henrysmom

I work inpatient at the VA. 95% of our patients are male, most elderly. Many of them prefer male CNAs, however there aren't too many of them so the modest patients must be cared for by females anyway. Check out the VA.

If money really matters, I would recommend becoming a Psych NP over a psychologist. My husband is a clinical psychologist and makes $72K a year in California at a salaried supervisory position. He also has a small private practice, but the reimbursement is so low it's hardly worth keeping his private practice open, especially during slow times like holidays. I am a MSN (FNP but not working as an NP at this time). I make $95K and will get about 10K more when I get re-certified and stay with the same employer. He loves his work, but we know lots of psychologists who make less than he does and there are fewer and fewer jobs as psychology moves towards medication and away from therapy. JMO, Kim

I am in a similar situation and I tell you what I am doing. I finished my MSN FNP in 1997 and worked for a year as an NP. Hated the clinic I worked in, went back to the bedside (SICU) for several years and then worked several years in a hospice/palliative care position (actually a great place to learn some primary care stuff over again). Now I am working as a case manager, but am looking to replace an NP who is retiring in a year or two. I was board certified by ANCC, but let it lapse a long time ago. First off, I feel comfortable about pharmacology, took a 40 hour refresher course about two years ago and actually taught pharm at one time. The one area I feel real weak in is advanced assessment. Don't do many head to toe exams in hospice.. So I am re-taking the advanced phys assessment at a local college this fall. Have bought the CDs of the Fitzgerald review course and plan on listening to them and using it to guide me into re-studying stuff I feel weak in. Did buy a few textbooks again, the Uphold one, the Fitzpatrick derm book, Jarvis, and have a few others. In order to take my cert test again, I have to take 150 hours of CEUs, the phs assessment will count as some of that, but I plan on taking real focused CEUs in areas I feel I am not up to date in. Will re-assess at that point and hope to take cert test maybe next summer. I also work with several NPs who have offered to let me sort of tag along with them to refresh knowlege. All in all, I feel pretty confident that I haven't lost most of what I was taught, but certainly there are areas I need to re-address, like diabetes and OB, lots of them actually and hope to crack the books this fall and re-learn! Kim

Hi! I graduated with my MSN/FNP in '97, but only worked as an NP for about 8 mos, then quit to go back to SICU nursing, which was my passion at that time. Took some time off when my kids came along, and then started working as a palliative care/hospice nurse practitioner about 4 years ago. My NP background was invaluable in the palliative setting, but I was working as a case manager and did not stay real current in a lot of areas that I didn't need to. Well, I just took a job with a different organization as a case manager, but have been asked if I would like to take the place of the current Palliative/Primary Care NP when she retired in about a year. I have already signed up to do the Palliative care cert. program at UAB just to bolster my knowlege, but need help with some of the other stuff. Namely..can you all recommend books that I might find useful? I used to love the Current book for quick reference, but could use any ideas at all..what's a good pharmacy reference? (been using whatever's on the shelf at my previous job), as well as quick reference books you all find useful. At one time I was ANCC certified, but let that lapse..will look into some of the reviews mentioned in other posts, but could use any info/advice you all have! Thanks, Kim

I had worked a long time in SICU and loved it for most of that time. Then..I slowly started feeling that a lot of what we did was futile (I worked at the VA and most of the patients were quite elderly and might have been better served by hospice care.). Many times I would enter the unit at night to go to work and think "okay, who am I going to torture tonight before they die?" I just think that the way we treat most of our elderly at the end of their lives is horrible. Anyways, I was becoming more and more disenchanted with critical care and a good friend of mine started working in hospice. She called me and said "you need to do this, Kim, you are really a hospice nurse at heart). I was vaguely intrigued, as I always felt it was a particular honor to be with patients when they died. But it took me a few more years to get my hospice feet wet. A family member of mine died while on hospice and I was so impressed by the nurse who cared for her and the whole philospohy that I decided to give it a try. I love it! Every now and then I need to take a little break due to the emotional toll (I live in my service area and constantly drive by the houses of patients I've cared for), but always go back and imagine I will end my career in hospice..to me, I feel called to a life of service and hospice nursing is really all about love and service...

I've done both SICU and hospice nursing, and have seen many, many memorable, special deaths. But one haunts me to this day.. I was charge nurse in a busy SICU. Got a call that we were getting a woman patient from OR, late 50's with metastatic ovarian cancer who had a horrible necrotic bowel. She was a DNR and surgeon came in and told me that the goal was to just "keep her alive" until her daughter and husband got there from a retreat that they had been at and that they were expected by morning. She had battled cancer for a long time, and had actually had terrible pain for days, but wanted her family to go to the retreat so never told them. The surgeon had opened her up and found a totally dead bowel and she was horribly septic. She was surprisingly, extubated and arousable. He ordered a morphine drip and basically told me to do whatever I needed to do to keep her going and that he would cover my actions with orders in the morning. I know, please no lectures about my license, etc. I found out from someone that she was actually a relative of his by marriage. He then went over, pulled the drape and talked with her, told her that there was nothing they could do, etc, but that we would keep her comfortable. AFter he left, I went and talked with her for a few minutes, did my assessment, gave meds, etc. I noticed she was not scared, in fact she was quite calm and peaceful and alert despite just having had surgery. A little while later she told me "I know what's happening, and I know you're not God..but could you do whatever you can to keep me going just until morning so I can see my husband and daughter one more time. But, if I die before then, just know I am with the Lord and tell them I love them". As the evening progressed, she worsened. Her B/P dropped, and she started looking worse. I started working nonstop, filled a saline bag with dopamine and started it (she was a DNR and in that hospital we couldn't have started Dopamin in the unit on a DNR) with no label, gave liter after liter of fluid, blood, etc. Gently titrated her morphine. It was this beautiful dance between us..dark and quiet in the unit, me working my a## off without a break trying to let her rest while she would occasionally wake up and talk with me, forcing me to slow down and just be with her. When I finally got her somewhat stable I noted she was awake and almost smiling. I decided to sit down for 5 minutes with her and asked her how she looked so calm in this horrible storm. She asked me..."are you saved, do you know Jesus?" I replied, "no, not really", and she said "you don't want to be where I am without him..but I know where I am going. If you like, we can pray together". And this beautiful dying patient said a simple prayer for me! A prayer that God would bless me, guide me, and show me his love and mercy. I cried and we held hands. I wasn't saved that day, but I was so touched by this brave woman that I still remember her face and name. Towards morning, she drifted off into unconsciousness. About 4 am her daughter and husband rushed in, she woke up and they actually spent about an hour talking softly and praying, until she required a lot more morphine. Finally when dawn approached, she started deteriorating quickly. The surgeon came in, talked with the family and told me to stop the dopamine, etc. She died about an hour later. I'll never forget her and the gift she gave me by showing such bravery and grace in the most horrible conditions. A few years later when my young son was diagnosed with a severe disability, I remembered her and her example and finally was saved. I have had hundreds of patients since then, but that night remains etched in my memory as one of the more important of my life...

I acturally graduated as an FNP eight years ago, got certified, worked for six months and went back to a bedside position, where I have always worked as a staff nurse. Most of the NPs that I went to school with are actually working as staff nurses...hard to get an NP position out here sometimes. I have thought of going back into it, though....

My first job out of nursing school was at a large Catholic hospital with a strict all white dress code for the nurses. Several of the nurses wore caps with their whites and the patients loved it. I for one loved the all white, I liked looking at the nurses station and knowing who the nurses were. Today I wear colored scrubs or white pants with a print top, but actually wouldn't mind going back to all white (pant suits, not dresses!). I also wouldn't mind a stricter dress code regarding shoes. Nurses, while not rich, make enough money to invest in a pair of shoes once in awhile. I notice a lot of colleagues wearing shoes I wouldn't walk the dog in, filthy, frayed, etc. Several patients have commented to me in the past about fellow nurses' dirty shoes, stained scrubs, etc. Even Walmart has nurses shoes for under $25....

I have left temporarily to take care of my son, but do plan on returning soon. During my career the only thing that has kept me sane is trying different types of nursing, from nurse practitioner to school nurse to SICU to ER to education. It keeps me from burning out. However, I know many nurses who have left nursing to pursue other careers including: law school (now a lawyer), a pharm representative, one bought a small mexican food stand, one went back to school to be a minister, a mortgage banker, and even one who started a business doing specialized interior painting like faux finishes. Not one has regretted their decision...

I am new to hospice, but saw this several times even in ICU patients. My own aunt who had an astrocytoma hadn't spoken a word in over 6 weeks. Just lay there sleeping, and when she did wake up, there was no acknowlegement that she recognized us, etc. Well, on Feb 12th my uncle was turning her and jokingly said, "I never thought I'd see you with a fat a##", she was always so tiny but had blown up from the Decadron. Well, she woke up, looked straight at him, laughed and actually talked coherently and sweetly with him for a few minutes before lapsing back into a coma. She died the next day. We always said it was her Valentine's gift to him, not dying on Valentines Day, but the bigger gift was that to this day he says..."she knew it was me taking care of her, not a stranger". This brings him great comfort and pride and was a wonderful final gift to him from her.

I remember a man about ten years ago, s/p CABG and valve who went into every imaginable rhythm for days afterwards, torsades, Vt,Vfib, etc. We probably defibrillated this man 40 or more times and had a zoll pacer for brady etc. He was extremely, and I mean extremely sensitive to any problem with his lytes, and was requiring tons of K,Mg, Phos, etc to stay on top of his losses. All he'd have to do was pee and he'd go into Torsades. He actually had a sense of humor about it all and after a few days things calmed down (after his post-op diuresis in retrospect) and he actually walked out of the unit with a very sore chest...Came back to visit us a few months later..

No you are thinking of atropine drops or scopalomine patches. Decadron is a steroid often used for people with brain tumors, etc..Kim

I am actually posting this for a friend, a hospice nurse who sadly has to work with a doctor who is not real knowledgable or savvy about hospice. She has heard that some docs prescribe Decadron for it's euphoria and appetite stimulating effects, even if the patient doesn't have bone pain, brain mets, etc. Anyone know about this? Doses? Typical patient responses? Thanks for any help, and I will forward this on to her (and encourage her to join!). Kim

I finally have joined your ranks and got a job today at a local non-profit hospice. It will be my first hospice job (my background is ICU primarily), and I will be managing 12-14 patients; this is a full time job. I just recently joinedthe HPNA and ordered the book by Peter Kaye. What other resources do you all find useful? The nurse manager mentioned an algorithm book (name escapes me) that is pocket sized and she found helpful. Any other books or websites you all recommend? Also..since I will be spending a lot of time in my car, what can I write off, tax-wise and what records should I keep? Thanks a lot! Kim

I am an ICU nurse who has for years wanted to switch to hospice after experiencing way too much terminal suffering in the ICU and after having three close family members die while under hospice care. Have taken the past three years off to stay at home with my little son, but now it's time to re-enter the workplace. I have called two local hospices and will be interviewing soon. I'd like any feedback you guys can provide! The first hospice is a non-profit here in So California and does not utilize LVNs at all. The second one is a for-profit and utilizes their RNs as patient care managers and each RN has LVN under her, as well as home health aides etc. Can you guys tell me pros and cons of each type of hospice? My good friend is a hospice nurse at a hospice which uses the RNs as patient care managers and says she feels she doesn't always get enough time with family members, but feels her job is easier in a way. Love any feedback and advice. I've started reading as much about hospice as I can and have joined HPNA. Any other ideas would be appreciated. Thanks in advance! Kim