coffeetalker

When it comes to sitters, there are really good ones, and others who see there job as sitting (and watching tv/reading but not really interacting with the pt). I always look for opportunities to educate them on what they can do to help the patient. At times I have been known to remind the sitter that the reason why they are there is because we know the patient has these behaviors. I would mention it to the charge nurse and mention to the chg. what I did to educate the sitter on their role (so that the sitter hopefully learns and gets really good -or does not continue to come to the unit and make more problems than s/he solves).

I would take the position, as this is a great opportunity for you as a new nurse. As other folks have said, I think that your dad would be upset with you for passing an opportunity for your life, even as his is ending. The drive will be do-able. I also encourage you to remember, it's not about the amount of time that you spend with him, it's the quality of the time. Phone calls and (if you're more technology inclined than I am) skyping are options for when you want to talk to him when you are working. I would also talk to your manager at the position about the situation.

(the new position is about 5 miles from my house)

There's only one other hospice in my area and it's 45 minutes away (not acceptable commute for me). Unfortunately in my area, there are not a lot of home health agencies- (and because I briefly worked for one in the fall last year PRN)- I know that the pay is nowhere near what I'm making. I know that it will be different (as I use to work cardiac stepdown), but it will be a constant paycheck. There are not a lot of hospitals in my area, either and the closest other one is 32 miles away. There are a lot of SNF's, but again the pay is not acceptable. (recently had one of the facilities that I use to go to for home hospice talked to me about a charge nurse position, but the base pay was $7.50/ hr less than what I make now.

I work in a 26 bed Inpatient Hospice, I have been here for 2.5 years, prior to that did Home Hospice for about 6 years. I left home hospice due to being on salary and my days consistently being 10-12 hours long. When I took the Inpt hospice position, I knew that flexing was an issue (at that time was about one flex every one to two months).....over the last several months, flexing has increased to generally one flex (12 hour shift) every two weeks. In addition, it seems like the number of truly skilled need patients is going down, while the number of nursing-home like patients is increasing. I really enjoy my co-workers and continue to love hospice. I have accepted a position on a Pulmonary/ Med-Surg Unit- but am really not excited about it. Last year, when the flexing was getting bad, I was able to help out Home Hospice (until they decided that they did not want to risk having to pay overtime even though they needed - and still need the help), I looked into helping Home Health but same scenario- don't want to run the risk of paying overtime. I don't want to have to spend my time off trying to find enough hours to make the mortgage payment. Any thoughts?

You've just opened a huge can of worms. Nursing is changing a lot , even from where things were with the profession since I started my RN career 12 years ago. I enjoy being a nurse and I think that it gives you a whole new outlook on your fellow human beings. Many people enter the profession thinking that every pt will be grateful for care, co-operative and that every shift will end with a sense of having really done some good in the world, and are quickly disillusioned. Nurses encounter people who are often at their worst- in pain/frightened/angry/ feeling out of control...and that's the pts, not to get into dealing with family dynamics that pop up. As there are many other threads here that get into that, I'll leave that alone. As far as 3-12's- that in theory does sound good, and can be good if you work days, but 3 "12" hour shifts is no picnic. And when I worked days, I would often be so exhausted at the end of it, that when I went home, all I wanted was a meal, a shower and perhaps a brief conversation with my family before going to bed to get up and do it again the next day. After that third day, a good chunk of the first day off was spent just trying to recover from working. If you work nights, you can't plan on doing too much before going to work that night, and then after the third shift, you either choose to be sleep deprived so you can flip back to a 'normal' schedule, or decide to basically live on a night shift schedule. I'm pretty sure other folks here are going to blast you for using the word 'whiney' , so I'll try to explain what the nurses in those articles are referring to. Short staffing/ not enough supplies/ having a pt load with a really high acuity level/ doctors who won't listen when nurses are trying to tell them something's wrong with a patient/ co- workers with attitude issues/ working on units that have so much turnover that the 'senior' nurse has been there three years/ administrators who care nothing about employees... and that's just the tip of the iceburg. You would be amazed at how quickly a '12' hour shift can turn into a 14 hour shift due to the documentation that has to be done..... and then how quickly supervisors can be to tell nurses that they should not be getting into overtime/ consistently staying late. Having said all that, you can be a nurse and live a happy life- but it will take you some time to find that balance and to be able to leave work at work.

There is nothing wrong with changing your mind especially as you are two months out from your start date. I tend to go with my gut a lot and yours certainly seems to be telling you to take the cardiac floor. Your first job will be an eye opening experience no matter what unit it's on.

Dakin's is good, continue Flagyl in wound bed, can also put kitty litter in a container under the bed to soak up odor, and of course, my favorite old standby, few drops of peppermint oil on a tissue in med cups strategically placed around the room.

I will be changing jobs from full time at an inpatient hospice to a pulmonary/med-surg. unit at a local hospital. The hospital is attempting to get Magnet status (and has been for some time). During my interview, I asked if due to achieve Magnet certification, I would have to get a BSN (as stated in title, I have been a practicing RN for 12 yrs- have done critical care to physical rehab, home hospice and even a little at home pediatric care) . The unit manager said that "it would be up to the Nurse Council" and seemed to imply that after so many years of experience, he doubted it would be required. My question is, does anyone have any experience with this sort of situation?

One of my favorite MD's I use to work with (when I did home hospice) when discussing code status with patients and families use to ask " So, what do you think would happen if your heart stopped, or your lungs quit working and someone did CPR on you?" ..... lots of times the response would be " Well, I'd be back at home in a few days, just like this" and discussion would result.

I think that the first thing that needs to be done here is a Goals of Care discussion and revisit having Palliative Care or Hospice see this patient. One of the great things about hospice (and palliative care) is our ability to control symptoms and your lady sounds like she needs some routine nausea medications (Haldol would probably work great for her as it is used for nausea at low doses), and can be given orally or via IV or even subcuteanously . Also, there needs to be some consideration of how much oral intake is she consuming- if she is eating at least one meal a day (and the nausea/vomiting is controlled) she should probably be on oral stool softners; if she's just eating bites over a day, she may just need a scheduled suppose. every 2-3 days. (Darn it- I can't see the original post--so I'll just throw out there that depending on where her cancer is- she may need scheduled reglan also). Thanks for advocating for your pt !

I totally agree with Double- Helix and would add that comfort care is a part of end of life care; DNR/DNI status can mean that up until the moment when a pt stops breathing/ heart stops, everything else is done to treat the medical condition. Also, in this situation the question of if the pt was symptomatic with the SVT should have been asked.

FAST was specifically designed for Alz. dementia. If RNs and MDs are not scoring the pt the same, perhaps more education is needed for them. Generally it is used at the end of every certification period. At my organization I rarely see differences in MD/RN scoring. Other measures of decline that I like to use are- weight loss/falls/ UTIs/ Respiratory infections-but these generally occur more with 'expected' decline in Alz. pts- and are really just supportive info for recert.

the 48 hours for observation---- to be honest, I don't know exactly where that is in guidelines, but at my inpt hospice we are told by our MDs that we do have 48 hours to observe (which makes sense esp as some hospitals have "clinical observation and decision units". As far as homecare staff 'making pts eligible that aren't"- keep in mind that all homecare staff knows if what family/pt is saying as they are not there observing 24 hours a day. Once a pt is in the inpt setting though and if what ever problem pt came into the inpt setting for management of is not presenting, then it becomes responsibility of MD and SW (with input from the rest of the team) to come up with a care plan or discuss discharge plans with family.

GIP level of care means that there is something that needs to be managed- ie- pain/agitation/anxiety/ nausea/ bleeding issues/ need for new route of medication/ LOC changes/ seizures/ ongoing constipation/ diarrhea/ extensive education needs of family/ psycho-social or spiritual crisis/ frequent med changes. Of course, having said all that, sometimes pts/ pt family will report new issues to hospice homecare staff and then miraculously they show up and look nothing like what you were expecting. With GIP status you are allowed 48 hours for monitoring of whatever brought pt in- but if you're not seeing it, then SW needs to get involved for potential level of care change to residential (transitional) or do whatever discharge planning issues need to be done.