Libby1987

Thank you for discussing such an important topic. Perhaps it’s implied but it seems some steps are missing. This is how I reconcile medications: Gather all meds in home. Verify which meds patient has been taking since last medical encounter. (ie since home from hosptial) Compare these meds against most recent MD ordered list of medications. (ie discharge instructions) Note any discrepancies, notify MD and correct with changing, adding and/or omitting as indicated Have patient/CG teach back reconciled list and identify container and how to take. Request/suggest how to safely set up/organization/storage of meds if needed (ie remove discontinued meds and store elsewhere, correct mediplanner) Leave legible med schedule written in layman terms with patient. Follow up for understanding and compliance next visit.

I might have missed it but why aren't you you bridging the job you had in nursing school until the grad program starts?

I was thinking that I would not want my photo associated with this story.

I agree. I'm not an acute nurse but regardless whether protocols were in place and/or followed, this nurse couldn't have tried harder to screw up. There had to be something going with her besides being rushed and working outside her scope. I think looking for opportunities of improvement are essential but I also think it was as simple as someone practicing with gross incompetence was overlooked. (I think with the fact that she was orienting anyone a hard look at how they are confirming competency is warranted)

I'm happy with my career and it's been very good to me. It's easy to be impactful everyday and make something cool happen. I've had many opportunities for growth and influence with much encouragement. It is hard work and the first years were the roughest but after the first 5 I've been treated well by every employer. With rare exception on the worst day I have not regretted it and am glad for my career. It's truly something I'd be happy to volunteer doing on a part time basis if I didn't need to generate an income.

As a case manager familiar with your patients you are being asked to contact the patients on your caseload to check in with them and let them know services are closed today and perhaps assess for needs that require attention. The weather makes travel a risk but they still need you to work to assist with patient contact. It sounds like your clinic hasn't provided a disaster preparedness plan but it seems a safer alternative to requiring staff to drive to the office to make these calls. I've been calling patients from home as a normal course of business for decades, without incident. Asking if you should block your number is a reasonable question for someone not accustomed to alternate communication practice but calling from home as disaster protocol (formal or not) would never be something I'd push back against due to discomfort. With the environmental crises in Northern California everyone is doing whatever it takes to communicate with patients. And of course you will be paid for hours worked as requested by your employer, that's the law though I would bet it's a non issue.

Not our call to make but I view it as selfish and weak, it's neither love nor advocacy when the family prolong and/or add to the suffering. I feel for the OP.

Stock and housing market gullibility. That is such a great analogy. Especially with thread after thread claiming ignorance to the NP education and market trends. I haven't applied for NP and I've read enough to see many of the problems beginning years ago. Yet those who would practice aren't doing the research, that's unsettling in of itself. I grew up when the best went on to NP, I can't un-know that influence.

I would advise my younger self to not look for the job to grow on me, to become something like able.. look at it as the opportunity it is, to learn and gain skill. Tell yourself every night that you don't need to like it or to feel confident. You're getting up in the morning to face the challenge and on the worst day you're still building skill and experience. Think of it as an investment in yourself for a career that's still ahead of you. Those office jobs by the way are 1) also attractive to nurses with experience 2) not all that you might think they are, with experience they will always be there, without experience your options will narrow. What you're doing now is essentially an internship, that you're being paid for to your benefit. If you can think of it like that versus not liking it, you can let it work for you.

Totally agree, be kind, direct and don't use your husband as the reason his behavior needs to change.

My current employer offers near zero OOP healthcare insurance if care is received within its own system. That's not fair compared to what? To my former much smaller company that had such high premiums and huge deductible without office and prescription coverage that the non licensed staff literally could not afford to use it or seek healthcare? Not fair compared to the tens of millions without coverage or inadequate coverage? This is not a fairness issue. Hearing an educated professional claim it's not fair is worrisome not only because it's better insurance than many have but also due to the free choice of employers one has as well as the giant screaming elephant of healthcare access being tied to employment. That's what is unfair and the Haves continue to support this long held societal norm.

Delete

Never been bullied. Have been scolded, embarrassed, feelings hurt, vented on.. never bullied.

Confirming the offer is important but a concern of mine would be whether this a position that is hard to fill and/or they only want you so will postpone the start date due to your availability?

Yelling/raised voice in of itself isn't an issue for me but a techibka HR issue and it can be unnerving when you lack confidence. I'd (and this is me who grew up at a time when being scolded by a senior nurse was practically a rite of passage) be more interested if there was a hard lesson in there for me. Did the actively dying patient miss a dose or under dosed?

I read your post as a pretty transparent admission to letting your friend down with self awareness that you have a pattern of inability to sustain any longevity. And I think you're needing to both put it out there that you feel bad about it but someone saying they're get it would help the guilt a little. That's pretty natural, I've certainly done the same with my friends where I feel like awful but I don't want to be awful. I can identify with that. I can also identify with those left behind whose worklife is going to remain difficult when someone quits, particularly with short notice. I can't speak for anyone else but I think that's where the comments that seem negative come from. One thing I feel confident about understanding through is that it doesn't come from jealousy. "You're just jealous" type reaction don't show an awareness of the impact that actions and words have on others.

Although not as physically tiring, you woukd have to deal with many of the same issues. Home Health is heavily measured on patient outcomes, reduced readmissions and customer satisfaction. I'm compelled to meet all 3 and I don't resent the, seemingly unnecessary and non sensical to many, hoops to do so including the tremendous amount of documentation that everyone underestimates prior to experiencing it. Home health is not for everybody but with every nurse that I've worked with or hired that came from a burnt out position they remained dissatisfied.

Where I am right now in terms of age and health, and it's witnessed as well as initiated timely, yes please attempt resuscitation. If I'm no longer highly functioning and/or have late stages of disease, don't even treat infection let alone CPR. Keep me comfortable and let me go.

Not home health.

Hugs, being a mom is hard no matter the circumstances. You're probably feeling like a single mom at times which is harder. And then to have a co parent who isn't like minded regarding parenting, hardest of all. These kids turn out to whom they're meant to be with simply love and support, you can't really force any course or direction on them other than ensuring they have those two vital things. But if you think your son needs more of your time and influence as well as modeling happy life balance, consider public school and cutting back on the hours you work to pay for private school.

This is the challenge working for a little start up, or one that never builds a referral base. Really, only experienced home health nurses should be part establishing a new agency because the hours are extreme and irregular until a patient census is built to support full staffing. I say experienced HH nurses because they know what they're getting into and would have their reasons to want to participate. Hard to find those nurses though when most want stable hours and wages. So not normal in the usual sense but expected with a tiny operation. Theoretically the agency has to provide services to existing patients (depending on active patients' needs) 7 days a week and there's no way around pulling on you when you are essentially and solely the nursing team. How did the director explain this to you? Also, based on your description of visit type and length, these aren't necessarily billable visits. Is this agency both licensed and Medicare certified (not likely)? ETA if you have 12 years recent acute care experience, you can do much better than a rinky dink agency. The challenge would be finding one who would hire an RN without home health experience into a part time position. A solid orientation period is costly for only a part time ROI as well as you want to be well prepared to work autonomously and competently in a field new to you. If you can and are willing to make the initial investment in return for years of future flexibility, I'd recommend obtaining a full time position with an accredited agency and reduce to part time after a year or so.

That sounds like pretty awful circumstances. I left nursing for several years to stay home with the kids, and on the heels of major changes going on in my industry so had some disillusionment going on as well. I kept my license in inactive status until I was ready to go back to work. When I did go back, I had more job satisfaction than ever. Is public health an option?

I understand what you're saying and if I worked for a different organization that would be true. Ours is tied into an urban hosptial and we accept the most psycho-socially difficult cases that other agencies would decline with their selective options. I support my staff in dealing with these cases and try my best to help them balance and manage the service we need to provide and the behaviors of these populations. Changing my perspective was a game changer for me, it opened the door to better managing these predictive behaviors in that I learned how to head them off before making patient contact. Going into a patient's home where the patient and/or caregivers have documented poor behaviors in the hospital stay/s and then responding to their behaviors at face value can be less successful than proactively preparing to validate the patient/caregiver experience before they act out sets a different tone and rapport going forward. Of course the outliers exist, impossible to work with, I would say most in my experience those had a personality disorder that were far beyond managing and forming cooperation, definitely beyond my skill set. I'm sure that sounds like complete bull crap but it took me years to learn ways that can minimize if not entirely prevent both their instinctual and learned behaviors. I haven't work acute care in decades but I've walked cold into thousands of homes over a span of 30 years, dealing with all walks of life (the articulate caregiver who with unreasonable expectations can actually be the most difficult). In years past I've ignited their aggravation, hostility and acting out and learned that my approach and attitude make a huge difference in their regard of me from the outset I definitely set boundaries but they don't I'm doing, you will never hear me say things like, "if you can't speak respectfully.. if you can't lower your voice...." And like I said in a previous post, I don't do handstands and I'm opposed to nurses who buddy up to patients/caregiver and form unprofessional relationships in order to be liked. All that said, I understand this is a thread intended for venting the stresses hospital nurses face and no one was looking for a different perspective, certainly not from a non hospital nurse who's not relatable.

You might want to look up the CDPH requirements for new grads. I had to develop a year long orientation plan including what/how the new grad would be instructed, supervised, measured and monitored.. after I provided proof that we had to hire a new grad due to a shortage of nurses in the area. It was quite the undertaking that had to be reviewed and approved so I imagine something sketchy is going on with your employer based on the scanty training they've provided you.

I love what you've written here and your mindset is actually similar to mine. I can see how it appears that I'm insinuating that the scenarios don't occur. Regardless of what I think does or doesn't happen is irrelevant since I not only don't work inpatient but I also don't work with any of these posters. My point was more about perception. After 30 yrs my mindset and perception have changed. I've gone from taking patient and caregiver behaviors at face value and as a result had more frustration. This not only affected my work experience but no doubt in my case affected the patient/caregiver behavior and experience and round we go. Once however I started mitigating those behaviors with the issues you've listed above, it changed the experience for both me and the patient/caregiver. How I see and react to those behaviors when I see them coming on (anxiety etc) is entirely different than it used to be and the outcome out of that is a lessening of the inclined behavior. I try to influence my team to have a different perception as well, not to be dismissive but as a way to navigate working in today's healthcare. To be able to have better job satisfaction after all of these years later in a more challenging environment, with the psychosocial complexities, consumer expectations and trying to navigate CMS VBP, than we've ever had before is a blessing. I apologize to those I've offended.