missninaRN

Got this in an email from the OK BON this week: "Effective January 1, 2014, Registered Nurses and Licensed Practical Nurses licensed in the State of Oklahoma must meet continuing qualifications for practice, by completing one or more of the following requirements within the past two years prior to the expiration date of the license: 1. Employment in a position that requires a registered nurse/practical nurse license with verification of at least 520 work hours; or 2. Completion of at least twenty-four (24) contact hours of continuing education applicable to nursing practice; or 3. Current certification in a nursing specialty area; or 4. Completion of a Board-approved refresher course; or 5. Completion of at least six (6) academic semester credit hours of nursing coursework at the licensee's current level of licensure or higher" Since I'm not currently practicing due to a disabling long-term illness, the only option that will be doable for me is the continuing education. I just not sure how to find CE sources that are fully accredited/accepted by the OK BON. I'm wondering if anybody else doing the CE option and/or can provide reliable sources for CEs?

I averaged 12 patients when I was working at my last agency. The agency did not consider travel time when scheduling my visits. I had patients up to 1 3/4 hours away from me that required daily visits and often drove over 200 miles daily. I was required to do an admission on a Saturday-though the patient's condition didn't warrant it, but the marketer had promised that I would. The patient was 1 1/2 hours from me and I was paid around $20 for it because I was salaried. It came out to about $4 an hour. I will never work at a for-profit hospice again.

I worked a long day yesterday. I went in early, stayed late, and barely had time to eat lunch. If one patient hadn't declined a bath, I would have still been working at 7:00 p.m. (Yes, the nurses are giving baths because we lost our CHHA last week. I pray every night that we get a new one and soon.) Shortly after getting home, my cell phone rang. It was one of our office staff who has a family member on our hospice service. The patient was in pain, couldn't have another dose of pain meds for a few hours, and she called to ask me to take care of it. This would have been fine if I had been the nurse on call. But I wasn't. Even if I was on call, the primary nurse is the LPN (I'm just the backup) and the proper way to reach the on call nurse is through triage. I admit that I was a tad irritated that my coworker did not call the after hours phone number we give to every patient and their family when we admit them. I don't know if she was just panicked or if she felt that being a company employee with access to the RNs cell phone numbers entitled her to call whoever she wanted whenever she wanted. So, I very nicely instructed her to call triage so that the on call nurse could handle it. Was I wrong? What would you have done?

Thanks for the link, will check it out. My community college doesn't offer it online and the online school I'm taking classes with right now doesn't have it either.

Some kind of stress management program/services for nurses. Maybe a package deal from a day spa specifically for nurses at a significant discount: a massage every week, aromatherapy treatments, yoga classes, organic/natural food discounts, etc. That would definitely get my attention.

I am down to my last few prereqs for my chosen online RN-BSN program through Southwestern Oklahoma State University. This semester, I'm taking A & P II, Dev Psych, and Public Speaking through Edukan. This summer I will be taking World Geography-also through Eduka- and, if I can find one, and online World History class. Edukan, for some reason, does not offer one. This would leave Stats for the Fall and then I'll be ready to start the nursing courses for my BSN in January 2011. I'm already accepted into the SWOSU and am applying to the RN-BSN program this month. I've googled "online World History" and gotten a bunch o history review sites but haven't found any classes. Has anybody taken an online World History class? An easy class is not important to me, but an affordable one is. Thanks!

In both the current hospice I work for as well as the one I was with previously, we were not permitted to carry O2 sat meters. As the post above mine explains, we will use O2 for comfort in terminally ill patients regardless of O2 sat readings. And, as a very experienced hospice nurse explained to me, the knowledge that a loved one's sats are below normal can be upsetting to the family, but there really is not a lot we can do to raise low sats when someone is actively dying.

Hospice-love it. More time with patients, less time spent charting, and having weekends and evenings off is great too. I was formerly on med surg Hated it. I hated being inside for over 12 hours, never seeing the sky, I ran the whole time, spent more time charting than on patient care, and never got to sit down for a meal.

I started in the hospital on the day shift, working 3 twelves. It was nice to have 4 days off every week, but it took some planning and paying attention to my physical health to ensure that I had the energy to enjoy my free time. Working 12 hour shifts for several days in a row can be very tiring, but lots of nurses do it and still have a very full personal life. I now work Monday to Friday, 8 hours a day. Not all nurses work in the hospital! I work for a hospice/home health agency. Since I am a hospice RN Case Manager, I am on call ever 3rd week. For us, call starts at 5 pm and ends at 8 am on Monday through Thursday and from 5 pm Friday night to 8 am Monday morning. I am an RN and there is also an LPN on call, who gets the initial calls and makes most of the visits. I only get called if she has questions or if a second patient has a crisis while she is out to see another one, which is very rare. Call doesn't really affect my life too much; I just need to keep my phone with me and stay in town when I'm on. I was never expected to take call when I worked Med Surg, but staff shortage was a constant problem, which meant we were often called and asked to come in on our days off. We could always so no. Our agency gives us all major holidays off with pay. In the hospital, we took turns. If you worked Thanksgiving, you'd be off for Christmas this year and would work the opposite schedule next year. I get 18 days of PTO my first year. I have to take sick days out of that as well as the paid holidays, so it will take a few years to reach the point where we can take an extended trip, but, since I don't work weekends, I only need 10 days PTO for a 14 day trip. I also don't have to take PTO for holidays if I don't want to; I can work some of those holidays instead in order to save up for vacation. Labor Day, Memorial Day, etc aren't that important to me to be off. As mentioned by a previous poster, it's somewhat easier to arrange your schedule for longer periods of time off without using PTO when you work 3 12 hour shifts a week. Not really. I was out sick a total of 3 days during my first 16 months of nursing and that was on a Med Surg floor. Good hand hygiene, universal precautions, and just plain old common sense are all key. I went to a community college and got my ADN for less than $15,000 total. That included tuition, books, lab fees, criminal background check, uniforms, insurance, vaccinations, etc. I used federal loans for some of it and got a scholarship from the hospital that hired me that paid for my final year (in exchange for working for them for a year). I'm now going to do an online program for my BSN that is also very affordable . To me, having supportive people in my life was essential to getting through both nursing school and that first year after licensure. It's going to be really important to you to have your wife on board with you on this. I do hope that the information you're getting will help her to believe that you can do this and get behind you fully. Best of luck to you and be blessed!

I worked on a neuro med/surg floor for 16 months with pt load of up to 7. I didn't find caring for neuro patients to be any more stressful than the medical patients (pneumonia, COPD, GI bleeds, etc). What I found stressful was the constant flow of discharges and admits associated with neuro patients. Most of our healthy, uncomplicated laminectomy and ACD patients were discharged within a day after surgery and our surgeons did several of these surgeries each week. That took a lot of time away from patient care, which is always stressful.

Your post reminded me of the RN who mentored and trained me in hospice. She works 60-70 hours a week, both as clinical coordinator of a hospice and DON of a LTC facility. She has more nursing knowledge than the rest of her staff combined and has been known to take on call 24/7 for months on end. And she's 72 years old. With no plans to retire.

I started nursing school when I was 43 years old. I excelled in my nursing clinicals and ranked at the top of my class on every exam. By my second year, I was being paid by the school to tutor underclassmen and assist the faculty during clinicals checkoffs. I finished school with the highest scores in my class and was selected by the faculty for an excellence in nursing award at graduation. I passed the NCLEX on my first attempt with 75 questions and began my nursing career on a busy med surg floor that specializes in neuro patients. I started on the day shift-something unheard of at my hospital-and was off of orientation and on my own taking care of up to 8 patients for 12 hour shifts. I ran with the "big dogs" and kept right up with them. Those experienced nurses, by the way, were all in their late 30's to 50's and they knew their stuff. I'd trust them with the life of any member of my family. Very few of the "young still in their prime" students in my class even graduated. A few did, and they are great nurses, but age does lend itself well to things like time management and critical thinking. I'm now 47 years old; I've been licensed for close to 2 years. I feel like I am in my prime. I do yoga, pilates, take walks, eat a ridiculously healthy diet, and sleep really well. My patients do not suffer due to the fact that I'm pushing 50. In fact, because I look very young for my age, some of them have expressed concern that I was too young to care for them until they learned my actual age. I did leave the floor behind a few months ago. I don't like being inside without a glimpse of the sky for 13 hours straight and I don't need the excitement of acute care. I'm now in hospice nursing and hope to advance in this specialty for the remainder of my career. My personal goals include finishing my BSN, starting a Master's program by my 50th birthday, obtaining certification in pain management, holistic nursing, and researching the use of integrative medicine in palliative care. You'll notice my plans do not include retiring when I'm 50, although a ten year career in nursing is better than none at all. I expect to eventually be an educator and mentor and when I finally do retire, I will volunteer in free clinics, train as a SANE nurse, and do missions nursing. There is a lot more to us older people than you think. I smile to think of how you will view yourself when you are older. You'll see what I mean someday. Our age does not limit or define us. Only our minds can do that.

I CLEP'd Humanities with very little prep time. I think it is doable if you are already very familiar with a wide variety of art forms, musical styles, and literature. My childhood was steeped in those things. My father is a musician and orator and my mother an artist. I also had a natural tendency to explore the arts. I have not mastered any area of the arts with any depth, but I had a good understanding of the basics. Get your hands on a CLEP prep book and take the practice test for Humanities and see how you do. I think that would be the best way to gauge how well you will test on it. Way to go on all of your other CLEP exams! It's a great way to earn college credits on the cheap, isn't it?

I've only been in hospice nursing for 2 months, but one thing I know for sure is that terminal cancer is painful; controlling the pain of terminal cancer patients is one of the greatest challenges of comfort care. The fact that the POA didn't want the staff to "overdo it" and wanted the pt to still be awake enough to be conversant tells me that, if he got his way, this patient died a needlessly painful death. That was terribly unfair to her. I find it disturbing that the ability to give her a good death was offered but rejected by the person with the authority to make decisions in her best interests. I'm afraid that, if I had been a staff nurse at that hospital, I might have shown my frustration with the POA too.

Tewdles, do you make all nursing visits on those 12-15 patients, or do you also have an LPN? I'm just trying to figure out what to expect at my new job. (I also need to learn to assert myself with my new employer so I don't end up in a situation similar to the one in which I now find myself.)

Thanks, Tewdles. I'm serving a rural area of Oklahoma. I've already made the decision to leave this company and have accepted a position with one that is local to my area. I will have an LPN and aid as well as several other hospice RNs nearby. The office is 3 minutes from my house and was full of cheerful, friendly people when I went in to interview. I'm hoping my initial experience with hospice is not the norm and that my new employer will respect my personal time and keep their promise to provide backup when I need it.

I've had up to 13, usually12, but do not have an LPN and, in some cases, no aid either, which means I do all pt visits and bathe some of them as well. I've averaged 7 visits per day until this past week; I've recently had some revocations and deaths so am only carrying 9 right now. I expect that to change very quickly, though, since there are several upcoming admits in the works. The number of visits per day can get even higher when a pt needs daily visits; I make all of those too because the nearest nurse is 2 to 3 hours away from my pts. I've had more than one patient actively dying at the same time with no backup, which means really long days (10-12 hours sometimes). My service area is also quite large, which means that, when I am with one of my patients, I am up to 2 hours away from some of my other patients. I do not have an admissions nurse either.

I know. It's amazing to me too. I keep a couple of bottles of water in the car and drink frequently while I'm driving and have already located the cleanest gas stations/travel stop shops in the towns where I will be working. Thanks for the tips, everyone. I will definitely look into the resources everyone suggested.

I'm taking chem online. It's pretty much self-taught. There is no lecture, though the instructor does include power points in the online materials. I have an A average right now, but it's not been easy for me. The calculations aren't that bad-just basic algebra really, and I am NOT a math whiz by any means-but there are a lot of formulas to memorize. Make sure you've got a good understanding of algebra. Buy some index cards if flashcards help you to memorize. Take good notes, read the assigned chapters and do all of the exercises. You'll get through it.

By way of introduction, I've been a nurse for 18 months; I was in Med Surg before starting in Hospice 2 weeks ago. I'm still on orientation but am starting to go out on my own to see some of the patients. One area that has not been covered by my preceptor is patient teaching on what to expect as disease progresses. Because the majority of my pt's deaths at the hospital were due to acute illness/injury, I didn't see a lot of end stage disease. I'm looking for some resources so that I can study up on what happens when treatment stops and the disease process is allowed to play out. Does anybody know of websites or books that would help me to prepare my patients and their families? By the way-I love hospice so far. Although it means getting up early 5 days a week instead of 3, the days are shorter, I get to see the sky rather than be trapped inside a hospital for 12+ hours, and I actually spend time with my patients! I've eaten lunch while sitting (!), had time to pee, and managed to drink 8 glasses of water every day for the past 2 weeks. A-m-a-z-i-n-g. Thanks for any ideas you can share with me. And advice for a hospice newbie is welcome as well.

I just finished reading this and have tears in my eyes. I've been an RN for 16 months and have spent that time on a Med Surg floor much like the one you described. Many of patients have been total care, but they are only one of the seven I was required to care for on a given shift. Factor in the rapid turnaround on our floor, and I could be charting on 12 patients in a 12 hour period. That leaves precious little time for patient care; I have often left the floor feeling like a terrible nurse because the actual patients got so little of my time. My last day on that floor was earlier this week. I'm starting as a hopsice RN later this month. Despite the relief I have just in knowing that I won't be on the floor any more, it is rather frightening to leave the only nursing job I've ever known for something so dramatically different. Your post helped to serve as confirmation that I've made the right choice.

Thank you so much for your reply! I was wondering if it was something I would want to do. I did end up applying for the job and have an interview this week. It will be nice to go into it with some kind of idea of what we'll be talking about. I think this might appeal to me. I've wanted to be involved in hospice since my nursing school clinicals and I thrive on accomplishing tasks/organizing and have experience in team leading. We'll see how it goes.

I saw an ad in the paper over the weekend for a Hospice Case Manager position. In the hospital where I work, "case manager" means discharge planner. Is it the same in hospice? Or are all hospice nurses case managers? Do case managers give direct patient care? Or does another type of hospice nurse do this? Thanks!

I have SAD. I did not tell anyone at work about it, at least not at first. If it comes out now as part of a casual conversation, I don't worry about it. My first winter as a nurse was rough. I don't know how much of that was due to the SAD and how much was just the stress of the job (being new, my floor closing, floating all over the hospital on my own when I still didn't know what I was doing, etc), but I did promise myself that, if next winter is as bad, I would get out of hospital nursing and find something that didn't have me driving to and from work in the dark (I work 12-hour shifts). I was fortunate, though, to start out on days. Night shift would have been suicide for me: sleeping during the day and staying up at night are absolutely counterproductive for treating SAD and will only make the symptoms much worse. I feel somewhat better now that the days are longer, but I'm still stressed. (I also have chronic depression.) I do everything I can to feel well: I eat healthfully, exercise, practice yoga and deep breathing, use aromatherapy, and drink lots of water, go to bed early and get up early, and sit in front of a light therapy box every morning (my SAD is severe; I need to use the light box year-round). Maybe I need medication as well, but the drug my doctor started me on made me feel like a zombie and horribly nauseated. I couldn't work like that. I've just started a cognitive therapy book to see if that can help me get a handle on the anxiety. If not, I'll call the Dr and ask to try a different med. My advice? Start by talking to your doctor to see if you need meds. Get a light therapy box and use it faithfully. Exercise, avoid junk foods and caffeine, and see how it goes. If 12-hour shifts don't work for you, get your experience and move on.

I'm a newer nurse with 15 months experience in Med Surg. I am contemplating leaving hospital nursing for something less stressful while I work on my Bachelor in Nursing degree. I may even go part time. I eventually want to teach and the ads for nursing instructor positions that I've seen usually want at least 2 years' clinical experience. What exactly counts as clinical experience? Is it just acute care? Would hospice or a Dr's office count? I just don't want to find out later that I should have stayed at the hospital for another year or so.