MissIt

I think for nurses with depression/anxiety, it is most important to find the speciality that is the best fit for you. I, personally, find hospice to be much less anxiety producing than other places I have worked. But, there are people who find it more stressful. Yesterday, I was talking with a nurse who said she wanted to go back to working acute care at a hospital. That was a better match for her and her strengths. I would say try hospice. Just make sure you know who your support network is and use them!

It sounds like it is your particular facility. Are there any other in-patient hospice and/or palliative care options?

Or maybe consider taking an RN refresher class (ours was at the local community college). You get a med-surg refresher and a brief med-surg clinical rotation. I found it very helpful.

In my experience, inpatient hospice is a lot more like floor nursing. Our ratios are 1 nurse to 5 for days. From reading posts on here, it seems like 4-6 is pretty normal for days. Our patients can be very acute and we do a ton of education and family support. It probably does depend on the specific inpatient unit, if it does mostly symptom management, respite, or end of life. I think inpatient hospice is a great place to start in the field. Actually, I think all new nurses would really benefit from starting on an inpatient hospice unit. :)

Mine was the same last month, you needed 101 to pass. I used the core curriculum and the study questions and felt I was well prepared. It's been a long time since I've taken a long test like that, so I think that was the hardest part.

Tell them you are going to leave if you don't get help. The office will collapse without you. As long as you're willing to work this much, they won't be as serious about finding you help. Give them a deadline. I do think that if there is any way for you to make it to a year, you should try. Maybe you're the one that needs to switch to part time or just do the after hours on-call. If you have to keep doing things the way you're doing them, try to envision it as a 5 month, intense, short-term, experience. Try to eliminate as many other activities and outside of work responsibilities as you can. You can't do this long term no matter how much you like your team. Nurses are like this, we don't want to let down our co-workers or patients (NURSING GUILT!!!!), so we do jobs that most other sane professionals would never agree to.

How often you're on-call depends on the company. We have after hours nurses who do the visits, so our case managers actually don't rotate call. At other companies, the case manager nurses do rotate call. A good question to ask! Inpatient hospice is, schedule-wise, similar to hospital nursing with a shift (we do 12 hour shifts). Like in the hospital, you might get out on time or you might not, depending on how your shift has gone. In homecare, at our company, the nurses have "normal" daytime job hours. There are times when those days go long or you have a lot of documentation to do. It really depends on what the day has been like. There are days when everything goes smoothly and you're done a little early. Other days, you're handling a crisis and you're late. Pay-wise, we do make a little less than the nurses in our local hospitals. Our salaries are based on experience, education, certification, etc. I always just think to myself 'would I rather be working in the hospital for a few more dollars an hour?' Definitely not!

I took time off when I had my babies and, honestly, I wish I had at least done something part time. Being able to work as a nurse, even if I ended up not doing so, makes me feel better because I want to know I can take care of my family if I need to. One of the things that is nice about nursing is that after a year, many places will consider you experienced. If it were me, I would try to get a year of hospital or skilled nursing experience and then do the home health. Weekends have been the answer for me, as well. My husband takes care of the children when I am at work and I make a point of volunteering in their classes and spending time with them during the week. Another option, if you decide not to do paid nursing work, is to volunteer at a free clinic or hospice inpatient center. Maybe do something education-related. Have something on your resume during this time.

If you can't get an inpatient RN position right away, another thing to consider is finding out if the hospice company has any contract beds at local hospitals and try to get a position on that floor. At ours, it is the local hospital's oncology unit. That way, you will get some hospice experience as well as inpatient experience and might know some of the people who work for the hospice company at the hospital.

I work inpatient 7a-7p. Our facility is a mix of acute care and EOL. Mostly, we have patients who have been at home or the hospital and who have acute symptom management needs. I like it because you aren't by yourself; there are other nurses there to back you up. Our day also starts with counting narcotics. It seems to take forever-- 20-30 minutes-- because we have to also count patient's own medications, PCA bags etc. I would actually be curious to know how other facilities do this, as it it makes it almost impossible to get out on time. After med count, we do report. Then, just like westieluv, I go through my room(s) and do a quick assessment of each patient. We usually have 5 or less. Then, we get meds together. Many of our patients are on all their regular meds (BP, dementia, etc. etc.) in addition to their hospice meds. Then we do report/rounds with the docs, social work, and chaplain. The nurse usually has the most knowledge about what has been going on with the patient, so this is a time when we can make suggestions and express concerns. We chart on the computer; it takes me about 10 minutes per patient. Then we just take care of what our patients need during the day-- education, dressing changes, prn meds for symptom management. We usually have admissions and discharges. I'd say that takes the most time because you have to do an initial assessment, education, get orders, take off orders, order meds.... It can take a few hours, especially if the doctors have already left. Discharges can take a long time, as well. Inpatient hospice is a great place to work. I do wish the days were shorter, but most days you feel like you have really made a difference for your patients and their families.

I agree. You don't have to give meds just because they are there. Some people will even prefer to have a little discomfort over the meds at times. Did he sleep okay, seem restless? If he had a comfortable night, you did a good job.

I agree that hospice inpatient would be a great place to start. After that, many hospices have nursing positions in things like quality assurance, infection control, IT, etc.

You get scabies from skin to skin contact. So, it is possible, if your skin touched hers in a place where she is infected. Watch your wrists because it seems like that would be the most likely place you'd have had contact.

It might be useful for you to see if there is an inpatient acute care hospice unit around you. Maybe you could do a few days of your rotation there or at least shadow a nurse and see what that side of things is all about. If you want to do hospice and still do a lot of hands on acute care-type nursing work, that might be a good match.

What I've usually done when I was trying to decide "what next" has been to find someone what I want to be doing and see if they'll let you shadow them or at least talk with them about how they got to where they are. You might also want to consider what specialty you would pursue whether you stay put or get a job overseas and do some volunteer work in that area... anything to set yourself apart from other applicants.

Our public health jobs are on our county website. Just google X county jobs and search all the surrounding counties. Another way to get to know the health department and see what it is all about is to join your local medical reserve corp. It's a group of volunteers that help our with health department needs and are available for emergencies. They have them all around the country.

Is there anything in particular that is stressing you out? Is it the time management, uncertainty about medication administration, rotating shifts, working so closely with patients? When I started, the rotating shifts really affected my sleep and I started getting more and more anxious from the sleep deprivation. I did end up switching to a clinic setting at the hospital and everything was okay. I think if you can start to pinpoint the specific problems for you, it will help you come up with a plan. If, like me, rotating shifts are the trouble, maybe you could talk to your manager about working straight nights or days. If it's time management, again talk with your manager for ideas. Maybe you need more orientation. If it's just a general sense of stress and anxiety and you can't quite pinpoint what is going on, talk with your doctor and/or a therapist.

I drank half a mountain dew and had an energy gel (like runner's use) at 1400 yesterday and was much better, still tired and able to sleep just fine last night, but not struggling during my shift. Thanks you all!

Thank you , guys. It makes me feel better that I'm not the only one!

Thank you both for your ideas. We definitely get most of our admissions later in the day. Hmmm... maybe staggered start times would be something management would consider. Thank you for the idea.

I do realize that I am lucky to be able to work straight days and not have to rotate shifts, that really throws my body for a loop. But, I'm having trouble with the 12 hour days. First, 7a is just too early for me. I have to wake up around 5:30 and I spend all night worrying about if I'll wake up or not. So, I'm tired to start with. I usually do pretty well once I'm there and I like the job itself. Then, around 5 or 5:30, I just feel myself crashing and the rest of the shift I feel exhausted. I can't really do caffeine at that time of day because then I really won't sleep. I thought I'd get used to the schedule, but it's now 10 months and I'm still having trouble. On my days off, I do go to sleep and wake up about an hour later (so 6:30 and 9:30/10 instead of 5:30 and 9/9:30). Does anyone have any suggestions? Thanks so much!

Very good point about increased respirations with anxiety. Somehow I missed that the respirations were increased.

It's very common to see high temps, sometimes there isn't anything you can do to get them down. It sounds like you did a lovely job trying to keep your patient comfortable. I guess for the breathing, it would depend on what you mean by a tough time breathing. Is the respiratory rate low, but non-labored, or are they having labored breathing. If it's labored breathing, it's possible they need more medicine, not less. Also, why are they on the Ativan? Agitation, anxiety, nausea? I'm usually hesitant to hold medications unless there is a serious reason to do so. If the patient is doing well, it might be because the medications they are getting are the correct amount. I would hate to hold something and the symptoms return, especially for someone who is so close to dying. I would consider holding Ativan if it is po and the patient is too lethargic to swallow, for example. But, if it is a patient being treated for terminal agitation and they are finally calm, I would not. I do think that more time in hospice is going to make you feel better about the medications. Compared to med/surg or most other specialities, we give some crazy high doses of medication to get symptoms under control. But, when you first start, it is normal to worry!

I did mine at a school health clinic. It was great! That will be through the health department. Also maybe try free clinics in the area.

Touting the need for a zero percent med error rate only makes people hide their errors, patients could be at risk and systemic problems don't get fixed. Hopefully the error rate won't be high, but their shouldn't be a punitive response if someone makes a mistake. Maybe it would be better if they set up a non-punitive reporting of med errors system and then evaluate what their error rate actually is and take it from there if changes need to be made. It would be useful to see why people are making the errors.