Alvindudley

Joining hpna can be a huge help.

We use allscripts and as it was not designed for hospice use, we are getting a huge revamping of it. I haven't seen my boss for weeks because she is locked in with the software developers redoing it. I would say that it is the reason why I spend so much time after hours documenting. I do chart at bedside, I always have a narrative note going and I do vitals and scales right into the database assessment. But then I have all these stupid circles to check and repetitive crap and it's maddening. Can't wait to see the new version but I'm not optimistic.

I am an rn case manager, home care only, no admissions. Last week was an aberration; I had 18 pts but lots of help from my colleagues. I wear business casual always, and I drive anywhere from 30-60 miles a day for my job with my caseload spread through a metro region. I see 4-5 pts a day. And I have at least 2 hours of charting after I come home. I have very critical and young patients mixed in with a bunch of "long termers"' dementia, debility, CHF.... My usual caseload is around 12. It was my first job as a new grad-2 years now. I love it. And I am going to take my certification exam in December.

I see 4 sometimes 5 pts a day, I work m-f and rarely take or have to do on call. I work about 12 hours or more a day when you add in documentation time and I drive 40-60 miles a day. And I love my job. I rarely do admissions, I do all home care, 2 facility patients right now and sometimes GIP in one hospital

I loved hp when we used them! We switched to one point and they just stink. I know hp was more expensive but honestly!

Actually hpna has an awesome flip book that helps with care plans and recerts. Message me privately if this is Greek to you. I struggle with care plans every day. We mainly use alt. in resp status, pain, alt in elimination, alt in skin, ineffective coping, dnr status, and hospice care plans. Hope this helps!

I saw a picture of all the new folks who participated in this program on facebook. Interestingly they were all young, pretty and white. Interesting, huh?

This is really well put. As a hospice nurse, if I do my job well and teach effectively, not only am I able to mitigate the pain and suffering at EOL but also empower my patients to make the best decisions for themselves. I have not yet encountered a suicidal patient but when I do, I hope I handle it with as much grace as you.

Here's what you need to remember about CHF and hospice. This comes from a colleague of mine who heard it a conference but it is wonderful. The goal is to have a metabolic death, not a congestive death. Death by dysrrythmia is far preferable to drowning in fluid from flash pulmonary edema. Lasix is a major player in comfort measures at EOL for our patients.

Don't bother with lpn. You won't get a job. Get an associates RN at a minimum

Stay away from family lives agency. They will hire new grads and the next thing you know, you will be working with a little sick kid on a vent. Not the. Way you want to start

oh--can so totally put my 2 cents in on this one!! a timex expedition diving watch--has ordinal (regular) numbers, a lumiglo backlight, a sweep hand, a dial around the outside you can twist and time things with--has big notches for 5 second increments AND is made to stand up to all the handwasking you can do--it was about $40 and then I bought a good metal bracelet style strap for it--also stands up to all the handwashing--had it fitted, it reduces infection-stands up to cleaning and I have it for 2 years--use it every day in my practice as a hospice nurse. timex ladies expedition--awesome!!

wow--that consideration of patient acuity is HUGE. I am a CM and I am on my way to having a full caseload of 10--now I have 7 and one patient in transition or a pain crisis can destroy your whole day! I feel like I shortchange my more stable patients--and sometines I get handed an absolute trainwreck of a patient and I don't have the time to get a handle on them and that's bad too. I like when I was a float and saw other people's cases. We have an LPN who does that--he's amazing--saved my butt the other day during a "poopstorm"....

the throughlifeand death link seems to be broken

just went to 0.51/mile plus tolls parking etc

working as a CNA during school totally helped me get work after I passed the NCLEX. I had a high GPA, Sigma Tau, etc. But I was able to work as a private duty nurse for the same agency that I did CNA work for. They usually don't hire new grads but they knew me. And this lead to me doing continuous care at end of life for patients on hospice which lead to me making connections that enabled me to be hired full time for a hospice which never hires new grads. I also did school nurse subbing--so I basically worked as a nurse from the get-go but now I have a full time job. Don't be afraid to do stuff like this--you learn a ton, you know more than you think but ALSO don't think you know more than you do! (I passed the NCLEX in August)

I don't feel that I had nearly enough time in clinical or skills lab. I did an ABSN program. I think this also puts me at a distinct disadvantage to those who did 4 year BSN degrees. You guys have lots more clinical time. I think the whole new grad issue is related to the state of hands on education (or lack thereof) in nursing school. And let me also put this out there. There is a real lack of nurses who are willing to precept students. why? Because they don't get paid enough!!!!! If we came out of nursing school ready to quickly handle simple tasks (I didn't), we'd be a better work force!!! So all of you experienced nurses posting about how tough it is to be a new grad, when your manager asks if you will accept a student to precept, WHAT ARE YOU GOING TO SAY??????

hey, it's me, canary in a coal mine--haven't heard from MGH yet. I just read this globe article and it is giving me PTSD as I did my immersion on Ellison 4. And I know ALL the nurses including the one who is the focus of this article when she was a new grad. She is still there and she is absolutely lovely. And she was very sweet to me during my immersion. Please note that I am not complaining about the $--not that money isn't important to me, but I have to decide that if taking this on is what I want to do. I should also mention that I am 52. And I have been offered a great job in hospice, which I really love and became even more compassionate about, based on my immersion in the ICU. So, for me, take the $$ away from the issue.... For me, it's more the potential physical issues and also, what happens if I don't succeed in the program? Where will I be? My new position is days primarily and some on call.

congrats on your new position. Your tips are great and just by doing this, I can see you are a team player. That will be a wonderful asset to you in your new position. I am a new grad nurse but NOT a new grad to the world of work by a long shot! I too just got my first nursing job, and it is my dream job (at least I hope it will be). good luck!!

So here’s the deal. I am fortunate enough to be the canary in the coalmine for this debate. In fact I logged on to allnurses to see if the topic had come up (YES! And then some ;-) and read what people are posting. Two things happened to me last week. I was offered a permanent full time position in an area of nursing I love that is not in a hospital and this company has accepted me as a new grad based on my qualifications and experience. They are making an exception for me as this position is posted as requiring 3 years of experience in this field. My initial hourly wage will be $28 plus benefits which is slightly less than I make now doing private duty. And way more than I make a school nurse sub. The other thing that happened to me last week is that I was granted the opportunity to interview for the new grad position at MGH which I did last Saturday. My interview went really well. I actually had a personal connection to the nurse manager I interviewed with and I believe that the there is a very strong possibility that I will be offered a residency slot. So I have a terrible choice to make—accept a wonderful job that will provide me with great support and training in a specialized area—I will learn many skills and procedures that are involved in acute care but I will not have hospital nursing experience. If I choose to leave this field, even as an experienced nurse, I will never be able to put “med/surg” or “critical care” on my resume. Or, do I bite the bullet and take the MGH position if offered, and gather all the skills and training and gamble with being offered a job in 6 months?(By the way, 5 eight hours shifts that rotate between nights and weekends does not qualify as a “horrible” schedule in my book). Assuming I successfully complete the program, I will have qualifications that will enable to work in any hospital setting, including the ED which has been a dream of mine. I really do have to gamble and choose—my orientation for the new position starts next Monday, and I know my contract letter will be in the mail today. Do I sign it and make the choice after I hear from MGH in the next 2 weeks? I won’t be that deep into my orientation, but I will be saying to an employer that I don’t intend to fulfill my commitment and why. The point is, I feel like I need to go forward with the new job but leave it IF I decide to go to MGH. I should add that I was offered a job recently by a home care agency that specialized in skilled nursing for critically ill children. When I was doing the paperwork, I came upon a contract that stated if I left voluntarily before 1 year of employment, I would be responsible for paying back the agency $5000 within 60 days of my voluntary termination. And I can tell you; this company advertises the fact that they will take new grads. Needless to say, I am NOT working for them. Beware of places that are eager to take you on as a new grad regardless of experience. Anyway, I am very torn, but based on the discussion on this board; I am leaning towards taking the “real” job. It is where my heart is telling me to go. But I’d like to hear from you….

knowledge deficit related to impaired airway clearance? Try focusing on teaching regarding cough and deep breathing, repositioning. I have a great exercise where you have a pt put their hands just below their xiphoid process with the tips of the middle fingers touching. When they take a deep breath that expands the lungs to the bases, the tips of the fingers move apart and on expiration, they move back together. This is also a really good technique for teaching s/p pain control. The very act of placing your hands on your abdomen that way is very comforting, it's almost like a self-hug. I use this ALL the time..... anyway-I find this technique even more effective for teaching deep breathing than using incentive spirometry. hope this helps!!!

what a nice post!! Congrats to you! I agree, Craigslist is great--I check it every day and I have to say that I just got an offer from a posting I initially saw there. Please send me info about a meet up--what a great idea!

I worked as a CNA (not certified) in my last semester of nursing school--I did an ABSN program. Smartest thing I ever did! The second I passed the NCLEX, I was transferred to their private duty nursing side, and I have worked at least 20 hours a week while job hunting. I just landed a case management hospice job because of this experience which is exactly what I wanted. I love home care and I learned it because of my cna experience. Good luck! Being a cna in home care shows you have the ability to be self directed and most importantly, trusted, and this will be great for your resume.

I get paid $55/visit for skilled and $32 and hour for private duty-goes to $34/hour on weekends. Another agency I work for is flat $33/hour. And they reimburse mileage at the hourly rate for travel beyond 1/2 hour from home.

this is great!! Nice job!! and I am a new grad in worcester....