KatePasa

I'm a nurse on a med-surg floor that treats inpatient hospice patients along with our variety of other patients. I have also worked for our local hospice prn. Lately, I've had a a lot of hospice patients at the actively dying phase assigned to me on the floor. I know that I am trusted with these patients because of my good relationship with our hospice providers and my love of working with hospice patients and their loved ones. However, I might be hung up on a few deaths and I need to know how to get past it. Over the past few weeks, I have had three deaths (the old theory about coming in threes) in which I administered the last dose of a medication to treat terminal agitation or dyspnea. I know this is a risk of the role that a nurse treating a terminal patient's symptoms runs, but I feel haunted in essence by the fact that my hand delivered a dose of a medication that was requested by family or made necessary by patient's dyspnea, pain or restlessness. Working this scenario may seem like Hospice Nursing 101 for old hands, but I'm still fresh to this. I truly love the work and entertain the idea of pursuing a career on a hospice inpatient unit, but I need to learn how to process the emotions of being the one who gave that last dose.

I've encountered times when the information on the Kardex was more accurate than the report given to me, and sometimes it's exhaustive to remember to give each item on there or detail each specimen that needs to be collected. Beyond that, after twelve hours on the busy floor we rely on the Kardex to relay information that we may forget to mention. It's a long day and we're human after all. I guess what alarms me most is that the nurses who have developed this habit are new grads. When I was newly minted, those Kardexes were my holy grail that helped guide me.

I did once. One of the new nurses said it was my "job" to tell her all of that stuff. I see report as an opportunity to share SBAR and information about what happened on the shift, not tell the other nurse what the standing orders are or the basic readily available info that's on our Kardex.

Incoming nurses. We the custom on my unit is to get the basics off a Kardex, ie name, dob, diagnosis, allergies, monitoring, labs, specimens needed, diet, code status, activity, standing orders and so on. Some new nurses, who just graduated, fail to see the point and come to report with a completely blank paper.

Sorry, I erased it because I felt kind of snarky, but this relates to dealing with coworkers coming to get report without even knowing things like the patient's name.

Any suggestions?

Considering she asked me to submit an application and what shifts I would be able to work, I considered it a job offer.

I completed my preceptorship on a busy med-surg floor. It was a great experience and I worked well with the staff there. Evidently so well, they gave me recommendations to the unit manager, who told me "not to worry about a job and just pass NCLEX". I finished up the last few months of nursing school, literally, not worried. I passed NCLEX and received my license. I had applied for the job before NCLEX, just to get my application in the door and got no replies. Now, I have resubmitted the application with my license number, as of Friday. I am wondering if I should go see the unit manager who assured me of a job and hand deliver her a resume. This is all complicated by the fact that I left my abusive husband after graduating nursing school. My funds are beginning to dwindle and I need to get working ASAP to ensure a roof over the heads of my daughter and me. Honestly, I feel more anxiety about this than I ever felt in nursing school or taking NCLEX. To long, didn't read: I was assured there was a position for me on the unit where I spent 5 weeks in a clinical preceptorship. I applied and haven't heard back. Should I be persistent and try to face-to-face the unit manager who assured me I would have a position upon licensure? Thank you!

I love you, Grn Tea! This is more or less what I tell all of my classmates when they complain that they about don't get to do or being sent to clinical sites where they just end up watching the nurse. Nursing school is so much more than poking, prodding, and procedure. We have to be alert for the learning opportunities, vastly abundant, that put our brains to work or challenge our hearts rather than busy our hands. After all and as you say, we will have plenty of time to poke, prode, and for procedures once were become nurses.

Have you ever fallen in love? If it was anything like when I started to feel something for my husband, you were nervous as all hell. I wanted everything to go right. And, any misstep or problem was a catastrophe. If he didn't return a call quick enough, I thought "maybe he doesn't really like me" or "maybe there is someone else he'd rather be with". Nursing school and a career in nursing are like falling in love. The moment that you become secure enough in yourself and your relationship with it... that's when you can relax and that's when you can feel the love. In this moment, you become confident that you are meaningful and belong exactly where you are. That's when you realize that you made the right choice. You were meant to be together. That's when you start doing things right. That's when you become a good nursing student. That's what will help you be a good nurse. So, don't let bumps in the road, mistakes, bad clinical days or poor test grades shake the love and dedication that is deep in your heart. Best of luck to you all.

Just curious...is the cancer patient white and the SSC patient black? Just curious. Is suspicion of drug seeking ever driven by a patient's race? Just a reminder...Med-Surg nurses are charged with treating the patient's medical conditions, not addictions. Unless you are working in a drug-treatment facility, you are not equipped or trained to treat the addiction. You must treat an addict's pain like you would any other patient's pain, which is to the point of reasonable relief.

It's sad to see SSC patients labeled as drug seekers once again. Nurses have no business projecting what their idea of what a person's pain SHOULD be. Valuing a patient report of pain as more valid if the patient is apprehensive about taking meds is ridiculous. It flies in the face of all we've learned about chronic pain and tolerance. The reason that these patients set alarms is because they are aware that their pain will return and want to avoid that. Patient report of pain is not all that matters. Ask your patient to report a tolerable level of pain and medicate to that. If it's zero, medicate so that your patient will report "zero" when pain is assessed. Patient care is ALL about the patient, after all. Not the nurse's expectations of how the patient should feel...

I've heard the average age of a nursing student is 30. Impirical evidence from my program suggests that's true. I'm 32.

I'll get it done. I always get it done. Maybe just writing this thread with provide me with the catharsis of talking to my peers and help me get through reviewing for the final exam that marks the gateway to my senior year as a nursing student. However, I can't stop thinking about the massacre in Colorado. I am so far removed from the situation and don't know anyone there. Still, my poor heart is hung off some terrible cliff, full of sadness and fear for the world. In my future as a nurse, I know I will be confronted with senseless deaths. As someone who lacks religiosity, I can't find comfort in knowledge that the departed souls of the deceased are bound for glory and the sweet hereafter. When faced with the stark evil that lurks in the hearts of men , I yearn for religion to comfort me, but I am forced to cope on my own. So, I wonder how you have dealt with your encounters with evil or senseless deaths and maintained your focus on your duties as nurses or students.

Preload is venous return/ventricular filling...so anything that would increase those increases your preload, for instance fluid volume overload or dilated ventricles. Afterload is systemic vascular resistance...so anything that increases that increases you afterload, for instance hypertension or SNS stimulation (vasoconstriciton).