jansgalRN

Hey, I have great news for you. I'm 28 years old and have been a hospice nurse for over 3 years . I recently became certified in Hospice and Palliative care. I love my job! Go for it. It is the most rewarding job in the world (for me anyway). I get so much from my patients, sometimes I feel like they help me far more than I help them. If you need any advice or information, feel free to email me. I work with some incredible people. Hospice is not the kind of place that people (nurses) get thrown into or stuck in. All of the nurses know what they are getting into and do it for that reason exactly. I've worked in so many areas of nursing (I floated in a 250 bed facility for 3 years) where people are so miserable. Follow your heart. It may be a calling from a higher power. Let me know if I can help.

My mother's advice to me: Marry for money and you will earn every cent. In many cases a good doctor must be married to his profession. Many nurses are attracted to these qualities. I think it has a lot to do with co-dependency and wanting to be "taken care of". Of course, I know many doctors who are married to nurses and seem to be just as normal/abnormal as my husband and I. The divorce rate in our country is high, but there is no link to doctors/nurses or any other professions. We all need to work on this individually.

I am a hospice nurse. I can totally relate to you dilemma. One of the hardest lessons to learn in home care is setting boundries. I think there are many reasons for this. First of all, as nurses, we all tend to have varying degrees of codependency. Not meant as a judgement (hello, I am a hospice nurse). We go into the field for many reasons, but we are caring and compassionate people in general. Being assertive is difficult for me. I really have to work on this daily. Secondly, we are welcomed into other people's homes. We are in their comfort zone-not our own. I found this quite challenging when I first left the hospital for home care. I think the most important aspect of setting boundries is something that cannot really be taught or learned. It is a sense for being able to determine the various personalities, communication skills, coping skills and emotional stability of the patients and caregivers that we encounter. Our responses and reactions must, in a way be calculated. I am often at risk of being sucked in to situations and manipulated by patients and family members who are grieving. For me, it is important to be aware of the fact that family dynamics become very raw and sometimes vicious during a crisis. This helps to keep me grounded and, most importantly, objective. I am often times a mediator for family members. The patient just wants everyone else to be okay, and everyone else is in so much pain that they can't recognize their own reactions and responses as being damaging. Learning to set boundries is important for us all. We are at risk for being taken advantage of. Knowing the difference between sincere, helpful, compassionate care and manipulation is extremely difficult, and not as obvious as it seems. One of the ways that I approach this with patients is by educating the caregivers and being very direct. Most people respond very well to this. I assign tasks and reward often. I always carry stickers with me and give them out to patients and caregivers. This boosts their confidence on both sides. I don't expect my patients/caregivers to always know exactly what to do. Generally, they are so afraid to hurt or kill the patient (not to mention being overwhelmed with emotions that no one has a clue how to deal with) that they get so nervous and forget to follow their instincts. Open, honest communication is one of key components when establishing a healthy relationship with your patients, actually, this is a good practice for life in general.

I know what you are feeling. Take it from someone who's been there. I'm sure many of us can remember those jobs, but it doesn't mean that you should get out of nursing. Just keep searching until you find the job that is enjoyable, even on a bad day. I've been with hospice for over 2 years and I can say, without a doubt, that even my worst day is much better than an average day at my previous place of employment. I do have one suggestion for you. I'm not sure how much acute care experience you need, but I worked as a FT in house float RN at a 250 bed facility. I loved it! Somewhere different everyday. The nurses were always glad to have me because they would've been a nurse short if I weren't there (big perk). I did not get involved in the "politics" on the units (not enough time spent there to even know what was going on, politically). I had much better pay. My schedule was much more flexible. I was only required to work one weekend a month and 2 holidays a year. My knowledge base was increased significantly. The hospital payed for any education that may have been required to work on a specific unit (ACLS-for ICU, basic EKG course for tele). Also, being the extra had its perks. If I was scheduled and they didn't have an immediate spot, but felt that the need would arise soon, they would call me to go in and just keep me busy (so I wouldn't talk so much, I guess) by sending me to pharmacy to help out. Or, one time the lady in the cafeteria who ran the register callled in sick, they called me at home on my day off to see if I would come in- of course I couldn't miss out on that. I had a blast. Being a floater, I knew many people from the units. Everyone laughed with me. It was great-the hairnet and all. Bye the way, I was payed my reg. RN pay. It's amazing what these guys will do when they are desperate.

Okay, before you judge me, let me tell you the circumstances in which I must ask this question. I was picking up a few things at the grocery store before joining my husband and his buddies who were at home watching a football game. I was at the checkout counter and gave into the temptation of purchasing one of those trash tabloids. (Rationale: my husband and his buddies are watching a football game and I had just finished a book, so, I needed something to read-good enough for me, anyway). Flipping through the pages, I read an article about a link between increased libido (I call this a high nature--my husband laughs) and indoor female cat owners. Has anyone else heard of this. It's in The Sun Oct. 21,2003 issue. I know not to believe what you read in the tabloids, but I was intrigued by this article. I happen to own an indoor cat. Could this be my problem?

If you aren't comfortable with something, speak up. Only you can determine this. Having been a nurse for over 6 years (floated all over for 3), I can honestly say that things didn't start to come together for at least 6 months. After about a year or so I remember thinking, "Oh, so that's why I learned this". It just kind of clicks at some point. Remember this: None of us were exposed to everything or much at all during clinicals. Confidence will help earn the respect of seasoned nurses who can teach you more than you can learn in a book. Think about it this way, usually lessons do not come easily, take advantage of someone else's. Also, people who aren't afraid to admit that they need help or don't know something use confidence just in asking! Best of luck to you and all new grads and future nurses! We all need you and are glad to have you on board!

Not in charting, but I've answered calls and was told by a family member "we gave the depository but he still didn't produce" [stool]. Also, family members pick up on things that nurses may miss (esp. in home care). A pt's wife called me once claiming his urine had a loud odor. I had never heard that one before. I was once told that she knew her husband's sugar was high because he tasted sweet. I didn't even go there. Often times, in termial care patients report visions of previously deceased loved ones. This is a common phenomenon, and is usually discussed with family members as a way of preparing them, sometimes giving an idea of imminent death. I was called to visit a patient once by a frantic family member. Unable to get enough valuable info on the phone, I finally went over. The patient's 23 year old grandson was scared to death, sitting out side on the front porch, refusing to accomany me inside because of ghosts, also he was demanding that we get the patient out(who was bedbound and incoherent). Poor thing. I ended up staying for 2 hours until his mom came home from work (he stayed outside the whole time-talking to me through a window.

I remember those days! In my first clinical semester my instructor was an old army nurse and I was scared to death of her. I failed bedmaking. I was so humiliated! I learned quickly that appearing confident helped me maintain my composure and I could actually think my way through situations and use good judgement.

Final Gifts is a great book for HCPs and families. Personal experiences composed by nurses. I've read it several times and I loan it to family members to help them understand the dying process. Dying well is also great!

I am studying for my hospice certification and I remember reading that Fentanyl is better absorbed over areas of muscle or adipose tissue. I am not sure that it matters where on the body, as long as the tissue is not scarred or broken, adequate circulation/perfusion is present,and body temp is normal. I have recently had very thin/cachectic patients who do not absorb transdermal meds and experienced little or no relief as a result. Also, I have found (along with my colleges) that sometimes the effects of Fentanyl do not last the 72 hr period. We frequently have to change the patch anywhere from 48-60hrs. I presume this has much to do with poor absorption, inconsistant release from the tissue, and metabolic factors that can interfere with potency and cause ineffective results. I find that the patch is an expensive, often ineffective method of pain control and the side effects can be serious. I must tell you that in certain instances when the patient is unable to swallow, drug abuse is suspected (happened when a patient's family member was taking her oxycontin and selling it), and the convenience of not having to take frequent doses or follow time schedules, fentanyl is very helpful. Our docs generally convert to something more predictable in its absorption unless the above issues are a factor. Feel free to correct me if I have inaccurate info-I need to know this stuff. jansgalRN

Our hospice offers a flat rate for call and a per visit rate. Our average census is about 90-110 patients. The inpatients are visited by an RN one day and a Dr. the other. The call time is from Fri at 4:30pm to Mon at 8:30 am. We also have a FT night position (salary), who takes calls from 4:30pm to 8:00am Mon-Thurs. The nurses that do weekend call are prn, mostly employed elsewhere FT. Sometimes they split the weekend call to lighten the load. The FT day nurses take one week of backup call and are utilized if needed. We have a roster for primary call in situations that arise if we (the FT day nurses) have to take call. I feel that this is a very fair and helpful in preventing burnout. The nurses who take weekend call have become familiar with each other and buddy-up to make extra money. The FT nurses rarely have to take call. If, for instance, our night nurse is on vacation or gets sick, we take turns with night call. We have prn nurses available to fill in for us the next day. Most of the FT nurses that I work with started out doing weekend call for hospice. I was a FT oncology nurse when I started weekend call. I was able to adjust my schedule to take a 4 day weekend once a month and do a weekend on call for hospice. My boss feels as though this is the most effective way to retain staff, both FT and prn. The nurses are happy and more effective resulting in better patient care. This is the only hospice that I've ever worked for, so I'm not sure if its any different or better anywhere else. Also, it probably makes a difference that I work for a non-profit, locally owned, locally run hospice. Hope this helps. JansgalRN