cadawasp

I think that Kaci is a brave nurse to speak out as she has. By doing what she is doing she is teaching the proper infection control practices for this disease. Before the first Ebola patient here is the US these brave nurses and doctors came back and followed procedure to take temps which is what Doctors Without Boarders recommends, and there was no problem but I think this has been forgotten. We as nurses need to do some teaching including the facts the the chance of an epidemic here are small because the cultures are different and sanitary facilities. We also need to teach handwashing, droplet precautions as these will help to prevent exposure to the flu as well. Right now the largest danger we face is from the flu not Ebola.

I had left nursing for 15 years and was able to make the return by taking a refresher class given at a local college during their winter break. I found the course by going to the NLN for assistance. I was a six week classroom and two month on-site program. When I finished the course I read every nursing journal I could to bring myself up to speed. I took a job in a hospital that was inner city and wowrked on a mostly medicine unit. They gave me extra time on orientation and I was lucky enough to find a great mentor to help me make the transition. I will not say that it was easy but it is doable. I have gone on to complete my BSN and am currently working on my MSN in education. My biggest advice when you start to practice again is when something comes up you are unfamiliar with ask questions and look things up you will find that you can go from novice to experienced in a very short time. Certain things we do not forget and they come right back.

Do not beat yourself up about this. You did your best and learned for the next time. I agree to allow the family to decide if they want to leave or not that is one of the lessons to take from this. I a a hospice nurse and would have done the same before working in hospice. What I have learned since then is listen to the patient he was saying that he wanted to go home, that can be saying that they want to go to the next place whatever that is to them. Giving the Ativan was what we in hospice do but would also add morphine to decrease the feeling of breathlessness. Many times the patient does not want the family to be their because they are afraid it would hurt the family members too much, and that may have happened here. You did a good job and you need to have the ice cream, wine and bubble bath and keep on learning.

CNAs are looked down upon by some people in all places. Those people that do look down upon them are not aware how important CNAs are and are also the nurses that "eat there young". I have worked with CNAs and worked with and trained HHAs who have the same problem. Nurses cannoot get by without the assistance of CNAs and HHAs. I have learned many things from the aides as well as having these wonderful people bring a problem they noticed to my attention. Anyone who treats a CNA or HHA poorly must be insecure in their own job and should be ignored. The aides I have worked with and I do mean with are some of the best professionals I have worked with in health care. Remember this is not a problem that is unique to NY but is present country wide but remember that you can only be made to feel little if you allow it. People ho try to make you feel that way are little themselves and not worth your time and energy.

Getting the staff to use the pain mess correctly. We usually give mess routinely so the patient's are comfortable. The staff does not understand the use of morphine for breathing. The idea of not feeding or giving fluids toward the dying. They frequently give fluids for hydration IV. Not attending education sessions when they are offered by hospice. When the facility gets these things it is a joy to work with and the patients due better.

I am surprised to hear that cancer was an uncommon dx. When I started hospice 16 years ago hospice was the most common. Now cancer dx is less then 50% nationwide. For us top three are. Debility unspecified, CHF and COPD.

I hear this about male aides as well although they do as we'll or better then some of the females and we try to accommodate them. I have also seen male aides try to get out of caring for females as well. Culture can be an issue in either directions. In some cultures a man can not be cared for by a woman other then his wife. This should be accommodated when possible.

Having been a hospice nurse for 16 years I have seen both work always putting something in to protect the stomach like ranitadine. If the patient is compaining about lack of appetite then the decadron is a better choice. I am a fan of ibuprfen but many docs prefer decadron. I have not seen them used together though. Lidodrem patches work well on nerve pain. Use for muscle or bone (at least for arthritis) pain. I say this from my personal experience when my nerve pain kicks in I reach for the patches but when the joint pain is present I go for the ibuprofen. My pain doc says to use what I need and I am usually using two one on each side of my spine with pretty good results and no negative results.