rngolfer53

My experience is that, more often than not, the patient knows, or has a pretty darn good idea of what's going on. When it's not a cultural issue, I've often seen a daughter or son, who was mommy's or daddy's little prince or princess (and has not managed to become anyone else's prince or princess) who can't face what's manifestly happening. Witholding information does indeed cheat the dying person of the opportunity to close their life out as they wish. One case I had: A man came in directly from a hospital to the IPU where I worked. A couple family members were in complete denial, insisting on IV heart meds, fluids, etc, because the cardiologists were all wrong. We got him settled, cleaned up, and comfortable. When his family came in, the patient turned to me--he'd known me for about 20 minutes--and asked if he told me his last wishes, would I see they were carried out. I told him I would do everything I could to make sure they were. There was really nothing special about me. He just used me to get the message across to those family members who wouldn't face facts. That's desperation, eh? Even then, one of the deniers said "That's just his sense of humor." Fortunately, other family members prevailed, he got to belatedly tell his loved ones what he wanted, and died peacefully three days later.

Training and orientation are different things. Orientation is to familiarize the new employee with the particulars of the agency, not train them in intrinsic requirements of the job. If you were building a house, would you hire an electrician who wanted you to pay for his learning to install, say, 220 volt wiring? Or would you prefer to hire someone with those skills already? Or course, as you say, the employers' market won't last forever. But you'd best have sufficient savings to buy groceries while you're waiting for the turnaround.

If I read your post correctly, you're about one year out of school. With your limited hospital experience, that may be "new grad" in terms of experience if not exactly time. I wouldn't hesitate to apply for "new grad" jobs, making it plain the particular facts of your situation. This question comes out a bit harsh, which is not my intent, but what in your life has changed to make you think that this time around in the hospital will be different as far as the things that made it untenable for you a year ago? Most hospitals still use 12 hours shifts and weekends are normal. If I were in HR, that's the first thing I'd ask, and hopefully, you have a well-prepared answer ready.

An axiom of used car dealers is "there's a 'posterior' for every seat." The many roles and setting nurses work in approximates the fit of "seats" in seats. There is no such thing as a perfect job or perfect employer. All have their strong points and weaknesses. Much is in the eye of the beholder. Thank goodness people have different perceptions, desires and goals. Not surprisingly, those may change over a working lifetime as kids come along, go to school, etc. Trade offs in life are frequent. I've always thought it makes sense to follow your gut as far as what feels good about where you work. I work hospice and love it. I talk to nurses who are family to some of my patients and many tell me they couldn't possibly do what I do......and I know I couldn't possibly do what many of them do. Nursing gives one a better chance than many disciplines to follow interests and needs of the time of life one is in.

I recently had a confused gentleman whose normal home routine was watching a couple old TV programs and a game show. He knew the channel numbers on his cable at home....but ours was naturally different, and with fewer channels. Anyway my first morning with him, I managed to find his game show just as it was starting. He gave a big smile....then promptly fell asleep for the whole show. :) That's nursing for you. He was one of the patients I had a chance to get to know a bit, and I really enjoyed him.

The general media is little but a repeater of press releases and other sculpted messages put out by institutions such as schools. They typically rely on the same few "experts" for their analysis, and never seem to bother to check whether the expert knows what he/she is talking about. Still, there's a good number of corporate type folks who want to do something very different, and more rewarding. Not all get to nursing out of desperation.

I work 12 hour days in a hospice IPU. I will, with a late call-out or some other emergency stay an extra six hours but only if I don't work the next day. I live close to work, so I run home to feed the dog and let him out at shift change (I don't have to give report to myself) so it works out OK. But I do sleep late that next morning. If I lived in the place mentioned in another thread that calls 911 for any resident who didn't get up for breakfast, I'd be in the ER after every 18 hour shift.....and quite a few 12s too. Of course the staff of that place would be with me in the ER....with wounds from me kicking and biting them as they tried to get me out of bed.

As a hospice nurse, I always think that un/undercontrolled pain is a cardinal sin.

I work inpatient hospice, and I get a good % of people who will respond with "uncomfortable" when I ask about pain, and I ask directly. Without getting into a lexicography debate, I try to dig to get at what they're communicating. I alway ask if I can bring these people something for pain. If I have a range of dosing, usual where I work, I'll tell them I'll give them the lowest dose if they are reluctant. If they don't want any meds, I obviously don't give them, but I do provide education on not letting pain get out of control and I follow up with them often.

I agree with this. What is the downside of asking a post-op Pt if they're having pain? If they say "yes" and there are orders for meds, then you give the meds. In some small number of people, I may end up feeding their addiction. (OK, so be it. That is their responsibility. I have no powers that allow me to unerringly determine who's lying.) That's the better outcome than having a patient in pain that could and should be controlled. The number of people helped swamps the number of people harmed.

Was this person A&O? Competent? If so, what ever happened to autonomy? I'm getting to be old and perhaps crotchety (depending on who you talk to ), but if someone tried to send me to a hospital because sleep seemed like a better idea than breakfast....well, there might be another 911 call soon.

Job descriptions should never be confused with the actual job assignment, in nursing or anywhere else for that matter. I'm pretty convinced that job descriptions are written as broadly as possible so HR folks don't have to trouble themselves with writing accurate ones for the many different kinds of positions, or having to update them more than once every century or so.

Why add complexity to a word when the addition provides no benefit? "Orientated" and similar constructs are often used by bureaucrats trying to sound important. A pox on all their houses.

The only thing I'd add is that you really found how much you miss LTC when you weren't around it.

Several months ago, I took care of a wonderful, and feisty LOL who needed to poop. Really needed to poop. She had tried Senna, PEG, the usual suspects with no joy. Finally the doc talked her into a Dulcolax suppository, which the patient viewed with a good dose of skepticism. Anyway, I gave her the supp, and pretty soon she has a BM...then a second, and a third. The poor doc came to see her just as I was getting her back to bed after the fourth session on the BSC. The patient initially ignored the doc and said to me "Is she the one who gave you that stupid order?" Then she looked daggers at the Dr. I had to get out of the room asap before I stroked out from trying to hold the laughter in. The Dr was on her own. The patient's daughter was trying to hold in the guffaw's too. I can't hear the song Angry Eyes without thinking of this patient, and I still tease that Dr about it. There are funny and sad situations that arise every day in life, and nursing gets its fair share of both. The normal human reaction is to laugh or cry. Last I looked, nurses are human, and need the release provided by both laughs and tears. Pick a safe time and place, don't tear down people and don't be stingy about laughing at yourself too.