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vampiregirl BSN, RN

Hospice

Content by vampiregirl

  1. vampiregirl

    Nurses forced to work as aides

    I don't mind filling aide positions. When I worked LTC, it was actually fun (but really physically demanding work for the now out of shape RN). It was those shifts I knew I actually might get out on time:) It was nice to spend a little quality time with my residents. And I got to see some of the issues the aides faced. Not to mention I earned the respect of an aide or two. I work hospice now. Giving someone a bath is a great way to identify any skin issues. If I notice a patient needs cleaned up, I just do it. I wouldn't want them to wait for aide to arrive. This also can be a great way to educate family members, some of these tasks are very new and uncomfortable for them. I gave a patient a sink bath the other day while the DME company was setting up his hospital bed for a formerly independent gentleman who had a significant decline in condition. After I applied lotion and helped him in to clean pajamas and tucked him in to bed and helped position him, I can't tell you how comfortable he looked. These tasks were part of nursing care that I provided that day. I wasn't forced to do them, I chose to do them because it was what my patient needed to be more comfortable.
  2. vampiregirl

    One of Our Own

    "It's not your emergency, it's theirs". This mentality was taught to me when I first started EMS over 18 years ago. It's what has allowed me to get through some tough calls. It keeps my thinking clear and objective when things get crazy. When something crosses that sacred boundary and it becomes "your" emergency too - that's when it get really tough. I'm not sure people who haven't served their community as a member of an EMS or Fire Department can truly understand what it is and means to be a part of these departments. The relationships between members are very special. Take care of yourself! You did well:)
  3. vampiregirl

    On call?

    Where I work, we don't have an on-call nurse. Our case managers rotate call, and we are aware of that upon hire. We also have a rotation for holidays. On weekends, we have a helpline nurse and a scheduled visit nurse from 8:30 am - 4pm ish. When we are on call, we get paid an hourly on call amount and OT for all visits, including travel time. If someone calls off (rarely happens), we usually split up the time. It really helps that all of us "play well together" so our call isn't too bad... Unless of course it's a full moon!
  4. vampiregirl

    Does Medic Experience Count?

    I'm an RN with 18 years EMS experience (as an AEMT). There are very distinct differences between the 2 "worlds". There are some things from EMS which have definitely contributed to my success as an RN... Scene size-up and scene safety - and my "scene" can be room with the patient and/or family members. Learning to look at the whole picture and not just see/ hear the patient. Identifying hazards to myself or my co-workers. Positioning myself with an "escape route". The ability to remain calm and think clearly no matter what is presented to me. The speciality I work has very few "true" emergencies from my perspective, but to the patients and their families this may be the biggest "emergency" they have ever faced. This skill cannot be taught in the classroom, it is learned through experience. People skills or how to play well with others... In EMS, having good people skills can make the difference between a safe scene and a not so safe scene. It also allows me to work with people to get the information I need to effectively care for them. The ability to adapt to whatever is presented with me. I have to consider available resources and how to best use them. And if I don't have what I think I need, I have to be able to figure out what I can improvise with my scope of practice, protocols and what is appropriate for that patient. These are just a few of things that come to my mind. It all depends on how you approach nursing (as with anything), but EMS experience can be an asset in nursing.
  5. vampiregirl

    Treat diabetes?

    Just as you are transitioning your mindset from the "save them at all cost" to the "comfort care" perspective, the patient also has to make this transition:) Making a 180* change in thinking isn't easy for either one of you most likely! Just like the previous posters mentioned, there are several factors that come into play when addressing blood sugars, diabetic meds etc. If the patient opts to continue addressing diabetes, I've found the oral meds are the ones I need to be monitoring as appetites/ intakes decrease towards EOL. Hypoglycemia (precipitated by oral meds) can be tough to address especially from the symptom management/ comfort perspective. Don't just throw away all you learned in critical care though - this knowledge base can be applied to addressing symptoms by understanding from a physiological standpoint why they may be occurring. It also will help when you are teaching patients and families about the disease process and what to expect.
  6. vampiregirl

    Another New Grad Nurse Dilemma: critical care nursing in IL.

    EMT skills can come in very handy in many areas of nursing. I would think this to be especially true in critical care. Granted, EMS uses different theory than nursing, but there is a time and place for everything. My EMS background came in very handy in LTC and even now in Hospice...
  7. vampiregirl

    RN - Crushing medications

    If your facility's policy is to crush separately (I have heard of this before), find out if you ask for an order to crush the meds together. Or, find out how to get your facility's policy updated - I'm sure there would be some appropriate EBP materials to validate your request. One of the things regulatory agencies look at is if the staff are following the policies of their facility - it doesn't always matter if the policy is practical or even the most up to date, just if the staff are following it.
  8. vampiregirl

    Ideas for Teaching Topics

    Advance directives might be an area to consider or non-pharmalogical interventions/ trouble shooting symptoms (restlessness is a good one). Or for a spin on nurses & their own grief - compassion fatigue is a good one or caring for a patient that the nurse knows (crossing the sacred boundary between one's personal and professional life). I work for a fairly small Hospice and sometimes the nurses do know or know of their patients.
  9. vampiregirl

    Would you quit over white uniforms?

    Nope, whites wouldn't be a deal breaker for me. I worked for a LTC that required all licensed nurses to wear white scrub pants. Nope, not my favorite color and a little challenging to keep clean and not dingy looking. But - it so has it's positive points. Many geriatrics associate white with nurses, it was very helpful at times:) Also, I kinda liked the traditional aspect. I learned the hard way - cheap white scrub pants are not a good idea. Eventually I found a brand that was a little heavier weight and learned how to take care of them. And lo and behold - they lasted longer than the cheap scrubs (so I saved money in the long run). My current job doesn't wear scrubs. But I do have a white lab jacket.
  10. When you started out as a hospice nurse?? This evening, I feel like a new nurse - kind of the evening before the first day of school. I've carefully prepared my supplies - notebook, pens and highlighters. I've "picked out" my outfit (uniform) and it's all ready to go, wrinkle free. Tomorrow I start clinical orientation as a hospice nurse. I chose to leave a management/ staff educator position to take a clinical position (and hopefully become educated). I will leave behind being the "go to person" in a LTC and be the "newbie" who has only book knowledge and limited experience caring for hospice patients. I got a position in a fantastic hospice that I am familiar with - they have a team atmosphere. I am so thankful for this opportunity and hope that I become an asset to them and the patient's I will serve. It's exciting, humbling and terrifying at the same time:)
  11. vampiregirl

    How many of you actually enjoy your job?!

    It took me several different nursing jobs to find one I truly loved. My first nursing job had an awesome schedule (Monday - Thursday 8am - 4:30pm, Friday 8am - 12n, no weekends or evenings ever). I so didn't love that job - it just wasn't a good fit for me in so many ways. My 2nd nursing job was a fantastic learning experience, but a hard job with long/ irregular hours. I miss caring for the patients but there are many things I don't miss. Now I'm working in a job that I do love. I love the type of nursing (and it's an area I never in a million years guessed I would be in) and the schedule is a good balance of work and actually having a life outside work to recharge. The best part is the team I work with and the manager; it truly is a professional team. My personality and skills set "fit". Learning is encouraged.
  12. vampiregirl

    Will my scars from cutting be a problem?

    I have a couple friends who always wear long sleeve shirts under their uniforms. Different circumstances (full sleeve tattoos), but I've never seen anyone make a big deal out of it. They make lots of different styles/ materials of long sleeve shirts to go under uniforms. You may have a dress code that specifies the color (black, white, navy etc) or it may be up to you. You can go coordinating or contrasting. I found some lower cut long sleeve shirts made of a thinner fabric (before anyone gets excited - the lower cut was so it didn't show over the neckline of my shirts. Trust me, I don't wear anything "low cut" as I'm a little fluffy.)
  13. vampiregirl

    Hospice patient requests to smoke

    If this was my patient, I would try to get the order ASAP. There are probably fire codes, state regs, policies, and care planning in place that need to be followed. Failure to follow all the steps could result in interruption of his smoking privileges (and those of others), which could results in more stress for the patient. It may seem like a "trivial" order, but it may be a bigger deal than it seems in the world of compliance:( It's usually best to just get the order in situations like this so you know the resident can have his cigarettes. If only some staff allow him to smoke other's don't, the patient could resort to "sneaking" cigarettes which present additional safety risks.
  14. vampiregirl

    Do you get sick alot working as a nurse?

    Same here! And I suspect I've also learned how to take better care of myself and am more conscientious with infection control/ hand hygiene than I was back then.
  15. vampiregirl

    getting unwanted advice from non-nursing staff

    Awesome job to the OP for how she handled the situation! I so appreciated any staff who were willing to be extra "eyes" and "ears" for me when I worked the floor in LTC. There were some though who struck the wrong tone to me or made inappropriate suggestions. This can be a fine line and then there is the issue of "playing well in the sandbox". But at the end of the day, ensuring that the residents receive the best possible care is the most important thing. Building a rapport with other staff members (such as the PT that the OP encountered) can be a huge benefit to the residents. Sometimes it just takes a gentle reminder that we are on the same page.
  16. vampiregirl

    Pt's home infested with bed bugs, fleas, etc..

    At least where I'm from, roaches don't qualify a scene as "unsafe" for EMS:( (I hate bugs that crunch when you step on them). I will say though that it is probably pretty likely that most care will be done in the ambulance (if possible). The job of EMS (and nurses) is to provide non-judgmental, high quality care to the people we serve. We would though make sure we check all equipment and ourselves to make sure we don't have any "hitchhikers". We've put ambulances out of service to allow crews to shower and change after exiting certain residences. This thread caught my eye because I just encountered my infested home as a nurse providing care in a patient's home. An awesome patient and family, just unfortunate living circumstances. It is so far out of my comfort zone I can't even begin to tell you! So far the family has no idea my aversion to the critters, in fact they complimented me on my lack of [outwardly apparent] fear of the roaches. I'm in the process of working with my manager to explore what policies we need to put in place especially related to bag technique to protect ourselves and our other patients. I'm guessing that a roach isn't going to stop at a bag barrier and know that they shouldn't go there!
  17. vampiregirl

    Transition from Floor RN to Mgmt

    I'd say one question to ask yourself is if management is something you are interested in. I advanced to a management position at a past employer, but in time figured out that my heart is with bedside nursing.
  18. vampiregirl

    Safe transfers/hoyers

    I think with some patients it's a measurable aspect of their decline and they are not ready to face it. Especially with hospice patients, this can be a big issue. A more personalized approach with education works with some people, reproaching a subject with a different spin. Sometimes focusing on what they still can do, and how a fall could change this. Hoyers can be scary to look at. I've actually let a patient hoyer me so they can see how it works. And show them the different safety features and considerations involved with a transfer. Or involve the patient in this process, offering options and having them make suggestions/ input their care plan. Even if it's what you were planning to introduce all along. With hospice patients, many things are out of their control. Giving them a chance to make decisions is very helpful to them (and to the therapeutic relationship:)
  19. vampiregirl

    Im just going to come out and say it..

    I am currently working in a speciality that I NEVER thought of myself in, and love it! A schedule that works well for me, a good fit for my skill set, awesome team members and a wonderful manager. Education and growth are encouraged and supported. I have the tools and resources to provide quality care to my patients. Sometimes it really takes working a challenging environment to really appreciate a great job where you are a good fit. I like this thread too:)
  20. vampiregirl

    OMG, I cannot believe it...I need PICU interview tips!

    Good luck in your upcoming interview! I'm not in the same specialty, but before I was interviewed for my current position (dream job) I also researched things that I suspected would be addressed in my interview. Of course a few things came up that I either didn't have personal experience with (but did have a knowledge of the procedure) and things that I wasn't 100% sure of. I was later told that one of the things that impressed them was my willingness to learn about new things. They don't expect you to know everything when you hired in a new specialty, that is what orientation is for:) They also may consider personality traits (to see if someone is good fit for a unit) and good critical thinking skills.
  21. vampiregirl

    Excelsior RN ADN program

    Actually when I looked at my other options, Excelsior was affordable for me. It took me a while to complete my degree (6 years), but I worked both a full time and a part time job throughout. I took some classes online through my local community college (I verified they would transfer - the prereqs). I had a little bit of employer reimbursement. I saved up for each test and basically paid as I went. I bought books from amazon and looked for used. Excelsior also has payment plans for some things, I took advantage of that too.
  22. vampiregirl

    Excelsior RN ADN program

    I had great success w/ purchasing the practice exams from Excelsior. I would complete the 1st practice exam at the beginning of my studying for each exam and complete the 2nd practice exam a couple of weeks before my scheduled exam at Pearson Vue. The 1st exam gave me a general idea of where I needed to focus my studying and the 2nd exam helped me to see how ready I was and if there were areas that I needed to review. I passed all my exams (at Pearson Vue) on the 1st attempt using this method. I was also one of the grandfathered in EMTs, I was not an LPN prior to earning my RN.
  23. vampiregirl

    How to transfer into hospice

    I was introduced to hospice patients working in a LTC. At least in my case, it gave me a great foundation. Another advantage for me was that the LTC was served by multiple different Hospice agencies so I got to know a little bit about the agencies and the care they provided. I was actually asked to apply to the Hospice that I'm working for by one of the Hospice nurses - so they already knew that I'd be a good fit for them (personality and skill set wise). Hospice has been a wonderful experience for me.
  24. vampiregirl

    Height measurement for double amputee

    You never know what you might learn cruising Allnurses.com:) This is something I've never thought about but could run into - and the pharmacy implication is something important to consider.
  25. vampiregirl

    I want to be a Hospice Nurse

    I got introduced to Hospice patients/ care working in LTC, I feel that I have a good skill base for caring for my hospice patients. I'm still learning so much though, which is a huge bonus for me. I also got to know the various hospices and "how they worked". I was encouraged to apply for my position (at the Hospice that I liked the best/ had the most respect for) by one of the hospice nurses from this organization - she knew my skill set and personality would be a good fit with the team.
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