pkateRN

RN in an inpatient unit, not on call. in Ohio. 27 an hour, one dollar shift differential which makes it 28 an hour. I just started last week, came from a rehab facility.

last night a patient died right in my arms as I was holding him. that is one I need to give myself permission to move on from.

tewdles, I wanted to say thank you for giving the advice of "it is your loss professionally, not personally." that mantra is one i repeat over and over and as a result, the deaths have become easier to deal with. thank you for the perspective!

My second death was Wednesday, but I wasn't there for it...and for that I am thankful. I had been taking care of a man with leukemia for 2 weeks who was transfusion dependent before coming to me, and they decided to stop the transfusions. when I went into work yesterday I asked about his passing. they were reluctant to give me details, but eventually they told me the truth- that he bled out from every orifice very quickly, and even worse, his family was there. I cried and cried and cried that this is how he passed. when I last spoke with him he was not ready to die, he still had alot of things he wanted to do, and was fighting until the end. when I got off work I sat in the shower and cried some more. I wanted him to have a peaceful death, and some acceptance. does this ever get easier? I feel like I'm not cut out for hospice when I have this type of reaction.

you know, I've never really questioned why we don't take vitals.

thank you for the insight everybody. the nurse before me put in a subcutaneous port because all of the meds were subQ and he didn't want to poke the patient more than once. I gave one dose of scopolamine subQ and it worked beautifully. does the patch work better/give a higher dose?

Marcy, I am in an inpatient unit in a VA hospital. the general name of it is the Community Living Center, which is mostly rehab patients, but we have 14 palliative/hospice beds, depending on the need. I know other VAs have their own freestanding hospice units. the paperwork you do sounds like no fun at all...I just do one free text note on my hospice patients every couple hours or so with my assessment and how they are progressing. because of this, I'm able to spend more time with them while they are actively dying. most of my palliative patients have terminal cancer, and I mostly do symptom management for them. I bounce back and forth between palliative patients and hospice patients. I'm a brand new grad and this is my first nursing job. I did one of those MSN bridge programs because I already had a BS in bio.

after typing the last response I feel like I should explain why I said "these residents are idiots." we are primarily a rehab unit, with one hallway of palliative and hospice. the residents generally have no hospice experience, so our most experienced hospice nurse sat down and explained that on this unit: 1. we do not take vital signs on dying patients 2. we cannot IV push medication, so it has to go through another route 3. this patient is minimally responsive on admission, so PO route is not an option after this conversation, the resident ordered vitals qshift, activity up with assistance daily, and all med orders in the computer were PO and IV push. all orders had to be changed before I could take care of this man. she also told me that she didn't want to give him much medication because his liver is shot and it will build up. it has been such a struggle for me to advocate for this man when I'm new myself and am still learning. last night the resident said "do you know how hard it is to take care of these people? do what you feel is necessary and I'll sign the order." I just haven't totally learned what all is necessary, or what all my options even are.

I forgot to add, our residents are idiots this time. we get new ones every 2 weeks and I have no idea where these people came from. this morning, myself and my charge nurse FINALLY convinced them to give this man a morphine drip. I could tell by this morning that his pain was getting progressively worse so I'm thankful he has that coming. thank you for the responses so far. I am eager to learn about what other nurses would have done here. as I said, he is my first dying patient and I'm flying by the seat of my pants.

I came in yesterday and to my utter shock, my patient was still hanging on. I was with him 16 hours yesterday until this morning because one of the night shift nurses called off, and I couldn't justify leaving him without adequate nursing care. when I got report, I was told he was extremely restless and agitated all morning. I looked at the orders and saw morphine 4mg q4h and morphine 2mg q2h PRN. there was also haldol and Ativan on board still. I called his sister (only family) to tell her that based on my assessment, she may want to come into the unit. She said she couldn't make it but if he was still alive the next day she would come in. so it was just me and this gentleman for those 16 hours. during the course of that time, he was restless, moaning in his sleep, and having trouble breathing. I took a step back and asked myself "what would you do if this was mom or dad?" I decided to give him both scheduled and PRN doses of morphine, the haldol q2h and the ativan every 4 hours. he began to look more comfortable until he was repositioned, and at that time he groaned loudly and even opened his eyes for the first time in 2 days with a grimacing face. I felt horrible. his extremities were weeping huge amounts of fluid, he was bleeding in random spots and I could hear the fluid in his lungs with no stethoscope. based on that, I continued to give him everything in my orificenal to make him as comfortable as I could. it was definitely a learning curve the first day with him, but I felt more comfortable yesterday and this morning....I told myself, "you have to be confident in this. you are not going to let him die groaning and grimacing." to the person who asked, I had him and 4 other patients on the evening shift, and him and 7 others on the night shift. I'm so tired today I can barely function.

Hi Guys, I'm a new grad RN who was hired into a palliative care/hospice unit at a VA hospital. I have no prior experience with hospice (or nursing in general) and was given very limited training in this area- only 4 days before I was on my own. Today I received a new admit who was given days to weeks. His sister was supposed to visit him on Sunday. The resident ordered morphine 2-4mg q2H PRN, and haldol 1-2mg PRN. I also called her to get ativan on board in case he needed it. At the beginning of shift, he was out of it but still able to answer yes or no questions. This gentleman was the yellowest man I've ever seen (think curry powder yellow). He had a hx of alcohol abuse and his liver and kidneys were completely shut down. I decided to give him the max dose of morphine and haldol every 2 hours on the dot because I didn't want him to experience any discomfort. He wasn't very responsive so it was hard for me to tell whether he needed more. After the first couple doses, he went from minimally responsive and very restless/moaning to almost totally non-responsive and fell into a deep sleep. I asked for advice from the other nurse, who thought it was better to err on the side of caution and keep giving him the morphine every 2 hours because he was still occasionally moaning. He received a total of 16mg of morphine, 6mg haldol and 0.5mg ativan from me during my 8 hour shift. By the time I gave report at midnight, he was apneic and only breathing once every 30 seconds or so. I can't help but think I sped up the process too fast since his body can't metabolize the morphine or haldol. What would you have done in this situation? Did I give him too much too fast, in essence shutting his respiratory system down within 8 hours? I know it was inevitable, but I am feeling intense guilt that his sister won't see him because she lives far away and thought he had at least the weekend. Should I have spaced out the doses/given him less when I saw he went into a deep sleep? He is my first dying patient and I'm still not sure how all of this is supposed to work.

My first as a RN was last week. I took care of a gentleman who fought in WWII next to general mcarthur. he was holding on so hard, he had so much anxiety about dying. all the anxiety complicated his breathing and pain. when he finally passed, I breathed a sigh of relief for him. my first as a student nurse was hard. I was working ER, doing chest compressions on a guy who coded after he got there. he didn't make it. it was rough because I was pounding so hard on his chest trying to save him. I also had to do post mortem care for the first time and drop him off at the morgue. the morgue still makes me queasy.

today I was taking care of an end of life patient who is a 90 year old WWII vet. I was trying to make him comfortable, and as I leaned over him grabbed my boob and said "I'm sorry, I had to grab a titty one last time before I die" I was speechless!

The above poster is correct. I work at the VA and it takes months all the way up past a year to get hired in. the paperwork is outrageous, and background checks/references take them months to complete. you may be close to a year by the time all that is finished anyway.

update: raising this issue to my manager went nowhere. in addition, the patient's daughter is his legal guardian and was called into a family meeting where she decided that he is to have surgery in order to remove 2/3 of his tongue. he will also be trached. I read the PA note, in which the PA stated she had doubts he understood what he was about to go through and will need to be sedated/restrained after the surgery for an extended period of time. he hasn't had the surgery yet, but his newest thing is to make a gun with his fingers, pull the trigger and act like he is blowing his head off. even the nurses involved in forcing his care are horrified at how all of this is turning out for him.