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.

I have my MSN, and I am a bedside nurse. my education cost me 65,000 dollars, but I love my job thus far and certainly don't think it was a waste. I have the option to continue on, but I'm going to give it some years before I do.

Thank you for the replies. I should have made my original post clearer. This patient will usually take his medications for me, and if he doesn't, I go back and ask him a few times. He has issues with certain staff members- will only let specific people (me, charge nurse, and one or two other nurses) go near him. he generally refuses for other people, especially when they tell him to do things instead of asking. When he refuses for other staff on days, they grab one of us to assist. They are very stringent about patient refusals here- one of our NAs was just suspended for disconnecting a tube feed after he told her no and to get away, and for trying to force him to get out of bed.

Hi guys, I wanted to get your opinion on this. I just took my boards in June and was hired on a sub-acute rehab floor in a large hospital. one of my patients has been there for months and is post-CVA, he also recently found out he has late stage cancer. this patient is in pain all the time (prescribed narcotics have thus far not controlled his pain), and because of the stroke, he sometimes has a difficult time understanding what is going on. He often is non-compliant and refuses medications and treatments, and will only let certain staff come near him. Yesterday I was giving report to the nurse on the next shift. I told him that this patient had a routine bladder scan ordered because of PVR, however he refused the scan and became combative. his provider was notified of this and did not give orders to proceed with the scan. the nurse told me that the refusal wasn't an excuse, and I need to force him to comply. he pointed to my lack of nursing experience for not forcing him to comply. I have also overheard that this nurse and a couple of others frequently hold him down against his will to get routine procedures done (nothing emergent). I had huge issues with what he said/did. We are a restraint-free facility, and in the patient rights, it says that physically forcing a patient into something against their will is assault. I decided to go to my nurse manager with it, not just to cover my butt, but also because it stung to hear that a patient I've gotten to know and like, who is at the end of his journey and in pain, is being treated poorly. My manager didn't seem overly concerned, and said she would talk to the specific nurse. I'm afraid I've poisoned the well- this nurse is my new charge nurse once I switch to 2nd shift at the end of the month. How would you have handled this situation? Is there anything I could have done differently? I'm wondering how to approach the situation if it backfires on me, and the other nurse finds out I blew the whistle. any advice is greatly appreciated, I am still learning (I've been a working RN for 3 weeks) and am open to suggestions.

OP, I have been there and I know how big of a blow it can be to your self esteem. during my last semester of school I precepted in the ER- I was in the direct entry MSN program. my preceptor and I started out fine, but things quickly went downhill. she was very quick to make personal insults toward me, in front of co workers and patients, that had nothing to do with my performance. she refused to let me sit down to chart, even after working 16 hour night shifts with her because she told me I was not worthy of sitting since I wasn't a real nurse. I went to my clinical advisor and told her all of this, who sat down with my preceptor. my preceptor openly admitted she thought the direct entry program was BS because of that, she had no desire to help me learn or treat me well. we have a shortage of willing preceptors here- often times, nurses are just told they're getting a student without warning. im sure it was frustrating for her since she didn't want a student, but it left me broken down every night and crying over the personal insults. in the end, I was transferred to another floor where my new preceptor was extremely willing to teach and was very pleasant. only you know how much you can put up with. I hope your job search works out.

Once, when I was in nursing school, I was shadowing the wound nurse for the day. The first wound-vac dressing change I was to do was on a man's scrotum. When he asked who would be doing the dressing change, and I said I was, he promptly opened his legs spread eagle and said "boy am I lucky!" ...this man also had a large, naked woman tattoo on his arm. creeper.

hi folks, this is my first time posting here :) I precepted in a public hospital ER, where we were the safety net and often last resort for many patients. I once had a patient who was probably 18 or so, told me he had a migraine, and this was his third ER today because no one would give him pain medication. I thought the whole thing was odd, but was instructed to start an IV, so I did. After getting the IV in, he told me he wanted to go out and smoke a cigarette. I was taught by the ER staff to never let a patient with an intact IV go out and smoke- drug use runs rampant here, and god forbid they'd leave with the IV, want to get high and shoot whatever drug straight through it. I explained to him that it was hospital policy that I could not let him leave with an intact IV- if he wanted to go outside to smoke, I would have to pull it, and he would have to re-register. After I said that, he screamed at me that I was worthless, and to go F myself. he then yanked the IV out and stormed out of the hospital. I didn't even have time to say anything back, but I don't think there was much I could have said. He obviously had deeper issues, and me going off on him wasn't going to make the situation any better. On the other hand, I'm curious as to how people here would respond to a situation (that I would consider verbally abusive) with my preceptor. It was only the second code I'd ever been in the room for, and while the other staff were working on the coding patient, I was instructed to put a catheter in the patient. I had never placed one in a male patient before, so I asked for guidance from the nurse across from me while my preceptor was behind me scribing. After I told the nurse across from me that I hadn't put one in a male patient before, my preceptor says behind me, loud enough for the entire room of people to hear, "she is so young, I bet she's never seen a d*ck in her life." as time went on, she would yell at me in front of other staff members, and told me after running around with my head cut off for 12-16 hours, that I was not allowed to sit in a chair at all, because "only real nurses get to sit down to chart." I told my clinical advisor all this, who had a conversation with her- and my preceptor flat out told my advisor the reason she was so mean to me was because I was working toward my direct entry MSN degree, and she thought the degree was BS. I never said anything back to her, because she was in a position of power over me. I still wonder to this day if I was right to take the route I take with my patients- don't say anything nasty back, or if I should have stood up to her.