Starting to feel like an idiot

[MomRN0913]

I started in hospice and palliative home healt 6 weeks ago. I worked ICU in the hospital for over 4 years and took a bedside break for a year and a half almost.

The company I work for is medium sized, but the hospice section is small. We also do the palliative cases.

Anyways, I warned before I was hired that the paperwork drove the last 5 nurses away and it drove away a nurse who had only been there 6 weeks, 3 weeks into my start.

They are not computerized AT ALL. Millions of flow sheets, a paper for everything. Even doing my time sheet takes up a lot of time.

I kind of went off orientation early, when the other nurse left. I kept getting praise, but i didn't feel like i was doing good. Well, last week, they slammed me because my supervisor was off and i become overwhelmed, backed up and freak out. I sat down with them, and they agreed to not give me 3 palliative admissions in a week like did and to lighten my load each day, since I pretty much went to 0-60 in no time.

Well, this week didn't get any better and my supervisor is starting to make me feel stupid because I am having a hard time chosing the right papers for different things.... There a paper for EVERYTHING.

I love the patients. But I do not love sitting with charts on the weekends, in the mornings before I go to work and also at night before bed. I don't get to eat all day pretty much, or pee.

Though this was going to be a little less stressful, but maybe I am wrong. I refuse to leave this job, as I haven't had a steady job since my ICU job (which I miss) I felt competent there.

Uggghhh, someone please tell me it will get better!

[Reigen]

First thank you, doing hospice work is not easy and it is stressful.

Not being a computerized agency is also going to be hard until you get each form you will need for different cases down pat and memorized.

If you can make yourself a few "packets" of different types of visits... for example: Make up a packet with every form for admission, discharge, death, routinue visit, extra visit, medication set up, make a telephone log sheet, and place these in a binder/folder for you personal use. Get milk crate or something that you can put these packets in the trunk of your car, in folders. Keep forms in binders in that milk crate.

Get a BIG daily planner book, and pencil in every visit and the time of the visit.

Buy yourself a nice lunch tote, that has a seperate area for ice packs so that you can keep food for lunch in there. Also in that trunk, pack a case of bottle water, juice boxes, healthy dry snacks, fruit roll ups, granola bars...

Since you were off orenitation early because of staff changes, you did not get everything that you might need in order to be the best you can be... therefore take a mental note and get yourself what you think you will need. Need an admission packet, make those up (see above paragraph) need phamlets of teaching education items, get that into that milk carton...

Carry extra supplies in the trunk as well... used needle containers, adult briefs in different sizes, skin care creams and washes, and plenty of antibacterial wipes, gloves, plastic bags.... put in another milk crate....

I used milk crates as these can be bunge corded together and anchored in my trunk, and are open so I can look and see what I have and need to replace from the supply room and forms rack.

Then do a self assesment... what do you think you are going to need in order to do the best job you can do. Make a work plan Example, this week I will learn how to:_______________ this month I will be able to do:______________________. Set self goals and also talk with your supervisor. Find another nurse in your office to be able to assist you when you are unsure.

Talk with your supervisor, and if you just truely feel you haven't got it are not getting it, ask for MORE time with another nurse out in the field. Let that supervisor know that you do not feel like you are ready to be off on your own yet, and that you feel that by going back to orientation you in the long run will be a better employee.

Try to NOT do the paperwork after hours weekends. If you have to stay at the client's home. inpatient facility in order to finish it, stay. When using a computer, you can't log in from home, so get used to finishing at the "bedside"/"place care was given".

Then each day do something for yourself....I for example enjoy a nice cup of green tea but I also am trying to master making that green tea as in a Jaapnese Tea Ceremony Way....taking tea that way is a mental break, peacful relaxing...

A buble bath, a foot soak, a great book....

Every 2 weeks go get a pedicure...there is something about that massge chair while papmering myself....

I hope this may help you, and again thank you

[MomRN0913]

That was excellent, excellent advice, thank you!

My 2 bosses have been suportive, although my direct supervisor seemed to be stressed this week and a little short and is usually kind of blunt, so I felt stupid a few times. They seemed very happy to have me about a week and a half ago at my eval, and said as much to education. This week, she seemed a little stressed. Somethings I didn't understand were things i did maybe once.

I have about 9 hospice cases, although they are not dying any time soon. Most are lovely people, and when it does come close, it will be difficult. One is a dump job that all the new nurses get, of course. They pretty much had me take and open up all the pallisatives, which are difficult and have much more paperwork, and I am still not totally getting the medicare regulations, which I think is screwing me up, although in 2 weeks, I will be having medicare classes.

When i confronted them they said I will have 2-3 visits a day, and one admission a week, but it didn't end up that way, too much to be done, not enough people. They haven't trained me yet in pain management and end of life care, because I think right now it is easier for them to have me do the palliatives.

Admission packets do come put together for me already, which is nice, I just have to get the millions of care plans, all which have flow sheets.

The egg crate is a great idea, along with the log. They jsut gave me my trunk box, which is huge..... and my sharps conainers.

I think my best bet is to not go back to the office so much to do paperwork. i go back, and about 5 aides need to be suped, someone is asking for something...... and I can't chart. I do my best when I get my visits done, go to the library and do my phone calls in the AM.

really,t hianks for all the advice. I am going to put some fo those things together this weekend and catch up on my paperwork, so I don't have to do it much after hours anymore.

It's stressful. But I don't want quit like the others. Nor do I want to get fired!! I'm going ot make this work!

[Reigen]

Happy I could help...

care plans the nightmare of any nurse.... there are a few places that have pre-printed ones that you cross out to personalize for your client.....does your agency have any standard ones at all that you can use?

I took a peek in my binder to see what all I had in there...I use a 3 ring 3 inch one

Everybody's phone numbers in agency... so that I have those out in the field if needed

Face sheet and driving directions for each client I have ABC tabs so can put under clients name

medication sheet for each client with medications listed as well as what pharmacy and the telephone number for pharmacy

other assigned persons: aide, chaplain, social worker etc, and what care the aides are providing and how often aides were assigned to make a visit, also if could obtain, the aide schedule to cordinate a supervision visits.

Telephone Log

Mileage Log

Time Sheet

Standard Medications and Standing Orders (which we can order without needing to call MD for)

Morphine to Methadone converstion table (I can never remember that)

Medication explainations and Teaching...like those from a hospital discharge to help educate family/clients

Other teaching Information

Examples:

How to make an occupied bed,

How to help with transfers

When your loved one won't eat

Dying Process Information for families

one each of packets admit discharge death

Other trunk things:

Disposable camera.. if in an accident to take pictures of car damages

Blanket

Extra set of clothes/underwear/socks/shoes ( never know if you will get something on you)

[unreal RN, ASN, RN]

I thought I was the only one having issues with homecare! I started off liking it in the very beginning, I've been at it for a few months now. Some days I feel like I never went to nursing school that's how much I don't get it...and I've been a nurse for over 20 years...mostly med/surg, icu. The company I work for is not computerized and there are a gazillion forms to deal with and hand cramps from all of the nurse's notes to be written. I hate having to deal with charts and phone calls at home..it's like I never get away from work...ever. My boss has done nothing but homecare her entire career. She is nice enough but she questions EVERYTHING I do and ALL of my patient assessment findings..like an instructor would address a student. I'm afraid to chart anything without her approval first as I can't seem to document correctly for homecare. Again, I have been a nurse for over 20 years and I've never had any issues with my documentation or assessment skills. I'm thinking about looking for another job as I don't think this one is going to work out for me. Thanks for letting me vent.

[Isabelle49]

Anyone working for a company that is on paper really needs to keep an eye out for openings with a company that is computerized. We went to computer late last year and it's been a breeze!

[anh06005, MSN, APRN, NP]

As reigen said packets for different visits are amazing! My agency has the secretary staff put them together so we can just grab them and go. And you do need to keep extras of everything in your car. I have my tote of course but also an accordian type folder for extra lab order forms, notes, etc. we also have pre made caremaps in a file cabinet so we just grab them and go. Also in the caremap packet is educational material for the patients. Some are pamphlets. Some are little 'books' made by nursing students. After reading some of the posts on here i definitely feel spoiled by our agency.