Keila

Hi everyone! I know that there are a lot of threads like this, but I am so excited.. I had to post one of my own. I have been a nurse for a year now, and worked 6 months LTC, 6 months med-surg/ortho. I went to nursing school with the intention of being an OB nurse, but when I graduated there weren't any jobs available in the dept. Even in one year, I gained a ton of experience and met a lot of great people, and I just accepted an offer for a full time OB position - my dream job!! It is an LDRP, so I will be working postpartum, L&D, and circulator for sections. They are also cross-training me for NICU and peds as they are our sister units, and if OB is slow I can float to these units. Granted, I won't be given the 'difficult' cases on the other units, but I am so excited about all of the training I'm getting ready to receive!! So excited to be joining your ranks - I was born to be an OB nurse. It's in my bones. I feel like I'm robbing my employer by getting paid to do this work!

Hey, there. I don't have any advice for you, but I just wanted you to know that I'm in a very similar boat and know how you feel! New nurse, graduated May 2011 and just started working night shift on a med-surg unit at the end of December. I've worked nights before, but this is the first night job I've had since my son was born (he's three). I love my job, and professionally, I'm fine with thirds. It's my family time/time off that I'm having a hard time with. I feel like whenever I'm off, I'm sleeping the time away that I could be spending with my husband and little boy, and I swear I'm in my pajamas 90% of the time! Makes me feel like a bad mom, and I feel like I'm missing out on so much of my little guy's day to day life! While I can't offer much advice, I've got buckets of empathy for you! Maybe we should start a support group for night shift mothers of small children, lol!!

I'm so sorry, Heart, I'm just now seeing this or I would've replied sooner. Arabstar was right -- I am the 'charge' nurse because I am the direct supervisor for my team of CNAs. From what I've seen of the charge nurse role in the hospital, the two are totally different and, like Arabstar, I would absolutely decline an offer to start out charging in a hospital setting. When I originally posted this thread, I did so because I was scared to death (and excited, too) that I had landed my first healthcare/RN position. That transition, from student to nurse, was my most difficult hurdle and lasted about 2 months. It really helped that I had an amazing preceptor who trained me for 7 weeks. The first few days I was by myself, she even called to make sure I was doing okay. It's me, an LPN, and four aides for 37 residents. I have the same 18 every day, and my LPN buddy has the same 19. I work 12s, she works 8s, and most of the time another LPN comes in for her hall on the 3-11 shift. There have been maybe 2 times that I've charged all 37 residents with a med tech. There are days when it seems like I don't have enough time to get everything done, but all in all, I love my job. We have great nurses on every shift, so if there's something one shift can't get done, the next one picks it up with no problem. Most of our aides are awesome, and let me tell you, they have really been patient with me. I jump in and help them whenever I can, but since I've never done transfers/toileting, they've had to teach me from the ground up. It's very different when you're transferring a mannequin in CNA school, lol. With a few exceptions, we all help each other, and that makes all the difference in the world. So to answer your question, I've been doing great, and I plan on staying with this facility for a long time :)

Thanks so much, arabstar!

Arabstar, I think this is the case with my position, too. I think the 'charge nurse' title is more of a formality, as the only nurses on the floor are charge or med nurses. I assume that on rehab to home, I will help residents heal from things such as joint replacements, strokes, possibly pneumonias... is this accurate? Thank you all so much for your replies!

Hello everyone! I just got hired as a charge nurse for a 20 resident rehab to home unit in a nursing home. I am a brand new graduate, and besides clinicals and a nurse externship, I have never worked in healthcare before. I am very excited and intimidated about my new position, and was just wondering -- can any of you tell me how the rehab to home units work? I have been in a nursing home before to visit a family member, but that's it. Before I got this job, I didn't even know that nursing homes did rehab to home. I believe I am in a good facility. I have six weeks of orientation, and when I went in last week to fill out new hire paperwork, I noticed a really good 'team' atmosphere, between all the nursing staff (CNAs to DON), but also between the different disciplines (therapy, social services, etc). I feel like I'm going to be well supported there, but I also want to hit the ground running, and be the safest practicing new grad that I can be. Any advice?

Just for your ATT, I would think. When KBN received verification of my degree, I was issued a provisional license from KBN. Then Pearson Vue sent my ATT via email.

I took my final on the 4th and received my provisional license/ATT for NCLEX today :)

No problem, finallyRN -- and I am far from always being right, lol. Thank you though, bonestAx, very kind of you :)

Hi, finallyRN! I live about 25-30 minutes north of Hopkinsville, so I'm afraid that I can't really give you any good information on schools, etc. I have visited Hopkinsville and Princeton several times, but not Russellville. Hopkinsville is a larger community than the other 2, and all areas are a short drive from an area known as Land Between the Lakes -- it is great to visit in the summer. I did Google some websites for you, to maybe help you find more specific information about the areas you asked about -- http://www.princetonky.org, http://www.hoptown.org, and http://www.russellvilleky.org. If you are moving from a larger, more metropolitan area, be prepared for a bit of culture shock -- all of these areas have a small-town vibe, maybe a little less so with Hopkinsville. These places are in the middle of farmland and coal-mining country, and I hope you like sweet tea :) A good thing about this region is that we are pretty centrally located to larger areas -- Clarksville and Nashville, and Evansville, IN are within 2 hours or less, and St. Louis, Lexington, or Louisville are maybe 3 1/2 hours away. I hope I have helped you somewhat -- sorry again that I didn't have the specifics you were asking about. In any case, welcome to western Ky -- we're all pretty friendly here!

Thanks for the information, Leda! It's interesting that you mention how brain mets looks so much like dementia. My great-grandmother had dementia and Alzheimer's before she passed away, and my family and I have discussed the similarities in the behaviors we saw in her and that we're seeing now in Gran. But in ways, Gran's behavior is sooo different. She'll have these moments of absolute clarity in the middle of complete and total confusion. Example: She was talking to my father the other morning on the phone (my uncle had called wanting someone else to try and calm her down). She told my father, "Edward, you don't need to be messing with me. You've got to go to work," and that was followed by a jumbled up story about how she needed to leave and find my great-grandmother because she was lost, etc. It's the strangest, most unnerving, heartwrenching thing I've ever seen. And it's so frustrating because it seems like there is nothing we can do.

Another quick question.... sorry if I'm driving you all crazy! I think Gran might be experiencing something like sundowner's, maybe. The odd thing is, she gets most agitated right before dawn; my mother and aunt have received several phone calls from my uncle asking for 'back-up' around 4 or 4:30 am. I know that traditionally, sundowner's is just that -- it presents when it becomes dark outside. But if Gran has her days and nights mixed up, could this notable increase in agitation be sundowner's? She is still in the pattern of confusion (thinking she's not in her home, that her mother is there, etc) at all other times during the day, but early in the morning is when it's the worst to try and calm her down. She displays a lot of anger, hatefulness, and will to leave her house during the early morning hours.

Thanks for the thought, Whispera... but nope. She hasn't had any med changes in the last 4-5 months. She's on an opiate (Lortab 10 mg) for pain, but she doesn't take it everyday. I don't think that she would have built up any sizable tolerance -- she'll only take one/day maybe twice a week or less. We've actually been really lucky so far -- her physical pain has been tolerable without having to use a very high dose of meds. She is on a benzo for sleep, and she takes that every night. She was in the hospital for about 4 days back at the beginning of May, and I don't know if she got her sleeping pill when she was there... but would that be affecting her LOC now? We went down to her house the day before yesterday and when we got there, she was calm again. No agitation, no nonsensical speech; she was good. It's like flipping a switch sometimes. I've never seen anything quite like it before.

Thanks Leda :) We will definitely do everything we can to keep her comfortable -- I would much rather see her confused, but calm and pain-free, than in pain, agitated, and A&O. Gran had a really good, clear day yesterday (the best we've seen her in about a month or longer), but we just got a phone call from my uncle, who lives with her -- she's been really 'thick-tongued' and thought she saw my great-grandmother on the roof of her house. My mother and I are going down there in about 30 minutes. Thank you for the well wishes... Gran and my family can use all of them we can get. Thank you all for being so understanding and supportive :redbeathe

Thanks for the reply, heron! I agree with you, and am hoping that soon we can eliminate all but the most necessary meds for Gran's comfort. That list will still include an opiate for her cancer pain, and probably a benzo to help her sleep.... but I still think if we eliminate most of her meds maybe some of the delirium will improve. She's on 18 different meds now.

Thank you for the information! We got her labs back from the doctor yesterday, and her UTI is gone, thank goodness. She's been sleeping better the last couple of nights, too, and a good portion of her agitation is gone for right now. It seems like we just have to take things day by day (and sometimes, minute by minute!). We'll be touching base with hospice Monday.

Thanks for your response, Whispera. My family has decided (thankfully) to begin hospice care for Gran. Since the diagnosis, they have supported Gran's decisions regarding her treatment, as long as she was reasonably sound-minded enough to make those decisions. They're realizing now that those days are behind us. My aunt called today, and we will have our first appointment with hospice next Monday. I tend to agree with you -- I think the cancer has metastasized to her brain, but at the beginning of May a CT with contrast showed nothing. She wasn't able to do an MRI because the machine was down, so they did the CT instead. With the behavior she's exhibiting, though, I truly feel it's spread there. I also think there are several co-morbidities and conditions adding to the agitation and restlessness. Her kidneys are beginning to fail (creatinine at beginning of May was 1.7 or 1.8), she's sleep apneic and doesn't wear the C-pap like she should (says that she feels like she's suffocating), she is a chronic COPDer with poor oxygenation, she is slightly dehydrated (and still taking Lasix with potassium supplement), she's having a flare-up of cellulitis, and she has a UTI. I feel like if we could maybe get somewhat of a handle on some of these conditions, that might ease the symptoms we're seeing, too. I know it won't completely eradicate them, but I don't think it would hurt. I have a quick question for you guys regarding how hospice works. If this is an ignorant question, forgive me. As a family, we've talked about possibly seeing if the doctor will 'weed through' Gran's meds and maybe DC the ones that aren't absolutely essential. She's on 18 meds right now. I would expect them to continue things like insulin, Plavix (she has a 99% blockage of one carotid artery; she had an endarterectomy on the other in 2005), Isosorbide, and Lortab for cancer pain -- but some of the others seem kind of futile now. When her hospice care begins, is this something we can ask her doctor to do, or will she look at us like we're nuts?

Thanks Leslie - I think we'll all feel much better, too. I've got a year left before I can take the NCLEX, so I have a little way to go... but I am the 'medical' person in the family. I'm the one that my family looks to for deciphering what the doctors are saying, etc... and at this point I know just enough to ask those who know more -- therefore, I am here :) I am by no means in any position to make decisions regarding Gran's care - my aunt is her POA. But with the knowledge I have (and the capacity I have to seek out more knowledge), I just want to help as much as I can. I want to share what I can so hopefully we can, as a family, make the best decisions for Gran. I really, really appreciate you guys taking the time to help me :)

Thank you both so much for your replies. Your responses mean so much to me -- this is an extremely hard time in my life. The doctor has been made aware of the hallucinations/anxiety/delusions, and I think finally they are going to re-evaluate and prescribe some anti-anxiety meds for her. My mother, aunts, and uncles are also holding a family 'meeting' sometime this week, and I suspect they'll opt to begin hospice care for her. Whispera -- I'm still learning, and trying to read everything I can, so if I'm mistaken please correct me! But is terminal restlessness mainly physical (like not being able to find a comfortable position?) Gran's is more of an emotional restlessness. In the last few months she has dealt with confusion, but we have always been able to re-orient her. Now, she is living in a world of her own, and she is worried sick about her mother (who died in 2005). She wants to get her mother's final business arrangements in order and make sure the burial is taken care of -- and that's been taken care of for years. But when you try to tell her that, it doesn't stick. She just keeps going back to it over and over; she also experiences hand/upper body tremors and tremendous anxiety over it. It's so odd, though -- she has moments or even hours of absolute clarity, and then, like flipping a switch, that clarity is gone. Leslie -- you're right. Her MRI showed no mets to the brain, but the cancer is in her CSF. She is showing all of the symptoms of the brain mets, except for the speech difficulty, seizures, and gait disturbances. I am really hoping that hospice will be brought in soon; I honestly feel that is the best option for her now, and for us. Again, thank you so much for responding!

Hi everyone. I am not a hospice nurse -- I am still a student, but I am slowly losing my grandmother to stage IV breast cancer (and CHF, diabetes, and a laundry list of other ailments). I am not asking for medical advice; instead I am wondering what your experiences have been with end-stage hyperactive delirium. I'm almost positive this is what we're seeing in my grandmother, and I'm just trying to understand the condition as much as I possibly can. Do you all have any good articles or resources for information? Also, when re-orientation is not possible, what are the best therapeutic communication tools that you can use? My grandmother is experiencing hallucinations and delusions that cause her a great deal of anxiety, and I would just like to find a way to communicate with and soothe her. Thank you all so much for reading.

Just thought I'd pop back in and let everyone know... the nurse I talked to was mistaken. It is 12 weeks of orientation, with additional if you request it. (Whew! I was kind of worried about only having six weeks!) Thanks again for the replies, everyone! :)

Shiccy, thanks for your comments. It's so odd -- sometimes Gran will seem happy that Mim is there; other times, it's as if she's "lost" her. She'll continually ask family if we've seen her, she'll say that she knows Mim has talked on the phone to one family member or another, but won't talk to her, she's worried that Mim is angry with her, etc. Generally, when she gets upset like this, we can talk her down and soothe her -- sometimes we try to reorient her and tell her that Mim is dead. She will acknowledge that Mim is dead in one sentence, and in the next she'll be telling us about her being there. Or she'll say something like, "I know that you say she's dead, but I KNOW WHAT I SEE." She is also experiencing profound personality changes, which I know goes along with the mets of her cancer. She has always been a very religious, spiritual woman, and as of late will be singing with her favorite hymns on the Gaithers' shows only to burst out with a string of curses. She'll then resume singing as if nothing happened. We have told her doctors about the hallucinations, agitation, and personality changes, and no one has ordered her any type of anxiolytic (sp?). Her Paxil dosage has been increased, and she has been prescribed a sleeping pill, but they haven't written prescriptions for anything else. Sorry to kind of derail the thread, but I just thought I'd share that!

Thank you, SWS, for your kind words about my Gran. I really do appreciate them :) And thanks everyone for the replies -- I, like Intern67, think this is a good topic for discussion. I hope no one gets their toes stepped on, though, while we're discussing. Diversity is what makes the world go round! With that said, I am about half and half on the topic. I know that hallucinations are freakish, although (sometimes) explainable, medical events. I also agree with Intern67 about confirmation bias, to an extent -- but I also feel that not all experiences can be explained as such. I am really interested in a couple of things that were brought up in this thread -- the first of which being the 'comfort mechanisms' that dying people have. Please note that I am asking these questions out of a sincere desire to understand. What are these comfort mechanisms? I believe (and if I'm wrong, correct me!!) I read somewhere that there is a large amount of dopamine released at or near the time of death -- would that provoke these mechanisms into action? What other comfort mechanisms are there, besides the hallucinations? And I know this is going to sound cold when I say it, trust me when I say I don't mean it that way. But from a scientific, rational point of view, what does it matter if the dying person is comfortable or not? I'm talking strictly about internal mechanism here, not family/medical professionals promoting comfort. I am no decorated scientist, but from that point of view, a comfort mechanism would be unnecessary, because either comforted or not, the person still dies -- the end result is the same. I don't subscribe to any particular religion -- trying to succinctly explain what I do believe is difficult sometimes. Suffice it to say that I believe we do carry on after death; now, whether or not we are sentient or just forms of simple energy, I don't know. I also believe that death is sacred, just as birth is. So maybe, even if there are medical explanations for end-of-life hallucinations, why could that not also be a little nod from the divine? Why would science and spirituality have to be separate? Looking forward to the responses, thanks again guys :)

Hi everyone. I've spent the last few hours reading the 'nursing ghost stories' thread, and along those lines.... how many of your patients see/talk to their loved ones before they pass away? I'm a third semester student so I don't have any nursing experiences to share, but my 74 year old grandmother (Gran), whom I love immeasurably, is losing her battle with breast cancer. She was diagnosed with stage IV last year, and to be honest, I didn't think that I would have the joy of another year with her. I have, and for that I am more grateful than I can ever put into words. Along with the cancer, she has a laundry list of other health problems, and she is on dozens of meds. We know that the cancer has metastasized to her bones and her spine, and a new onset of symptoms is suggestive of metastases to her CSF as well. She isn't "on death's door" quite yet, but I don't think we have much time left with her. For the last four or five months, Gran has been seeing her mother (my great-grandmother, Mim, who died in 2005). Not just glimpses of her -- according to Gran, Mim is living with her. She said that she sees her every single day, and that most of the time Mim will talk with her for hours. At other times, Mim will not look at or acknowledge Gran; she'll just stand beside her, which bothers Gran tremendously. Mim was the only dead loved one that Gran would see, until recently. Her husband (who passed away in 2006) visits her, although infrequently, and they also talk. Those 'visits' don't cause Gran any distress. I am a logical person, and I realize that Gran's age, conditions and meds most likely account for the hallucinations. But in my heart, in a place where logic does not thrive for long, I feel that she is truly seeing her mother and her husband. I've heard about people seeing dead loved ones in the days before they pass, but this has been ongoing for months. I guess I'm just trying to understand -- if you are a spiritual person, but a logical, analytical person as well, where do you draw the line between medical hallucination and spiritual occurrence? I don't mean to ramble on... I've read these boards for a while and post rarely, but you all seem like such a good group of people. I would love to hear your experiences with things like this and your thoughts on them. (... and thank you for sticking with a long post!)

Thank you all, and schack, I totally agree about learning the basics. That was what kind of worried me with a six week orientation... not only would I be learning my way around the specialty, but also trying to find my 'groove' working in health care for the first time ever. I'm starting my externship on the same hospital's med-surg floors in a couple of weeks. I'm really going to focus on things like time management, and just orienting myself to the medical field. I won't be doing many 'nurse' things -- I'll be practicing more in the scope of a CNA, and I really think it will be a nice intro to how everything works. Again, thank you guys for all of the responses! :)