tencat

It really doesn't matter if he is putting on makeup or lipgloss or perfume. And if you're going to get on his case about toning down perfume, you'll have to make sure you get on all the other kids too, as ALL jr. high kids wear WAY too much perfume and cologne. :) As to sexual behaviors: these days ALL sexual behavior is risky, whether it be heterosexual or homosexual. So I don't think it's appropriate to single him out to 'preach' about the risks of a 'homosexual' lifestyle. The kid is attention seeking. However, it's not worth making a big deal over. If he's a frequent flier in the nurse's office, then the issue needs to be addressed. I'm willing to bet his peers are less than supportive of his oddness, and he's having issues with the other kids. Maybe he sees you as a safe person and your office as a safe place. The school counselor should also be aware of him, if that person is not already. I think you are bothered by a boy acting like a girl. That's ok, but you need to make sure that feeling doesn't interfere with your care of this kid or any other kid like him. For the record, I've seen girls who pretend to be boys, as well as boys trying to look like girls. Some of these kids will 'grow' out of their particular way of creating shock value in the adults around them, but a lot of them will not and will struggle for the rest of their lives with their sexual identities. There is a high suicide rate among gay/transgendered kids.

I have held medications when patients have had respirations of 6-8 per minute. I had one recently who was snowed on dilaudid q 3 hours ATC and we backed off, gave a long acting med (methadone), and she woke up :) So there are times when it is appropriate to hold meds. The hospice nurse should have been able to tell you WHY the morphine was ordered ATC and should NOT have given you the "He's dying anyway" answer. It's a fine line we walk in hospice: comfort vs. 'safety' of the patient. The challenge lies in striking a balance, and always the patient's comfort is the top priority. In response to ronpanzer: There are other reasons to give morphine besides for pain control. Just wanted to point that out.

I was a high school teacher for 12 years before I went back to school for nursing, and I'm not sorry I did. Nurses face some similar issues to educators: No respect, huge workloads, 'customer' service vs. doing what's right. However, I've found in nursing (and I know not every nurse feels this way) that I'm not responsible for what my patients choose to do or not do. In education teachers are responsible for EVERYTHING, whether or not they have control over it (such as attendance in the classroom, kids beating each other up on the way from or to school WAY off school grounds, etc.). The only thing I REALLY miss is a decent amount of time off to be with my family on vacations. Of course, now with two kids we can't afford it anyway :) so I guess it all evens out in the end. It is hard to be older and start out brand-spanking new to a field after having established one's self in another field, but in some cases my age has helped earn me respect as many folks think because I'm 'older' I have been nursing for a while . That can backfire, too though when you don't know something and get a blank stare on your face. Then you get the whole "Wow, what an idiot! Did she get her degree out of a Cracker Jack box????" look.

Why does everyone have to die at 2:00 AM????

"Tramp Stamp"....heh heh heh.....thanks for the new term! :)

Instead of taking it out on the coworkers who are sick, blame management for not planning ahead and having enough folks available just in case someone has to be out. There are some of our coworkers who abuse the system, I know. But so many times those that staff don't even plan for known absences, much less emergent absences.

So many misconceptions from medical people who SHOULD know better...so take the time to learn, those of you who feel that we must keep people alive at all costs and we are killing them if we withdraw nutrition and hydration. If someone is dying and their bodies are showing signs of not using food, the LAST thing they need is to be filled up with fluid and artificial nutrition so that they can choke on the fluid filling their lungs and wallow in their own diarrhea. If your patient is as thin as a match stick, has fluids and nutrition, and is constantly having stomach pain and diarrhea (I just had one like that) the KINDEST and most HUMANE thing to do is to discontinue fluids and feedings. The physiology of dying is such that dehydration and lack of intake actually cause a natural cascade of endorphins in the brain that help ease the dying process. It is horrible to watch someone die when we fail to withdraw what only causes more pain and misery. After a certain point it becomes torture. Terri Schiavo is obviously a different case. It would have been good if she had made her wishes widely known. But what quality of life did she have? She had no higher brain function and was alive in the strict minimal definition of the word. But how many of us would want to be alive like that? I sure as heck wouldn't. But if someone wanted to be, then it should be done.

I agree that once someone crosses the line and steals drugs from patients, it's time for him/her to rethink careers. I have issues with letting these nurses come back into the 'fold' because there is a HIGH probability that they will do it again.....and again....yes they have an illness. However, that illness makes nursing a job they should probably avoid. Not because they are subhuman or lacking morales, but because they will be around drugs daily and that's too much temptation.

I was a high school teacher for 12 years before I went to nursing school and have been a nurse for 5 years. I love what I do, and I'm not sorry I switched careers. I miss all the vacation time teachers have, and I miss the retirement I could have had :) but the day-to-day....NOT A BIT. I have tough days and get grumpy or cry at times, but on the whole I am enjoying my new career and can see myself in my current job for years to come. I just wish I had more than 2 paid weeks a year off and a decent shot at retiring before I'm 100.....

Our office used to do that, and I was never comfortable with it. There are many things that can go wrong. The powers that be decided that maybe it wasn't such a good idea after all and scrapped it. It can be a pain to try to get meds for someone in a rural area or in a place where there are not 24-hour pharmacies. Our company has now contracted with a courier service, which has helped.

Vomit. Sympathetic vomiter here, and it's REALLY hard to hold back! I'll do poop any day over vomit :)

Made me chuckle! I'm sorry, but I just don't see how this is offensive. Someone somewhere will ALWAYS find something to be offended by......we can't stop getting older, so we might as well laugh about it. I know the current generation of increasingly elderly folks has a lot of individuals that could benefit from lightening up about getting older....just saying......

EVERYONE IS ENTITLED (Yes, I said entitled) TO BE RESPECTED AND TREATED DECENTLY WHEN THEY ARE DOING A JOB. Period. There should be no discussion of IF it should be done. And people who hold your particular view of those they manage wonder why on earth turnover is so high and no one wants to work in their facility.....'customers' do NOT have the right to do whatever they want to do to whomever they feel like doing it to, no matter how much 'money' they bring in. Yes, the reality is that those in power don't care anything at all about those who work for them, but that doesn't make it ok or right. They will also find that the care in their facility will become substandard as they continue to belittle the importance of their staff and lose more of them. I don't think it says 'be abused daily and smile while it's happening' in anyone's contract, so NO I don't have to bend over and take it. I can refuse a patient or make a stink about it. Yes, I can also lose my job, but I'd rather walk. There are other places I can work that are better. At least we both agree that leaving is an option.

I think the fact that the OP was honest and forthright says a lot. At least she is honest about how she feels and willing to own it. It is what it is. If her attitude impairs her ability to give her patients good care, then it is a problem. I think if she were not honest with herself about her prejudices (and we ALL HAVE THEM) she would be more likely to give sub-par care. As so many have said, professionalism is the difference: Recognize that you may feel that way, but don't let that stop you from giving the 3-pack a day smoker with lung cancer the best care possible.

THATS what is bothering me. A sheet or gown CANNOT cost that much that it needs to be discarded to save pennies for the bean counters.

Disrespectful and not necessary. I know the person doesn't care, but the loved ones DO.

Thanks all. Just wanted to know if this was the norm. I admit I got a bit paranoid, too, and wondered if the other agency 'forgot' on purpose :) But I think it was a miscommunication thing. Everything was handled at the main office, then transferred 100 miles to our staff, and the meds got lost in the shuffle. Sometimes it's really inconvenient to be 100 miles away from the big town and office. This is the first time we'd had a patient from another agency, so I suppose we were both assuming that the other would get what was needed, and of course neither did!

I have been working hospice for 4 years, and I've only ever worked for one agency, so I don't know if this is normal or not. A rival company has an inpatient unit, and they had a patient there from our town who had not yet signed up with our agency. Patient was there for pain management issues after a relatively new diagnosis of cancer. Pt family wanted patient back home with hospice, but rival company does not serve this area, so patient was referred to us. All fine and dandy until patient comes home. Spent 7 days in inpatient unit with PICC line being titrated on Dilaudid (morphine allergy). Two days before discharge patient yanks his OWN PICC line (agitated) and goes on oral meds. Patient transported home, I get there as Ambulance is leaving, and first thing I notice is patient is REALLY agitated and moaning, take vitals and HR is 125. So I ask wife when his last dose of dilaudid was. She said it was right before he left the unit for the 2-hour ambulance ride. He has been on PRN breakthrough doses every 2 hours, so I ask wife if we can give him a dose. She says "Oh good. You brought it with you." "Noooo......don't you have some?" I ask. She gives me the blank look. So I ask her where the prescriptions are that he might have been discharged with. He was discharged without ANY medications and NO written prescriptions to fill any medications late on a Friday afternoon to a town with no 24-hour pharmacy. We got it taken care of, but it took 4 hours of the day, a special favor from a pharmacist that knows the family (nothing illegal), and an annoyed physician to do it. (Dr. wasn't mad at me, thank goodness). Is it normal to discharge a patient from inpatient without pain medications or prescriptions for them? Hospitals do that to us sometimes, but I kind of expect better from HOSPICE.

Unfortunately, it is the unwritten policy for most nurses as well.....I've got bronchitis and my employer is peeved because I had to take the day off. Dr. ordered it and encouraged tomorrow, but my boss would have several cows if I did that as we are down a couple of nurses already due to the firing of two of them (not related to their work attendance).....don't really want to be the latest blip on the radar to be shot down....so I'll work

My pleasantly demented little old man called the police to come to his house to take his wife away because he was mad at her. While wife was telling the story I asked him if it was true. He very seriously replied, "Yes. And they didn't come. I don't know why." Same guy was taking a nap in bed when I came to assess him. I woke him up and he flipped back the covers and moved over saying "Oh good! You're here to get in bed with me!" When I told him no, he looked really disappointed and said, "Oh. Are you sure?"

Is he cognitively impaired? If not, then it's HIS decision whether or not to have pain medication, no matter what wife says. If she's the POA and is officially making his decisions, then you've got another issue on your hands. You might try asking wife why she doesn't think he needs medications, or why she's afraid to give him any.

To the nurse I now work with: I love you! I love you! I love you! If I were going to have more children, I'd name one after you! You've made my job SO much better because of your great attitude and willingness to do whatever needs to be done without incessant complaining, unlike the LAST nurse I had to work with. :)

SEAMEN are FULL of bacteria, especially after days at sea without a shower....

Hospice is probably the most misunderstood niche of nursing there is, at least in my experience. Either people are terrified of it (I can't watch a patient die!) or they are suspicious of it (Morphine??? Are you crazy???? He'll quit breathing!) and most other medical people I've run into don't take the time to understand it. Psychosocial stuff is a HUGE part of what we do (I sit and watch Judge Judy with one of my patients as a large part of our visit because that's what he likes to do and he's lonely. I really don't LIKE her, but it makes him happy). Do I check vitals? Yes, I find them to be valuable to me as they can show me when a patient might be making a turn for the worse, especially if they can't tell me what's going on for whatever reason. Usually we've worked with our patients for a long enough period of time that we know what's going on with them without a detailed assessment every time we visit. Ask your clinical nurse about what she does when her clients become more unstable, maybe request she help you see a more unstable patient with another nurse if she doesn't have any right now? It will take more than two days with her to see what hospice is about.