KAW1962

Today while at work I went into one of the patient's rooms to help him with something. He had a roommate who I easily recognized. I will call him GR. GR's wife passed away within the past year and towards the end of her life she was in the hospital almost constantly. The dear woman had had a stroke some years ago and was left bedridden and barely able to communicate. Even in her fragile state you could see that she was once a very beautiful woman. GR had private caregivers at home who took fantastic care of her and GR doted on her. GR would come onto the unit every day with a big smile on his face. He liked joking with the nurses and bragging about how great his wife's caregivers were. Although he used a walker he was still in pretty good shape. Tonight GR was sitting up in his chair for dinner. He barely touched it. He was hunched forward; he had spit dripping off his lower lip and snot running out of his nose. He was staring at the floor. I felt as though someone had punched me in my heart. He looked so lost, so sad and dejected. I almost started crying right there on the spot. I sat beside him, rubbed his back and asked him how he was doing. In a barely audible whisper he replied "I'm tired. I'm so tired." I asked him how he was doing and he told me how rough it has been for him since his wife died. I sat there with him for a few minutes then helped him into bed. Every now and then I have a patient or an experience like this that just zings me. The look on his face is burned into my mind. I really don't have any purpose in posting this. I just wanted to share my experience with some anonymous people who won't think I'm being silly or overly emotional. Nurses are such special people. Thanks for reading.

Great website. I ordered the book. Thanks so much for your help!

The instructor focused mostly on anatomy and physiology of the heart, which was a great refresher, and what each individual wave of the complex signified. What I was hoping for was to go through strips, identify what rhythm it was and why. There are some rhythms I can identify so I'm not totally lost but I have a hard time with others (PACs, BBBs). She showed strips and people just blurted out what they were without really explaining how they came to that conclusion. Make sense? I understand it better when I learn WHY something is what it is. Thanks for the suggestions. I have already started looking into them.

I work in a small hospital on a med/surg tele unit. The unit can accommodate only 10 tele patients at a time unless we borrow tele boxes from ICU. Tele has never been my strong point but I would like to learn more about reading the strips. I did attend a basic tele class offered through the hospital but to be quite honest, the instructor blazed through a lot of the material and didn't put much emphasis on reading the strips so I didn't get as much out of the class as I had hoped. I have been searching the internet for instructional videos for nurses on reading telemetry, something that I can take my time and watch repeatedly if necessary, but so far I've come up with zilch. Does anyone have any suggestions on where I might find this material?

Since moving to California I have had a difficult time finding full-time employment, so I signed on with an agency. I have been fortunate to work a few shifts over the past month, so my recruiter was able to get me into another local hospital. I went this morning for an orientation. To begin with, they had no idea who to assign me to. They asked one nurse when she came in and she said NO, citing the facts that she had precepted a couple of weeks ago, plus she had nursing students today. So they took me to the nurse's lounge and had me wait there until they could figure out what to do. After about a half an hour they told me I would be working with so-and-so. Nurse so-and-so had already received report on her assignment, then I find out I was expected to handle this assignment. Okay, maybe it was partly my fault for not finding out exactly what the expectations were for this orientation. Did I also mention that the orientation was for 4 hours and that it was unpaid? I knew it was unpaid going into it but was not expecting to take an assignment. I stopped by the agency after I left the hospital and expressed my concern regarding any liability issues. In past experience, I never even charted on a patient off the clock. I was definitely not comfortable with this. My recruiter said he would talk to the supervisor on Monday about my experience, and he seemed genuinely interested in receiving my feedback. Overall it was a very disorganized morning and did not leave me with a good first impression. I spent the time reviewing their charting system, MARs, etc., so in the end the time was not wasted. I told my recruiter that if they will have me back I will be willing to do this again BUT I want to walk in there with a firm assignment, get report and go from there. Were my concerns out of line or overblown? Was I making too much of this?

Thank you for the advice. I updated my resume and produced a cover letter briefly explaining the gaps in my employment history. I've contacted other nurse travel agencies and there's nothing they can do for me either. I know for a fact that some of the hospitals are hiring new grads but are telling me they want experience in the last year. I'm really stuck and am ready to give up and chuck nursing all together. I don't know what else to do short of pounding on the doors of the recruiters, but something tells me that won't make me any friends.

I will try to keep this as brief as possible. I moved from PA to CA in March of 2008 after my husband secured a job here in CA. In June of 2008 I obtained a position in one of the local hospitals. Shortly thereafter we began experiencing some marital difficulties related to his alcoholism. I had only been employed for a month and a half when things on the home front became intolerable and I was forced into making a very difficult decision. Unfortunately I had to abruptly resign my position without notice, packed my belongings and drove back to PA and stayed with my family. At that time I was not anticipating returning to CA and my previous manager was kind enough to give me my old job back. Over the next couple of months my husband was working on his issues and he also had to undergo surgery (unrelated to the alcoholism) that left him non-ambulatory. So I returned to CA to care for him after surgery. My old boss was very understanding of the situation and was actually happy for me that we were able to salvage our marriage. When my husband was able to return to his normal level of activity at the beginning of this year I once again started looking for a job. This unfortunately also coincided with the depressed economic situation. It is now August and I have yet to obtain a position. I have signed on with a staffing agency and while it's only been one week I have not even had a nibble. I want to continue looking for a regular position but my resume as it is makes it look as though my last job was March of 2008. My questions are: Do I also include the two short lived positions which would show employment until November of 2008? I am afraid that might hurt more than help me. Second question: Would it be appropriate to include in a cover letter a brief outline of the circumstances, without going into too much detail, that let to sporadic work history for last year? I am afraid that I am being punished for circumstances beyond my control. Believe me, if there was anything else I could have done to change this I would have, but at the time I had no where to go. I have no family here, didn't know anyone and felt really stuck. Any input or suggestions will be appreciated.

Thank you for your response. I had emailed a local recruiter who works at a hospital that has an excellent critical care orientation program, as well as several ICU positions available. I inquired as to how to go about applying for such a program but she won't even give me the time of day. It is very discouraging indeed. I keep picturing myself taking a job where I have to say "would you like fries with that?"

A few months ago I moved to the South San Francisco Bay area. I have been diligently searching for a job for the past month and have applied for about 10 positions at this point, but I am getting hardly any feedback whatsoever. One hospital at least had the courtesy to email me to let me know that the positions I had applied for (three in all) were already filled. I have a diploma from a reputable school of nursing back east and have 11 years of solid medical / surgical experience. I have never had this much difficulty getting a job and was wondering if anyone can shed any light on the subject. Could it be that I lack a degree? I would surely think that my experience alone would be enough to land a job. Any feedback would be appreciated!

I went for my interview and walked out in an hour with a job. The greatest part was that I really didn't have an interview. The unit manager and I chatted for a few minutes and the next thing I knew we were discussing my start date. My salary will be more than when I left the hospital last year and $3 / hr more than my home care salary. I really love working at this particular hospital and now question why I left in the first place. It truly wasn't a grass is greener thing, I just wanted to try something new. I am a little disappointed though because I wanted this job to work out, but I realize that it takes a special kind of person to be a home care nurse. For those who love it, more power to ya...I tip my hat to you!

It has been a while since I visited my original post, but I wanted to update everyone on my situation. I have hung in there for 10 months now and I would quit tomorrow if I could. Having a laptop has helped somewhat, but I still have extra work that I am taking home with me. Sure, it's great to be able to finish work from home, but who wants to work all day then work the better part of the evening as well? We have been having some 90 plus degree days lately, and by the time I get home I am so drained I just don't have the energy for anything else. I went to a home the other day to do a resumption of care, the house was all closed up, no air movement at all, and by the time I left I was drenched and had a pounding headache. Right now I have a recert sitting on my kitchen table that I am trying to motivate myself to finish. My census right now is a little low so I have been given patients from different teams to see, patient who I have no previous knowledge about and am expected to discharge them or try to troubleshoot problems. So not only do I have my own patients to manage I am taking on problems of patients from other case managers as well. I wish I could turn the problems I can't solve over to their case manager but the attitude seems to be if I identify it, I have to fix it. I really do pitch in and help out when I am low but it seems that when I need help covering my patients, none is available. Even the scheduler said yes you do help me out, I am sorry I can't get help for you. Getting backup from the team leader is sometimes a crapshoot; either I will get some assistance or am told "I have things to do." I spend a great deal of time on my cellphone and let's face it, the reimbursement is pitiful. I really had high hopes for this job but every day I wake up I dread hitting the road. There are still things that I like about this job but overall those few things are not worth sacrificing my life and free time for. I don't want patients calling me at home (no matter how many times I tell them to call the agency or leave me a message on my pager, they still do), I don't like not knowing which side of Jabooty I will be sent to on a moments notice, I don't like my car looking like a travelling Rite Aide, I want my life back. The good news for me is that this past Thursday I filled out an online application at the hospital I used to work for, they called me Friday morning, and I have an interview Monday morning. I didn't realize how much I missed the hospital environment and I really enjoyed working at this hosptial in particular. I want to go home!

Thank you all for your comments and suggestions. There are many things I truly enjoy about home health: flexible schedule, spending one-on-one time with patients, actually being appreciated for your work, among a few, so I'm not quite ready to throw in the towel just yet. I started computer training Monday, so that will cut down on some of the paperwork. Also just today I got two snaps up from my team leader: during a recent survey, one of my patients gave me high marks, and UM brought one of my recerts to my TL and held it out as an example for others to follow. I really needed that little boost to my ego! During one of the breaks in class today, my fellow classmates and I were discussing the pros and cons of home health but overwhelmingly agreed that is was much better than working in the hospital. I suppose everyone goes through these phases while adjusting to the new position, so I know I'm not alone. I've just decided to give it more time and see where it leads me. Thanks again!

I started home health nursing last November. Prior to that I had 10 years hospital-based med / surg experience. There are many things that I truly enjoy about home care, but I am getting really discouraged at this point. Mounds of paperwork, less free time...seems like all I do is work, work, work. I am about to attend class to learn the laptop charting system, and I am hoping that this will alleviate some of the paperwork. The fifth month of my new job I was literally in tears and told my supervisor that if things did not get better by June I was looking for a new job. I thought it only fair to give myself a little more time in the job, but I feel like I've hit another low point where I just want to chuck it all. When I worked in the hospital, after my shift was done that was it--no phone calls to make, no labs to track down, no paperwork to finish, no schedules to do, etc., etc. Does anyone have any advice, any words of wisdom? How do you manage to do a good job without sacrificing so much of your personal life?

You will want to familiarize yourself with total hip / total knee precautions (proper ambulation techniques, transfers, etc), your physical therapist will be able to provide you with this information. Also learn how to perform appropriate neurovascular assessments, and review your facilities procedures for administering blood transfusions, which you will do often. Learn about the different forms of post-op anticoagulation used on your unit, e.g., lovenox, coumadin, aspirin, as well as pain control (big issue in ortho). Most importantly, learn proper body mechanics that will save your back, as you will be assisting patients with transfers as some of these patients can be difficult to move, especially during the initial post-op phase. Your ortho unit may have pre-written protocols for many of these issues...ask for copies so that you may review them. There is so much more to learn. Good luck!

My father-in-law underwent what we thought was a liver biopsy last week. The path report came back metastatic renal cell carcinoma. He had a partial nephrectomy in 2003 for renal cell carcinoma. During his most recent check-up, he was found to have a 3x2cm lesion in segment 4 of the liver. The radiology report also showed 2 very dense areas in the liver in segment 4. Can anyone provide me with info regarding this diagnosis? I am an ortho nurse and have had very little exposure to oncology. Thanks in advance.

Hello all and thanks in advance for any information you can offer. I am very interested in pursuing UR/CM and was wondering if there are any on-line courses available for these positions. I am looking for some guidance and direction as to the best route to achieve this goal. I have been a med/surg nurse for nearly 10 years and it is time to move in a different direction. I live and am currently licensed in Pennsylvania. Any help would be appreciated.

It is far easier for "us" to be able to say that, because we are on the inside and we know what the score is. Unfortunately, those outside of this profession have probably had little experience in dealing with this type of situation. Many family members do not want to be looked upon as being responsible for their loved one's death. When I have a patient that the entire medical staff knows in no uncertain terms will die, regardless of what measures are taken, yet the family members want everything done, I gently ask them if they are basing their decisions on what they want, rather than on what the patient wants. Sometimes the thought that "we did everything we could" is more acceptable to them than deciding to withhold heroic measures. I believe that if we encouraged more families to openly discuss this topic with each other before tragedy strikes, they will be more comfortable with the decision making process. Then they would be able to say "this is what ________ would have wanted."

This occurred last week at work and I would like some opinions. I work on a specialty unit (ortho). The business office called and asked me if we would be willing to take an observation patient being admitted for a GI bleed. The patient had requested to be placed on our unit because her niece works there. I told them we were unable to take the patient, and the patient was subsequently placed on the Obs unit. I happened to mention this in passing to one of my co-workers yesterday, who's response was "boy, aren't you nice. I wouldn't want my family member anywhere else." I didn't say anything to her at the time. My reason for not accepting the patient was because in my opinion, this opens the door for conflict. I have seen it happen too many times. The patient expects preferential treatment, the employee expects the patient to have preferential treatment, the rest of the family now feels that the employee is at liberty to discuss details of the patients' care, and heaven forbid if the patient was unhappy with the care received, they may be unwilling to report a legitimate complaint, or it may put the employee in a delicate position. Was I wrong to say no?

I always thought that that was what the sun did every morning....

Tony: I pray to God that I never find myself in the same situation you were in. You obviously handled yourself in a very professional manner and did what needed to be done for the patients. The manager of that unit did not do her job and should be held accountable for the mess you found yourself in. But you know what they say about sh** rolling downhill. I agree with everyone else that you need to find another job. Believe me, things like this DON'T happen everywhere. Just remember that a notice of resignation is only a professional courtesy, and considering the shoddy way they have treated you, they do not deserve a notice. Do make sure that you schedule an exit interview and make your voice heard. Be sure to tell administration that you will warn everyone you know not to seek treatment at this hospital. Word of mouth can be good for business as well as detract from business. Let them know that you will take your story to the local news (the public eats that stuff up). They are stringing you up and hanging you out to dry and you deserve none of it. I'm sure there are plenty of hospitals out there that would love having an experienced and qualified nurse on their staff. I wish you the best.

Yep, some of those air mattresses come with satiny mattress covers and the patient can just slide right off. Seen it happen.

Sometimes in the real world, things don't always work out perfectly. I had an experience a couple of years ago where I was working with an LPN, an excellent nurse with over 20 years of experience. One of her patients was crumping and while I was attending to the patient, she was on the phone with the docs, as she knew the patient inside and out, and the only thing I knew about the patient was what was related in report. When the code team arrived, I went to the nurses station and wrote the verbal orders she received from the docs. Now the docs knew she was an LPN, but they also knew what kind of nurse she was. I didn't have much choice at that point, because I can't be coding the patient and taking phone orders at the same time. I trusted her abilities as a nurse and had no qualms in writing the orders. When the docs did come in, they signed the orders without any problems. In this situation, we did what needed to be done for the patient. I have also had some LPN's take verbal orders and expect me to write them. I have had to explain to them the position they are putting me in, had them call the doc back and tell them that by rights they were not permitted to take phone orders, then put me on the line to verify the orders.

In the facility where I work, pay is based on how long you've had your license, so it really doesn't matter whether you are a diploma grad, ADN or BSN.

At the facility where I work there are 2 units that are using the medication reconciliation forms on a trial basis and from what I've heard it is going well. The rest of the patient care units will go online with them starting the 17th. I am all for making the docs be responsible for ordering the meds on admission and discharge, as it should be, instead of them just writing "continue home meds." If some of the docs refuse to use them, they will be required to completely write out (especially) the discharge orders on the physicians order sheets. After all, this is their responsibility. The patients can then keep a copy of the list and produce it when they visit their doctor or on subsequent admissions. Since our admission assessments are computerized, we will be able to update the list at any time if necessary. If the patient does not know the name or dosage of a medication, have the family bring the meds in or call the pharmacy where they obtain their meds. Generally the pharmacies are cooperative. I've had instances where a patient says they take a certain med but the pharmacy told me that the med hasn't been refilled in months. In my opinion this is one of the best ideas JCAHO has come up with!

Where I work I don't believe you can just voluntarily cut back on your hours unless you apply for a part time or casual position. That always gets me how hospitals give you sick time then ding you when you take them. It's bad enough that nurses aren't allowed to eat, use the restroom, etc., now we're not allowed to get sick either?!