entertainment type items.) In response to this environment problem, I have tried to remain nonjudgemental and I have encouraged my patient to call his case manager to help him with resource information. This patient says he has talked with the case manager and he is calling phone numbers to apply for a move to a government subsidized, high rise type apartment. It seems that encountering patient environmental challenges sometimes is part of the "home health nursing world"! Good luck to all of us!

Hello again! In the situation where a home health patient is admitted to a hospital with sepsis, is your latest question what are "good patient management" priorities for a private duty nurse who stays in the hospital room with this patient? The prioritiy of care by private duty nurses in hospitals where I have worked was to focus on helping the patient with activities of daily living(such as bath,assistance to bathroom or with bedpan, grooming, assistance with meals). As you probably know, while patients are in a hospital the responsibilities for medications and treatments are usually handed over to the hospital staff nurses. Or is your latest question what are "good patient management" priorities in general for patients who have sepsis and thrombocytopenia? If that is your question, maybe a good resource for you would be a good quality professional nurse reference book which includes standard nursing care plans for patients with various medical conditions. Your honesty as a younger nurse in looking for nursing goals to help your patient is very refreshing! (Us "oldsters" have taken care of just about every medical condition under the sun for decades, so education and experience has taught us quick ways to zoom in on "good patient management"---good for you for asking questions as an advocate for your patients!) Peace to you.

Hello! Your question about "good patient management" seems to be about what are priorities of care as your patient continues to loose ground. Though I have worked as a nurse for 35 years, I have just started doing private duty home health and it seems that the definition of "good patient management" is somewhat different for each nursing specialty. In the case of home health nursing, to me one priority of "good patient management" of some of these patients with a poor diagnosis is to focus on avoiding as many new complications as possible(such as avoiding infection). Unfortunately, we know we cannot help with a cure for many of these patients---when the medically expected downturns develop, to me other "good patient management" priorities are comfort measures for patients and referrals to grief counseling resources for patient and family as needed. Good luck with your home health adventures!

Hello! I appreciated reading your comments about private duty home health situations in which there are dilemas about professional boundaries versus family requests. As a fellow private duty home health nurse, I have made some calls to my employer about clearing up doctor orders which were not consistent with what the patient's family was asking me to do. It is good that bsrn23 writes that the agency is supportive of the nurse. So far, my agency has been supportive of my patient advocate efforts,too. I believe that it is the ethical duty of us private duty nurses to speak up for "clinically wise" care for our patients. Good luck on your home health adventures!

Hello To All! Since I have just started a job in private duty home health nursing, it is oh so helpful to read your comments about the current trends in salary and health insurance for this type of work! My new employer, Maxim Healthcare Services, offers group health insurance after one calendar month of service to employees who agree to work 30 hours or more per week.(my fellow employees say that this Tennessee Maxim office just started the benefit of group health insurance a couple of months ago). I am thankful that this agency now offers ANY option for health insurance because the trend for many years has been that private duty nurses are on their own for health insurance coverage. (Several health insurance companies have turned me down this year on my request for individual health insurance due to my "pre-existing health conditions"---group health insurance requirements are generally much less picky about health conditions when an employee completes application papers for enrollment!) I agree with your comments that the nursing pay and the employee cost of health insurance are different than the options I have experienced in working other nursing jobs in hospitals,clinics, or the state health department. But I also agree with your comments that private duty home health work is generally much less difficult than other nursing work which involves responsibility for several patients each shift. To me, these differences in pay and health insurance for private duty home health work are a reasonable "trade off" to be able to do nursing work at a much slower pace. I am older now and have some health limitations so working in a fast paced nursing job is no longer a safe option for me. Best wishes to all!

hello again barathi7 : To answer your question about whether most employers in the U.S.A. select nurses by giving private tests, the answer is yes. Most employers require a registered nurse applicant to pass a private, mulitiple choice, written medications test. The health services agency where I am applying for a private duty R.N. job requires more private tests than I have been required to take with previous nursing job applications. The first three written tests were on medications,general med/surg nursing and home ventilator care and I had to prepare using my own nursing reference books. Now I have learned that next week I am required to take and pass three "open book" tests on OSHA infection control guidelines,HIPAA patient confidentiality guidelines,and general patient safety guidelines and that the agency provides the reference information for these tests.(but before the tests I am reviewing at home some info on these topics which I have found on the Internet). Since I have been out of nursing for five years, I don't know if all employers of nurses are requiring more than a medication test now? Best wishes in your efforts to get back into nursing. Peace to you.

Hello barathi7 ! Your written words of "...will pray to God and let him show the right path for us...." touched my heart because I am also seeking a path to return to nursing work! Yes! Amen to your prayer! I think you wrote that you did check with the board of nursing in your state to learn what the requirements are for working as a registered nurse in your state. Yes! The state board of nursing in one's current home state seems to be the key resource to learn steps to be eligible for registered nursing jobs in that state. Regarding review books, I agree with one of the other writers on this site that if you are required to take a refresher course there will probably be recommended nursing reference books within that course. If you are not required to take a nursing refresher course, I have found very good quality review books at the bookstore here called Books A Million for prep for the ususal required written tests for job applications for registered nurses(meds test and general nursing test)---best picks of review books for me were pharmacology review books and NCLEX review books with sample questions and answers with good rationale for best answers(zoom in on ONLY most common stuff such as med surg and zomm in on ONLY twenty or so key meds such as digoxin,lasix,insulins)---these review type books helped me oh so much to actually pass the written tests for the private duty R.N. job I am currently applying for! Good luck in your experience in India and best wishes on your efforts to meet requirements to return to R.N. work when you return to the States! Peace to you.

Hello 123sunnid, I agree with some of the comments of others including the suggestion for you to continue to renew your R.N. license in case you later choose to work again as a nurse. I also agree with the comment that one option for being more at home with your kids might be for you to reduce your nursing work hours. The suggestion for you to talk about your career ideas with a "disinterested third party" is also good so that you could further explore the pros and cons for you of changing careers. You wrote that you have "started taking classes toward something (you) have found to love, floral design". Some people do seem to have a need for career change. For example,one of my favorite cousins worked as a policeman and as a detective for many years, and then at age 50 he decided he wanted to be a nurse--he worked while going back to school and earned his Associate In Science Of Nursing in two years--he has truly enjoyed working as an R.N. for eleven years now. Good luck in your decision!

Hello focuszx5, Have you called the office of the Board of Nursing for the state of New York? The staff at that office should be able to advise you about how to pick back up in the process of being an R.N. from the UK who wants to obtain an R.N. license in the state of New York. I am sure you were a good nurse when you worked as an emergency nurse in the UK. Your experience working as an emergency room nurse probably means that you can keep a cool head when all heck breaks loose in a medical situation! Some medical facility or medical agency will probably be very glad to have you as a nursing employee after you have completed whatever the required steps are for you to obtain your New York R.N. license. Maybe you could work a non-nursing job while you are finishing any steps to obtain your R.N. license in the U.S.A.? Best wishes to you!

Hello To All, I once had a friend who was a long term diabetic, and I was shocked when he told me that he often gave himself insulin injections through his shirt! When I asked this friend why he did this, he explained that "the restrictions of being a diabetic had become so depressing that he just did things in haphazzard ways"--yes, maybe the reason diabetic patients do less than safe things such as apply injections through clothing and eat high sugar content foods may be because the lack of ability to do "normal stuff" makes them feel depressed?

Hi again all, Enjoying all your comments about differences in nursing "back then" ! Canoehead, especially appreciated your comments about the big difference of rare use of gloves in care back then--so agree with your comment that back then the school of thought was "using gloves to clean a patient would be detrimental to the patient's body image"!--when read your accurate comment of back then " not using gloves was care planned for fresh colostomies...bleah",got memories of such messy colostomy care experiences(which always made me seriously nauseated) and got a big laugh at your "bleah"--yep!! Best wishes to all.

Hello all, I graduated nursing school in 1970. One difference back then was about writing doctor's orders. When I made rounds with a surgeon I was expected to listen to him and quickly write most of the new,long post-op orders for each patient--and doctors considered nurses less competent if they asked the doctor to repeat or clarify these verbal orders. Another difference back then was fewer guidelines to do some medical procedures. One registered nurse on my floor was placed on probation for about two weeks from work because the doctor was running late and she removed a few sutures from a patient's incision so that he could be discharged home. At that time, the hospital guidelines included that only doctors were allowed to remove sutures. One other example of differences back then was less availabiltiy of patient monitoring equipment. For example, there were no electric IV pumps on some of my first jobs. We were required to make IV rounds each hour to check the site, count the drip rate to make sure it matched the order, and mark how much IV fluid was remaining in the IV bag(and notice if difference in volume in bag from previous hour was consistent with rate ordered by doctor). The risks for IV problems were higher because the only "sensor" you had between IV rounds was the patient who might have been too sick to notice any change. Yes! Many things in nursing were very different "back then" !