RN416

Does anyone have any general guidelines on when to call a doctor? I know it seems like a basic nursing skill but I still have difficulty deciding when to call and when not to. We have such sick patients with multiple comorbidities like heart disease, diabetes, dialysis, and I have a hard time deciding if a small change in condition is OK for them or if it’s serious enough to bother a doctor in the evening. Just looking for some general guidelines. Thanks!

Thank you all so much for your helpful replies!!

Thank you all for your advice! ?

I'm a fairly new nurse struggling with critical thinking and being detail oriented. I'm working on trying to notice details and small changes in a patient's condition and feel like I'm improving at it. But the struggle that comes with that is, when I do notice something wrong or different, especially when the change is subtle, I either second guess my assessment or don't know what to do about it (like don't know when it's appropriate to call the doctor or just monitor). Does anyone have any tips on improving critical thinking skills and knowing what to do about an abnormal assessment finding?

Hello, I have a patient going through chemo/RT for head and neck cancer who is not eating and losing a ton of weight because food tastes horrible. I've tried giving this pt recipes for different high calorie smoothies and other things but the pt says everything tastes bad. I am a novice oncology nurse and don't have much experience dealing with these taste changes. What can I do for this pt to help them eat more? Any help is greatly appreciated.

Thank you all for your responses! How were you able to transition from having a curative perspective to having a palliative care outlook? Have you guys been fulfilled as hospice nurses even though you can't help your patients get better?

I'd love to hear from some hospice nurses about the pros and cons of this field, and your experiences with it. I have home health and oncology experience, which I think are probably good experiences to help ease the transition to hospice nursing. I love getting to spend lots of time with patients, listening to them, being a comforting/calming presence to them in times of distress. I love getting to use my critical thinking skills to help patients feel better. Symptom management is my favorite part of oncology nursing, but in my current job the doctor does it all and I feel like I don't get to do much. I really feel, and have felt for a long time, that hospice might be my calling. I'm scared to make such a huge jump though, and I'm scared I'll hate it and regret it. I've had 3 jobs in the last 3 years, and I don't want to job hop. I want to make sure it's a good move and wise decision for me long term (more than 1 year), and that I'll be happy doing it, before I move again. My hesitations about hospice are that I would be totally on my own, and having to be on call. I am used to being on my own in home health, but at times it was very intimidating and I didn't feel very confident on my own, with no one there to help me or back me up. Also, I want to have a life outside of work and be able to make plans without having to worry about getting called into work all the time. Based on what I've written, do you hospice nurses think I would be a good fit for hospice nursing? I would appreciate any advice!

I was burned out after a year of working in the hospital, and honestly I feel like I could have written your exact post two years ago. My solution was to get out. I worked in home health for a year, and now I'm working in a cancer clinic. I'm so much happier, way less stressed. To me, the extreme stress and burnout weren't worth it. I also think that if I'm going to spend 40 hours a week doing something, it might as well be something I'm happy doing. Personally I'm so glad I got out of the hospital setting, and I don't ever see myself going back.

There are some things I like better, and some things that I miss about bedside. I love the consistent schedule of a clinic, M-F 9-5, never any weekends, holidays, or call. I love only having one patient I'm responsible for at a time, instead of 5-6 like on the floor. I love the lower stress levels of clinic work. I like that the patients are generally happier than patients in the hospital are, because they're stable and not acutely ill. I can't speak for all clinics, but I work in an oncology clinic and with this patient population I get to know my patients over time and develop a relationship with them, giving me a unique opportunity to help them more and make more of a difference in their lives. I also get to do a lot more teaching in the clinic, which I really love. Overall, I enjoy my job. The only thing I really miss about the hospital is using my skills. In the clinic I don't use many of my nursing skills except for assessment and patient education. I sometimes miss starting IVs, inserting foleys, hanging blood, passing meds, calling doctors for abnormals, etc. I sometimes miss the acuity and having to closely monitor labs, vitals, etc. But to me it wasn't worth the stress and burnout I experienced, and I'm much happier working in a clinic. It does have its boring days, but I'd take boring over overwhelming and worried about losing my license any day. I've never worked in a SNF so I can't say how it's different than a SNF, but it's different than bedside because you get to spend more time with each patient, you get to know them over time, you get to do a lot more teaching and to me it's a lot more rewarding. Hope this helps!

That is very helpful! Thank you for your detailed response!

I have a question for all you radiation oncology nurses. How does your facility manage side effects of treatment, such as burning to the rectal/perineal area from rectal cancer treatment, or mucositis/mouth and throat pain from head and neck radiation, for example? What is your protocol, what products do you have patients use, etc? I am looking to try to help improve how we manage symptoms at my facility so I would love as much input as possible. Thanks!

So, I have had two different patients' family ask me this week about if they'll survive cancer treatment. Both patients have been on treatment for a while and they were both not tolerating treatment as well as they were when they first started. I wasn't sure what to tell them. I don't want to say "I don't know" or anything like that because that adds uncertainty to their already uncertain situation. I'm curious as to how other oncology nurses handle this type of question. Thanks in advance!

Hello all, I was hoping to hear from some nurses who work or have worked as an RN in an oncology physician practice. I have an interview at a large cancer center for a position in the MD's offices, and I have never worked in a doctor's office before. Now, MAs are the ones doing the typical duties of taking vitals, etc and I'm not clear on what an RN's role in an office is, particularly an oncologist's office. I was told by HR on the phone that I would be triaging and doing lots of patient education regarding treatments, diet, etc. I would not be administering Chemo or cancer treatments in this position. I was hoping some of you could maybe describe what a typical day is as an RN working in an oncologists office. Thank you in advance for any help that will help me make a decision if I'm offered the job!

I'm a home health nurse looking into hospice nursing. I was just wondering how it compares to home health, other than the obvious difference that hospice is focused on comfort and home health is focused on healing. For people who have worked both, which one do you like better and why? Are families difficult to deal with in hospice due to their grief? Do you have to make critical decisions on the spot like you have to in home health? Does being on call interfere with your work-life balance? Any feedback would be appreciated.

I am in a similar situation and have had similar doubts as you... I am also under 25 but I am not a hospice nurse, I work in home health. I LOVE home health and like you, I was burned out after just one year in the hospital and frustrated that I couldn't spend enough time with my patients in the hectic busy environment. I've been in this home health job for a year now and from the start I've had the same feelings as you, especially about being hireable for other jobs later on in my career. But then I think about what other jobs I'd even apply for. I definitely don't see myself working in a hospital ever again. If I had to spend the rest of my career in home health, I'd be happy. So maybe think of it like that and ask yourself that, if you really love your job and think you've found your place in nursing (which by the way, is a HUGE relief and so nice to feel fulfilled by the work you do) then I wouldn't worry too much! Hope that helps. Also, about the confidence in skills aspect, it comes with experience and the more you practice the easier it becomes. And I'm sure you have a supervisor at your office, I'm sure she/he wouldn't mind you calling and just running things by them to get a second opinion. Better to ask then risk harming your patient!