Compassion75

Go into home health, or pediatric private duty, psych, hospice, or try clinic nursing or go back to long term care. There are soo many options in nursing and you already have a nursing background as an lpn. No need to be miserable! I've been in nursing 27 years and 24 of those have been in some form of homecare/community health nursing. The hospital was not my thing and I was definitely miserable. I finally found my niche in homecare.!

Try pediatric private duty homecare. It's low stress one on one care with medically fragile infants children and young adults. There are high tech cases like trach/vent/tpn and lower tech cases that pt just needs tube feedings, meds and monitoring. I've been doing it 8 years and it's extremely flexible and rewarding and most agencies train you. And there is opportunities for advancement to clinical nurse supervisor/case manager after a couple of years experience.

Try pediatric private duty nursing. It really worked well for me when I had to care for for my sister who had a very aggressive form of breast cancer as well as also help her care for her special needs son. It's very flexible. They have 8,10, and 12 hour shifts with the 8 hours being mostly your feeding tube patients and 12 hours are those that have a tracheostomy and are ventilator dependent. It's one one one patient care and alot lower stress than your nursing homes and hospitals and you can pick your schedule. A good agency will train you and put you through classes for trach and vent and allow you to shadow with nurses and get checked off in the field until you feel comfortable. Or you can just start off with your basic feeding tube patients. We treat all ages from infants to children who have aged into adults. It really helped me keep my sanity while caring for my sister and her son. She passed away this January, and now I am caring for her special needs son. The trach and vent cases pay more up to mid thirties per hour depending on location and experience and the type of Medicaid insurance your patient has and how Medicaid is funded in your state. The feeding tube cases tend to pay lower into the mid to high twenties, lower thirty per hour depending on the above mentioned factors. Try to get a low stress case to start out with because it sounds like you have a lot going on with your dad. Later as you get more comfortable upgrade to the higher paying, more complex cases. Home health visits are also a great way to pick up visits and extra money, but the OASIS assessments for admissions, recertifications and and post hospital visits can be quite daunting for RN not accustomed so pick up simple task oriented LVN type visits such as wound care, IV's or simple disease process teaching and assessment. I hope this helps!

I would continue to keep good records and witnesses. Also invest in malpractice insurance should you ever have to go before the board and need to hire a lawyer. Its relatively cheap and a must in this day and age. Mostly I would be looking for another job , because the management is not supportive in adequately addressing issues and its just not worth the extra stress. Nursing is stressful enough.

I believe an MSN is a great benefit eisp if you want to go into case managment. Currently I am working as a home health case manager and have also worked in hospice. I have been stromgly considering going back to school for my MSN esp with all of this health care reform and care coordination focus. As a case manager you have the choice of direct or indirect patient contact and can still be in a quasi bedside/administrative role making a huge benefit to pts. It definetly has its perks of more autonomy, better scheduling, ect. I see alot of older nurses and nurses with disabilities or chronic health problems such as myself find fulfilling careers in nursing case managmenet. And many of them enhance their credibility, opportunities for promotion, and salary with and MSN and experience, not to mention making extra money on the side teaching. I have been forced to be creative in creating a career trajectory due to health issues and really considering how to make an MSN work for me...

HPNA the Hospice Palliative Nurses Association has a study guide for the CHPN as well as the core curriculum.The study guide contains test questions and explanations and the core curriculum outlines and explains basic hospice concepts. These two are all u really need to pass. They can be purchased from the HPNA website! Good luck! I became CHPN certified in 2009 and these are the two guides that I used. I believe HPNA also has online courses now as well.

Dear Fellow nurse, If u find home health works for you I would stay in that. I am also a current home health nurse and have been doing home health and hospice for the last 13 years. I for other health reasons such as chronic fatigue syndrome and fibromyalgia, diabetes, as well as recently diagnosed hypothyroidism and another pituitary disorder that also calls for lifelong injections of human growth hormone, cannot tolerate a hospital environment either. home health has its stresses but its worse day wil never be as bad as the hospital. Real nursing is not just in hospitals there is a whole world open in community health and ambulatory care settings. Plus you learn alot of administrative skills such as case management which can parlay into careers with insurance companies and other settings. When I get discouraged because of all the paper work and bleary-eyed nights documenting, I remember that I basically get to work from home, make my own schedule, work basically 8-5 m-f, enjoy music and my favorite sermon tapes while I am driving in a peacefully quiet new car, enjoy beautiful scenery and sunshine, and get to work with one patient at a time. To me u get to practice true nursing in case management and community health because the nurse basically creates and directs the wole plan of care and the physicians truly respect and collaborate with u because u are their eyes and ears in the home. I recently had a little setback in which I had to have medication adjustments and had been out of my human growth hormone due to lack of insurance. So I had to battle with chronic exhaustion and fatigue and poor concentration and got behind in paperwork cause I couldn't focus and slept alot. But now with a few medication changes I am feeling better and catching up. I also rely on extended release Ritalin and caffeine pills to help keep me awake, but my doctor is switching me over to Nuvigil because it will decrease chance of heart palpitations. I am saying all of this to say God put u there for a reason so resist the urge to job hop and stay and get good at what u are doing. And trust me u are not losing skills as the patients are now th ICU patients I had 10 years ago. I have managed Primacor and Dobutamine drips, PT/INR fingerstick checks, telehealth patients, pts with external defribillator life vests awaiting AICD/Pacemaker implantation, IV's, central and picc lines, complex wound care/wound vac, plus various med surg diseases such as copd, chf, diabetes, parkinsons, cancer and a whole host of other condtons. So on the contrary your med surg skils and assessment skills will become very strong as u are forced to become very astute and creative in problem solving in the home setting as u work as part of a multidiscliplinary team, but u also work alot alone and autonomously. So take heart! I believe that if u enjoy your current job you are in the right place! Plus a strong resume and longevity shows, stability, dependability, and expertise and will open up a whole lot of doors later on. Start looking into all the careers u can go into into case mangement, disease management, health and diabetes education. I hope this helps!

Wow!! This sounds like a terrible hospital. Unfortunately, its not nursing itself, it is the horrible working environments and conditions that exist in nursing, particularly in acute care nursing that make it like this. Poor working conditions have existed since the days before Florence Nightingale in the hospital setting, particularly because the hospital is not run and controlled by nurses. This will likely continue to be the case until nurses regain control of the acute care setting. However, if one reads Florence Nightingale's work her ideal for the profession of nursing was that ultimately nursing would return to caring for patients in the home and community setting which is where nursing is currently headed. It is here I believe that Nightingale saw that nurses would have the most power and widespread opportunities to effect more change through health promotion, teaching patients how to manage and maintain chronic illness at home, health policy formation, case management and advanced practice nursing. Do not despair acute care nurses, there are a plethora of opportunities outside of the acute care setting to affect change and find your niche and have a healthy work-life balance and still make a decent living. I also find that Magnet run hospitals tend to really practice and adhere to the shared-governance model and nurses have alot of say in what goes on in these hospitals. If at all possible I would try and get on in one of these. I have had good experiences with Magnet hospitals and they are a stark contrast to acute care settings where nurses have no voice. I believe that this is the model Nightingale would be proud of. Its not perfect, but it is an excellent start. Rule of thumb, don't despair in finding your niche in nursing, hospital nursing is only one aspect of nursing and does not define the nursing profession, do not work somewhere which would violate your conscience and would not put your own parents or kids in, let alone your dog. It may mean sacrifice such as a long commute, undesirable working hours, or even a change in specialty or practice or furthering and advancing your education,or possible relocation. But you will have more peace of mind, feel good about what you are doing and have a more positive outlook and prevent burnout. No nurse should feel powerless or helpless continually. :redbeathe

I also tend to agree with the posters above to a certain point. 14 years ago I started out as a new grad in a cardio vascular recovery unit which was very stressful and did not have a good preceptorship experience but made it. However when I decided to transfer to a stepdown unit I think I left the hiring manager with the impression that I thought step-down was a step-down which is not a good thing. This is where most new grads make their mistake. And actually my ICU instructor in my last semester of my ADN program had suggested a slower paced environment. Her exact words were that I was very deliberate, methodical, in my nursing but a little slow. I believe I took a little offense to this statement, but she foresaw what I later know now to be true. I eventually ended up leaving the hospital unfortunately due to continued lack of support and not able to transfer. At the time I continued working at a long-term-care/subacute unit as a charge RN. It was here I honed my skills in medication management, wound care, trach management and suctioning, IV therapy and central line care, dealing with a variety of diseases such as chf, diabetes, AIDS, cancer, COPD. U name it. Also taking doctors orders, proper documentation, documentation according to Medicare guidelines for skilled nursing, skin assessments, how to pronounce patients, and valuable skills in tube/peg feeding management, placing ng tubes, foleys, time management, priortization and triaging, and supervision of cna's and lpn's. It was here that I also got my first initial experiences in the ltc setting with hospice which is where I have been for the last 12 years of my 14 year nursing career .The experienced lpns i must say took me under their wing as well as the RN's and mentored me. I can proudly say when I returned to the medical-surgical ICU setting I was alot more well-prepared and orientation was alot less stressful. I also had an excellent and very supportive nurse staff developer, manager, and preceptors which are also key ingredients in my success. The break away to a less-stressful and more supportive work environment really helped me to mature as a nurse. Also working nights was helpful because the nurses are a little more laid-back, work together closely and more supportive because of less staff and distractions at night, and the slower, slightly more quieter pace allows new grads the chance to pace themselves more. Plus pay was a heck of alot better at nite which really helped me alot financially. Just remember to take all criticism and correction constructively and wisely. It will make you a better nurse in the long run. Nurses unfortunately continue to eat their young, but you must also pay your dues. No nursing experience is ever wasted no matter what the setting. A stable job history is a must esp. in these economic times. Try to transfer to nites if u can in your ICU setting to see if that will help. If that is not is not possible then go to the telemetry/step-down unit. But stay and pay back the hospital if at all possible. It will benefit u in the future, you will be a stronger nurse, financially stable, and gain valuable experience. In my day it cost approximately $30,000 to train a new nurse in six months and that was 14 years ago. Also with budget cuts and because u only did six months, technically u are still considered a new grad, and new facility will consider u a high risk investment, and u may not be able to procure another job in a timely fashion putting u in dire financial straits. And do not start the bad habit of job-hopping early in your career because it will catch up with u and delay your development as a nurse. Trust me I learned the hard way. If u must change facilities try to find a step-down/long-term acute/subacute care like I did with a variety of patients and disease proceses. But by all means commit to staying at least a year in all jobs as a rule of thumb unless u are jeapordizing your license by staying. U will eventually be able to get the jobs u want in the long run because of the experience behind u. I had already been working as a cna/student nurse at both facilities before I became an RN and also kept the ltc/subacute prn after I graduated which was why I was able to later switch because I had an established work history. Sorry this was lengthy, but I would that all new nurses could learn from and be spared my mistakes. Always remember no area of nursing is easy and will come with stressors of its own, but the key to longevity in nursing is finding your niche and remaining in it and also please continue your education to a BSN at the minimum, preferrably MSN. All new grads this is a must and I would finish it ASAP. Just in case you get burnt out in the hospital setting or get an illness or injury that doesnt allow for bedside nursing, there are so many doors open in nursing outside of the hospital setting with advanced education. The future of nursing is rapidly moving into the homes and communities opening doors into home health/hospice, case management, managed care nursing, telehealth, pt and nursing education in all types of settings, and advanced practice nursing.:redpinkhe:nurse:

P.S. also document, document document. Names, dates, times, and details of incidents like this. You have to pray, fight for what you want, and let others no that unfair discrimination due to your disability will not be tolerated and may violate the ADA act. The only complaint that you told me about was that you were slow, but that is not enough to fail someone as long as you can safely carryout your duties safely, even with modifications and accomodations to your environment.

Don't get discouraged SuperNurse!! I had a similiar experience in nursing school. Some preceptors are unfairly biased. And I believe that making comments like that borders on discrimination and is unprofessional. I believe that you should talk to the dean of your program and also get a disability counselor at your school involved. Most colleges and universities have one onsite. I would also definetly get a new preceptor. Keep your head up! and see maybe if you can repeat clinicals and ask for any special accommodations you might need. By law they have to provide this and know your rights under the Americans with Disabilities Act. That's where your counselor can help. Keep me posted, and I will be praying for you. :redpinkhe

Dear SuperNurse, Thanks! I know what it is like when you are chronically fatigued. It is an indescribable type of suffering! Esp. when it significantly impacts your quality of life, your ability to make a living, and your independence. I know what it is like when your friends and family just don't know how to help anymore or try to "pep" you up or "snap" you out of it. I have learned alot over the years through trial and error, researching reputable internet sights, and reading good books on diet and nutrition by licensed doctors, registered dieticians, and even naturopaths. Don't worry about the naysayers. When its time for you to graduate God will find the right job for you!! Just remember to pace yourself, don't compare yourself to others, and that you know your body and your limits and do not ignore when your body is saying slow down!! I have crashed and burned the hard way by doing that! I just wish that I was as far along as you! You inspire me! I would like to eventually do counseling or helping others esp with disabilities, and maybe even do independent case management or private counseling practice. I am debating between psych NP/CNS or MSW. There are alot of people who need help out there!!:redpinkhe

P.S. Dear SuperNurse, See if your doctor will give you free samples of your anti-fatigue medicine, that's what my doctor did. If you are talking about Provigil, yes its very expensive. Also, if you get financial aid take out a small loan to cover the monthly costs of that particular med or see if the doctor can switch you to a cheaper med. Also appeal your decision to your insurance company. Esp. explain situation in writing. Many insurance companies will reverse decisions with appeal. Esp. if you have a nurse case manager managing your chronic disease, many are patient advocates and will fight to get you what you need. Also make sure there are no other underlying diseases complicating what you have. I just got diagnosed with diabetes type 2 and since I have been on medication my constant fatigue and brain fog, loss of appetite, general unfeeling well has improved alot!! My doctor was wise enough to do a glucose tolerance test after many years of doctors telling me I was boderline! I also recently found out I have a food allergy to shellfish which causes severe GI distress and bloating, as well as another gross adverse effect which will remain nameless here, as well diverticulosis which is aggravated by this. Also drink plenty of fluids and make sure you do not have chronic constipation which can be a problem for MS sufferers. Dehydration and an unclean bowel can be a significant cause or add to fatigue and a general feeling of unwellness, not to mention UTI's which can also be a chronic problem for people with MS. Just a few things to think about!

Dear Super Nurse, You have come so far!! Believe me I know what its like to be chronically ill and nurse. But never give up!! With an NP you have more flexibility so set your own hours, work in different areas such as case management, clinics, telephone triage, write, research, the opportunities are numerous!! Esp. with a debilitating disease you will have far increased your earning potential and opened a variety of doors to jobs that may be less physically taxing, but will still allow you to make numerous and meaningful contributions to nursing. I am sitting here contemplating the very same thing whether to go back to school or not for an MSN. I loved nursing and due to chronic illness have at times felt like nursing kind of throws you away when you can no longer work the bedside. But I do what my aunt always tells me and that is to pray and take it one day at a time!!!!:redbeathe She always says that God only gives us strength for today and that the Bible says not to borrow tommorrows trouble, that each day has sufficent trouble/challenges for that day. And God promises not to put more on us than we can bear and to provide for our daily needs!! When I was in my associate degree of nursing program I too had an instructor and a dean tell me and my father that I wouldn't graduate, approx six months before graduation. But God gave me the strength and I went on to graduate and to become the first licensed RN out of my class. I had wanted to do a dual MSN/MBA program and struggled in which way to go in nursing. I know that I love community and public health nursing, patient education and case management. I also love geriatrics and medically fragile population. I believe at this time I am going to keep it simple and folllow my own advice and just pursue a generalized MSN for now for you can always add on certifications and post-graduate certificates to specialize later. Currently I work per diem as a hospice float nurse/relief case manager. Remember God will not bring you this far to fail, and Proverbs says that in all work there is profit but mere talk only leads to poverty. May God continue to bless you and keep you!!