Raviepoo

You were absolutely crossing the line. As a nurse you have a professional relationship with your patients, not a personal one. You can be compassionate and personable, but gift giving is not OK. What if one of those patients had tried for years to become pregnant without success? What if one of them had given birth to a child of rape? What if one of them had a terrible relationship with an abusive mother? What if one of them had lost a string of pregnancies to miscarriage? What if one of them was grieving a child taken away by it's father? Mother's Day is not a happy time for every woman. Some women have reason to dread it. Did it occur to you that your gift might have actually brought up trauma for a patient? Giving Mother's Day flowers to a woman you don't know intimately is pretty presumtious and has the potential to be the opposite of therapeutic.

I suspect it depends a lot on the agency and your case load. At my agency there is very little real management of the CNAs. It's just a bit of coordination. We have awesome aides who do a great job, and if they don't, upper management takes care of that. Case Managers are asked for input, but they don't do the difficult stuff. At my agency the case managers work more with the patients and families.

Parakeet, I'm not here to argue religion with you, just to point out that the opposite of your statement is also true. Just because someone believes something,does not mean it exists. Yes, this is related to the OP's post. As nurses we are required to provide culturally sensitive care. Nurses are part of a team of professionals who revolve around and serve the patient. The patient's needs and belief system are primary. Every person has the right to their religious beliefs, but no person has the right to force their religious beliefs onto a patient who might not share them. I was raised within a major, non-Christian religion that does not have a concept of heaven and hell. In my religion the dead live on in the memory of those who loved them. That is enough for me. I certainly hope you would not try to convince a member of my religion otherwise as they lay on their death bed. That would be rude and upsetting. Every single patient deserves sensitive, culturally competent care. Every single patient deserves autonomy and the right to make their own decisions whether or not their nurses support those decisions does not matter a bit. If a patient or family in the ICU chooses a terminal wean, it is not up to any provider to try to influence their decision.

I am learning something from a conversation with my sister Margaret. First of all, people with Alzheimer's retain songs, prayer and poetry longer than speech because those things are accessed via different neural pathways. (Margaret didn't teach me that.) That's why you sometimes hear a person who hasn't spoken an intelligible sentence in years sing along with Frank Sinatra and not miss a syllable. It's also why a non-verbal patient may bust out the Lord's Prayer for no discernable reason. Margaret asked me for suggestions of songs, nursery rhymes and poetry that our mother knew back in the day. She read parts of the Song of Hiawatha to mom and mom recited along with her. Mom also sings along with Frankie without missing a beat. Ok, now I'm getting to the point, finally. What I learned is that family members know the best way to reach a person with Alzheimer's. They just need a little help pulling it out. Generic music from the 1940s did a really good job engaging my resident's when I worked in LTC. Getting specific suggestions for familiar song's prayers and poetry works even better for individuals. Seems simple, doesn't it? I have always HATED hearing contemporary music played in an Alzheimer's unit. The sound track of an Alzheimer's unit should serve the patient's quality of life. If the staff wants to listen to thier preferred music they should do it at home.

The questions you're asking aren't easily answered and the answers are not the same for everyone. In my opinion, my father died 2 years before his organs failed. He suferred a TBI and never became conscious again. All of his life experiences; all of his memories; all that made him himself were lost forever. Although his body existed for 2 years after that, no one will ever convince me that he was still in it. A religious person would not agree with that assessment, but that doesn't matter to me or to my mother who made the decision to have his feeding tube removed. End of life decisions are personal and should not be dictated. May I suggest some reading that might help you come up with your own answers? A good place to start is Being Mortal: Medicine and What Matters in the End by Atul Gawande.

To me it sounds as if she would qualify, if her MD ordered an eval and treat AND her husband agreed to hospice services. None of it makes any difference without the husband's buy in. He is in full control. An army of MDs, MSWs and RNs can try to educate him. If he wants "everything done" you may have to code her in the end. It's sad, but some people only learn by going through it.

Yeah. That's the insane part I mentioned in my post. I have had weekends where I have had a line of people waiting for me, plus a death, plus an admission, all needing attention at the same time. Not fun. It wasn't every weekend. Some weekends nobody called at all and I felt guilty for collecting a paycheck.

There is no such thing as better. There is only what works best for you. Weekend on call can sometimes be really insane, but then, so can Monday - Friday. At my agency there is no such thing as 9 - 5 (or 8 - 5.) There is just a patient load, and the needs of the patients. I prefer on-call to case management, but that's just me. They are different. If you are doing case management you will get to know your families really well. If you are working on call you are likely to step into the lives of people you don't know very well at times of crisis. We are talking about two different skill sets. Which do you think you might do better? Which do you think you might enjoy more? Your answer might be different than mine. You're in the enviable position of being able to chose. What do you want?

I don't know whether to trust this program. As soon as I asked for info I got a call from a "counselor" who wanted to sell me on it. That doesn't leave a good taste in my mouth at all.

Um, based on my experiences and the experiences of my classmates i think everyone has gone through nursing school with depression. It's doable. P.S. Trying to wean yourself off of meds while in school is a REALLY bad idea. Don't ask me how I know that.

The really fun thing about MS is that it's different for everyone. You might have the mother of all relapses after giving birth, or you might do just fine.

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I'm not sure that you did anything wrong but that tech certainly did. She had no business messing with the catheter afterwards. Because of that, you will never know if there was any saline left in the bulb or how much was left. It is not a tech's place to interfere with the education of a nursing student. Who the heck does she think she is?

Honestly, I think if it's not a passion or a calling you should go find something else to do. There are less stressful ways to earn a living.

That is my chief concern. I'm not looking to take services away from families who need them, but I do want to keep my license.

My use of "their" instead of "there" is humiliating and now I can't correct it.

Yes! Who pays for it?

I'm not at all concerned about putting patients on comfort care and I think it's a crime against nature to insert a feeding tube in an 80 year old woman with advanced dementia. My concern is about the legality of accepting hospice patients who don't fit the criteria for eligibility. I think some of the nurses at my agency admit patients just because their is a referral from an MD, and the MDs don't take the CMS criteria into account.

This is the crux of my problem. I am asked to evaluate patients (and have a few patients on my case load) who have not made it as far as 7a on the fast scale. These are both facility and home patients. Yes, hospice services are beneficial to them, but I honestly don't think they are eligible for hospice under the CMS criteria. I think they would benefit from nursing services and extra attention from a CNA devoted to them only, but if they are talking up a storm (even if it is a confused storm) they are not eligible for the Medicaid benefit paid by the government. We keep getting these referrals. I just wish the MDs would take the CMS criteria under consideration when making referrals.

I see a number of patients who have mid-stage Alzheimer's. Some are pleasantly confused Some have behaviors. Some are sundowners. When they are ambulatory, able to feed themselves, continent on and off, memory impaired but still able to hold a conversation and appear just a wee bit forgetful to people who don't know them well, I just don't see them as hospice appropriate. I have no trouble with the Alzheimer's patient with a sporifice vocabulary who has lost the ability to feed themselves and forgets to eat. These patients are sliding into death, whether it takes 6 months or 6 years. The patient I have trouble thinking of as hospice appropriate are the ones who are still finding some joy in life; still able to do things for themselves, still able to recognize loved ones (even if a daughter become "that lady who takes care of me"). I look at these patients and I don't see a dying person. I see a person living with chronic illness. What do the rest of you think? When is a person with Alzheimer's truly appropriate for hospice? I have my own ideas but I want to hear from seasoned hospice nurses.

You are not moving to PA. PA is not one, big, homogenous entity. It is Philly and Pittsburgh, and Harrisburg and Scranton, and Johnstown, and Enola, and Meadeville and a host of other locations, all very different from one another. I can tell you nothing about the job outlook in most of those places. I know that the hospitals in the less urban areas DO hire new grads. Hershey Medical has a very reputable new grad residency. Local hospitals in the mid-state area DO hire new grads. I think you would endure traumatizing culture shock moving here from California, however. It's odd here. Where do you want to live? What kind of lifestyle do you want? What areas of PA are you considering? There is no simple answer to your question.

Are you looking for a school that has lower standards, or a school that will accommodate your disability? Do you want to be an LPN or RN? There is an LPN school in Willow Street PA that will work with you. They do accommodate disabilities and they allow students to repeat trimesters if necessary. Take a look at Lancaster County School of Technology.

I have my fingers crossed for you. I hope you get in and do really well in the program.

This week I learned that you can't help someone who insists on being a **.

I'm fairly new as a hospice case manager and I keep finding myself in situations where I have to rely on the more experienced case managers for help. I know that it will take some time for me to become competent on my own, but I want to bend the learning curve a little if I can. Does anyone know of a program that teaches hospice case management for nurses who are new to the field? I'm willing to travel.