MSNce1

Joy, I saw your posting as a Faith Community Nurse. I appear on Westberg from time to time and get the Journal of Christian Nursing but albeit there are other faith based nursing journals out there. Currently practice dual nursing as a faith community nurse in pediatric home care for special needs kids. Both child and parent (s) need much encouragement and support. I too believe nurse burnout is so common and such nurses who practice or are interested in faith support could use a faith based community nurse for inspiration and support. Thank goodness there are other forms of nursing that are not as strenuous mentally and physically. I would encourage such nurses to do some investigating into such sub fields of nursing at least for a break. Some alternatives I can think of are long term care, home care, office nursing or adjunct faculty teaching in ADN or still functioning LPN programs.

Loved the article on hospice nurse experience. I learned that even non-hospice home care shared many of the same attributes of nursing care approach. Keep writing as your perceptions are very helpful and enlightening.

Of course prayer is needed. As a faith community nurse I feel you are absolutely aware of the influence such event has not only on this student's family but the peers as well. The awareness of such mental health disparity in the community has grown by leaps and bounds and a workshop for parents should be something the school could arrange in management efforts to prevent such mishaps.

One of my nursing jobs involves home care and the company I work for is still paying hourly which benefits Medicaid/Medicare and other insurance in that sometimes care delivery can occur in smaller packets of time. I was pleased to see you examined how the administrative position choices for payment of the nurse affected nursing care delivery as I have not seen such posting before. Calling nurse entrepreneurs in your state to set up their own agency and change up nurse pay to hourly unless this is a state mandate. When I train for a new case I believe the lack of client nurse interaction is from training but have heard from parents how this is not usually the reason as documentation usurps the nurse:child interaction time. As we know this also occurs in other settings like hospitals or outpatient care. I have also heard many a client complain about a docs head being focused down onto a laptop while with a client. So by what schedule method would you propose documentation be handled?

If you choose a reaction based on what others think of you life will be robbed of joy. It could be such student(s) are not angry at you rather embarrassed at not being prepared. Presentation will influence your responses such as "From what I gather...." rather than commenting what your understanding from a reading assignment or prep work.

Like Juan I believe making decisions based on passe' beliefs about aging leaves little room for true understanding that aging is not in and of itself a disorder. There could also be rationale for this choice to obtain a DNP later in life which regard improved income function say post divorce or loss of a spouse/partner. Use of the NP does not have to involve independent practice rather a more senior professor position well supported and audited in an academic setting. The nursing profession needs continued growth in such leadership positions whether from younger or more experienced generations.

I totally agree with concerns expressed about client outcomes secondary to mismanagement of resources ( a secretary making nurse assignments-the clinical director is not taking responsibility) and lack of effective leadership. Call behaviors inducing unfair treatment, racism or whatever you like but these actions still create an atmosphere of competition and derision rather than teamwork and caring. There is no doubt clients/their families and add line staff (housekeeping, phlebotomist, transporters, nurse aides, etc.) will pick up on this which affects the conditions such populations must endure as well. Remember the old adage 'the fish stinks from the head on down' well this rings true in these circumstances. Sounds like such work environment is caustic not nurturing and must be stopped.Type an anonymous letter but do not sign it and send it to HR, this way you do not risk bringing attention to yourself. Good luck.

The time you have with your 'lil' one goes by so fast. If it was me, I would take just one a course at a time until your child is at least in a pre-school/day care program. Meanwhile you can share what you learn with your colleagues which enhances the profession. Sounds like you love women's health and it is a natural for you so I believe you chose the program well as George Town has an excellent reputation and is more well known (Lord knows they advertise a lot). You will eventually get that investment back in spades and to name a few options can get work in a clinic with other nurses or midwives or a hospital system. If you apply for loan forgiveness at least some of the debt load can be reduced significantly. This works best working for a state or government facility such as on a military post but as a civilian worker once you graduate. Like nurses wear multiple hats so it has been shown 'we can have our cake and eat it too':)

Sounds challenging but you have found something that works. Thank you for sharing with the rest of us.

Client (in this case via a family rep) abuse is never acceptable. The fact remains such volatile reaction not only affects those personally involved but others around them. Holding your ground by remaining calm and professional is a testament to your awareness of this fact. I have been verbally abused by not only those I am directly caring for but add line staff such as doctors, other nurses, supervisors and nurse aids. Ironically, our humanity often gets in the way of our functioning though victimization venting is perspective dependent so usually ineffective. Like others in their responses, to you dear heart, I believe from all perspectives there is usually a lack of understanding and frustration plus a sense of inadequacy involved (regulated by emotion). A position of service will always run the risk of such maladaptation. I am sure you have thought about how this may have been avoided or at least modified such as communication to family about client's choices. I understand your advocating for client choice as those with dementia go in and out of awareness and providing dignity through choice is something I would have done as well. It is challenging to deal with family members who want to 'run the show' yet are not there caring for their loved one 24/7. Awareness of all these factors I hope will aide you in future family or staff confrontations despite your prudent care.

I know someone at 92 who is at end stages of vascular dementia and so I understand from an emotional standpoint both sides of this very creatively composed story. Interestingly enough, it is some of the nurses who are caring for this woman are having a hard time with letting her go. They will wake her up to try and feed her three meals a day but she is having a hard time swallowing at points and one never knows when this issue will come up so why take the chance on having her choke to death or get aspiration pneumonia. She is being advocated for this with the staff but the social worker mentioned though she is on hospice care, because she is not in a hospice place, the staff are not as attuned to this. She does not acclimate to new environments well. An in-service is desperately needed here.

If you are sick you are sick and state of mind when ill is altered but not in a good way. So yes by all means stay home. If your kids are that ill, it will be hard for you to concentrate while at work which could lead to a med error, slower work, or not picking up on assessment accurately. Again, this is what the Family Medical leave act is all about, taking leave when there are health related issues within the family unit. Besides, is it really ethical to come in sick or be a carrier from your kids illness and bring such pathogens to your clients- a rhetorical question of course; as nurses we have to take care of ourselves before we can take care of others. To not be supported in this is abuse (horizontal violence) between one nurse and another.

I worked mother-baby many years and loved it. Like Silver1 said there are protocols to follow which I believe you will learn quickly. Look at a U tube ahead of time on feeling a fundus though hands on is more effective learning but you will at least have some familiarity. Does you school have the latest OB manikin model 'Victoria'. It is amazing how the simm experience can help you. Remember you will sometimes see a lot of blood and clots- just stay with client and stay calm massaging that top of the uterus (the fundus) till bleeding reduced and the fundus will usually firm up. I would not get someone up to the BR with heavy bleeding rather have someone bring you a cath kit if mom's bladder is pushing her uterus up and way off to the side and the uterus does not firm up and she is unable to void. A full bladder makes the uterus displaced up or off to the side and boggy (soft). You may pull the nurse call chord out of the wall at the bedside it will many times emit an emergency response sound so you will get assistance sooner, or you can call your preceptor from the bedside. The BUBBLE acronym for assessment is the check Breasts (for nipple inversion or flat and s/s of redness &/or excess warmth of the breast tissue or firmness and while examining the upper front body you can listen to lung sounds; Umbilicus (to note where the top of the uterus is at in relation to the belly button area-above it, to the side or a horizontal finger width below-Bowel sounds, softness and if BM occurred or problems having one; Bladder-should not be but is it soft and spongy and distended? (try waiting to go to the bathroom to urinate and check how your supra-pubic area feels) and ask if any UTI s/s and of course if there is a C-section incision in this area check if intact and with or w/o signs of redness &/or induration; lochia (lady partsl discharge/bleeding if it is bright (Rubra)or dark red, mixed with serous clear fluid (serosa) and are Kotex type pads being soaked through in an hour ( not good) or less, plus are there any clots especially > the size of a plum); and last Episiotomy- check after they have just used their peri wash bottle-is it real red looking, intact or open or very bruised (nursing action through your preceptor to let the doctor know)? There is another addition to this acronym with the letters HE standing for Homans- check for clots in the calves- but latest evidenced based practice says not to do anymore as if there is a clot the nurse would possibly be dislodging it so instead check for hemorrhoids which look like pink to skin colored lima beans, and The 'E' here stands for emotional welfare as (if mom is unable to take care of herself unless post C-section day 0 or 1 this can be more than the baby blues setting in) Silver 1 had mentioned. So nursing care would involve documentation, possible need for teaching like the need to keep incision areas clean and how or use of nipple protrusion aides, and giving pain &/or healing meds such as Motrin or Epifoam for perineum) or Pitocin ( to manage PP bleeding) in IVF. The first time or two OOB your fresh C-section will need your assistance and of course and maybe help with care of the baby. Since lactation consultants are not usually available at night the BF mom may need help getting the baby latched on properly. There will also be a newborn assessment and care you will learn about. This is a lot of what you will do or be supervised doing but not all. You will learn it quicker than you think and many things will become routine so enjoy it over an acute med-surg setting:0

Lovelyeve27, as a nurse educator I have inside information that Hurst is the most successful NCLEX preps used for nurses. To me that would be worth it though many of the study where I teach love Kaplan and hate HESI. The latter does teach students to think on how to think before answering a question. Our school uses a cross-section of NCLEX prep programs. I studied with a bunch of nursing students that had just graduated like I did and each of us helped the other in our area we did best in. That worked out well.

You should be proud. That is not only hard work but takes a lot of self discipline. I did my certification years ago as maternal-newborn nurse and boy I was surprised how much respect one gets for certification specialties. It amazing what you learn that you did not learn in nursing school. It is more fun studying for this as a group though. I might need your advice as thinking on arthroscopy during winter break from teaching clinical as I just found out I have a torn meniscus and MCL tear but support devices worsen the pain. Any suggestions?