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!

I have a year of experience in inpatient oncology and I am Chemo and OCN certified. Currently working in home health. Two years of experience as an RN total. Hated the inpatient setting but loved the oncology part of the job. I've applied to outpatient oncology clinics (opportunities are very scarce where I live) and haven't had any luck there. Oncology is my passion, it's the reason that I'm a nurse. Its the only thing I like about nursing... helping people with cancer. In my current job, I've had a total of 3 cancer patients and I've wondered why I've been dissatisfied for so long. But it's because my heartbeat is for oncology. So what else can I do to increase my chances of getting into outpatient oncology in an area where opportunities are scarce? Besides the fact that I only have 2 years of experience, that I can't control, but what are some things that ARE in my control that would make me a better candidate for these positions? Just a newer nurse looking for some helpful hints from people who have been doing this longer than me. Thanks

I am a home health nurse and I've found that I really love the wound care aspect of my job. I love education and to me wound care is the perfect combination of clinical nursing skills combined with patient education. I'm thinking about becoming WOCN certified. I have some questions about it and I'd like to hear from people who have this certification. Which WOCN program did you take? How much did the program cost? How well did the program prepare you for the certification exam? How well did the program prepare you for actually taking care of patients who have complex wounds/ostomies? How confident in your skills did you feel right out of the program? What are the benefits of certification? If I decide to leave home health someday, how easy is it to get a job at a wound clinic, hospital, SNF, or other facility? What kinds of doors does this certification open as far as career advancement? Any help and guidance would be much appreciated! I am reluctant about spending more money on schooling and I also hope to go for my masters someday, after I've had years of experience, for nursing education which would obviously require even more money. So I just want to make sure getting this certification would be worth the money (and time!) Thanks!

I've been a nurse for 2 years, my first year was in a hospital and after a year I moved to home health. I still sometimes feel like I don't know what I'm doing. My preceptor at the hospital (who has precepted many new grad nurses) said that it usually takes nurses 2 years to feel confident and I've hit the 2 year mark and still don't feel confident. Home health is harder because you're the only one there. The doctor isn't going to make rounds and do his own assessment later that day so it's up to you to detect any problems and if you miss something it's all on you. Anyways, I just hate feeling like I have no idea what to do in some situations. Is it normal to still feel like this after 2 years of nursing experience?

I really miss it too. I've been out of the hospital setting for 9 months and I want to go back. My husband thinks I'm crazy because he remembers how miserable I was due to the stress of my unit constantly being understaffed yet having such high acuity patients. That part, I don't miss.. nor do I miss the constant call lights, bed alarms, phone calls, interruptions, etc... but I miss taking care of people. I miss the structure and teamwork aspect. How hard is it to get back into a hospital setting after being out of it for 9 months and only having one previous year of hospital experience?

I live in a semi-rural area, but the closest big city is 45min-1hr away and the commute wouldn't be too bad. I'm just curious as to what are some perks of working in a big city hospital compared to a smaller, more rural area hospital? Other than better pay... Are the working conditions better? I know it depends largely on the individual hospital, but just asking for generalizations (if there are any!) Thanks!

I am having trouble with the autonomy as a home health nurse. Particularly, if a patient has a problem, knowing whether to educate/monitor or call the doctor or send to ER. It seems like I have to make a lot of decisions because I'm the only one seeing the patient on a regular basis and I can't go down the hall to ask someone what they would do. I have only been a nurse for 2 years so the limited experience isn't in my favor either. Does anyone have any tips?

Hi everyone. Home health nurse here, used to work in hospital. I love taking care of people and helping people but I can't handle patients and families taking out their stress on me. I'm an extremely sensitive person. I understand that when people's conditions get worse, they become stressed and they often take out their stress on the nurses. I get taken advantage of for my kindness and willingness to help beyond my job description, and I get accused of being selfish and not caring when the family doesn't see that I've busted my butt to help their very sick family member and to try and take some of the burden off of them. How do you handle this? How do you handle patients who are ungrateful and how do you not take their frustrations so personally? It is stressing me out. I got burned out of my last job at a hospital and I don't want this job to burn me out too.

Thank you so much, this is very helpful!

Hey everyone. I'm new at home health (less than 6 months) and I'm struggling with discharges and recerts, specifically how to make the decision whether to discharge or recert when the patient's certification period ends. Obviously if the patient has a wound or pleurx or something you would recert. But for the patients we just see for teaching and monitoring, such as CHF, COPD, etc., I have trouble making a decision when it comes to end of cert. Do you guys have any tips for someone new at this and trying to figure it out? Thanks!

Personally I haven't but I haven't been a home health for that long. Only a few months. When I was in orientation my preceptors patient had an emergency and we called 911 and she was taken to the ER. If I would call RRT in the hospital then I'd call 911 in the home. But if I have a problem, like I can't get a blood draw or something and I need another nurse to help, I can always call a coworker and the supervisors in the office are very good at answering questions I have on the field. Does that answer your question?