What is the hardest thing about your job?

SoCalRN1970 · Jan 11, 2011

I will be honest. The toughest thing I have to deal with is the master of denial. Angry family members who will take out their own anger on you, the advocate for patient comfort. Educating family members who are dpoa and have no sweet clue about hospice is a tough nut to crack.

Just today I was asked by a grantdaughter dpoa why I was giving Morphine to her grandmother ? I explained the use of it. Grandma is cheyne stoking and really is having periods of respiratory distres.. Gdtr asked the facility to call her before each dose of morphine ( Gdtr is an accountant with NO medical experience ). I openly said to the gdtr. I understand where you are coming from, but honestly? You need to come and see your grandmother before you jump on the decision. I am hoping the vision of a woman breathing 20-30 times a minute, and gurgling is enough to convince her about the morphine..

SoCalRN1970 · Jan 11, 2011

But the denial issue only comes across about every 2 out of 10 patients. The work is very rewarding and you do learn life lessons on a daily basis. Patients and family who are 100% on board of goals and treatment are ever so appreciative of what we do and how we do it. It's rewarding to see symptoms finally treated and controlled to help those who are facing end of life..

FYI.. Home Health has a slew of paperwork that does not apply to Hospice. Paperwork and documentation is easier, but the work is more emotional as out lined by above.

ErinS, BSN, RN · Jan 11, 2011

The hardest thing about my job is that I am personally accountable for 15-20 patients and their families that are going through the hardest time of their lives. They are angry, in denial, grieving, happy, sad, sometimes crazy... It is a level of responsibility I am not sure you get in other areas of nursing. And in the end, everything that goes wrong (or right) comes back to me, since I am their case manager. But that being said, I love my job.

Vtachy1 · Jan 11, 2011

Do you bring a lot of paperwork home and work for hours after you have completed your day? I know I've heard Home Health talk about doing this.

SoCalRN1970 · Jan 11, 2011

I do not bring my notes home ever. In fact I keep my documents out of site and never work on them at home. I do it at bedside or curbside if need be. But No, I never bring mine home. If Ihave to do extra paperwork.. I allow for it during my day. or ask for office time. Otherwise it takes away from my personal life and I refuse to give my job that. It takes a mind set to do what I do, took awhile to get it down, but it must be done this way.. or you are swimming in notes at home.

furballfarm · Jan 11, 2011

I have two areas that I find exceptionally challenging.

*As others have mentioned, I have times that are very challenging concerning family members. I have also encountered the grdtr who didn't want any ativan or roxanol used because it was making her grfather too sleepy. She was too busy to come 30 miles to visit, and really chewed the LTC nurse for sedatiing her relative. He was confused, combative at times, restless, grimacing with some resp distress at times. Educate and educate, without any positive result for the pt. Thankfully my DOCS encourages call in SW, when we reach the point for beating our heads against the wall.

*My other area of challenge is the company that I work for. I work on-call 5pm Friday until 8am Monday. It is not unusual for me to receive a call on Thurs regarding a possible admit 125 miles away on Friday. I am usually willing to start early on Friday, but now they seem to assume rather than ask. Additionally there are numerous times of training regarding HP, new forms, or peer group that occurs during the week. We are not compensated anything extra for the hours during the week, and they are usually mandatory. Numerous times I have asked if "it doesn't really take that long" or "it is a requirement for doing our job" why does the train not take place on Sunday morning? Some how I am supposed to just be happy when I have a conference call training once a month 6-7pm, with new form training on the 20th. Additional calls to HP or concerning DME at 9am Monday. While none seems like much, when added up over a few months it begins to seem like a lot. Additionally I receive text messages on my work phone, if I don't respond quickly (yes, during the week) then my personal phone rings. We have training to encourage us to take care of ourselves by setting boundries, but those boundries don't seem to apply to the company.

tewdles, RN · Jan 13, 2011

I have two areas that I find exceptionally challenging.
*As others have mentioned, I have times that are very challenging concerning family members. I have also encountered the grdtr who didn't want any ativan or roxanol used because it was making her grfather too sleepy. She was too busy to come 30 miles to visit, and really chewed the LTC nurse for sedatiing her relative. He was confused, combative at times, restless, grimacing with some resp distress at times. Educate and educate, without any positive result for the pt. Thankfully my DOCS encourages call in SW, when we reach the point for beating our heads against the wall.
*My other area of challenge is the company that I work for. I work on-call 5pm Friday until 8am Monday. It is not unusual for me to receive a call on Thurs regarding a possible admit 125 miles away on Friday. I am usually willing to start early on Friday, but now they seem to assume rather than ask. Additionally there are numerous times of training regarding HP, new forms, or peer group that occurs during the week. We are not compensated anything extra for the hours during the week, and they are usually mandatory. Numerous times I have asked if "it doesn't really take that long" or "it is a requirement for doing our job" why does the train not take place on Sunday morning? Some how I am supposed to just be happy when I have a conference call training once a month 6-7pm, with new form training on the 20th. Additional calls to HP or concerning DME at 9am Monday. While none seems like much, when added up over a few months it begins to seem like a lot. Additionally I receive text messages on my work phone, if I don't respond quickly (yes, during the week) then my personal phone rings. We have training to encourage us to take care of ourselves by setting boundries, but those boundries don't seem to apply to the company.

I would guess you work for a "for profit" hospice.

My recommendation is to look for other employment if the company refuses to acknowledge your important and reasonable boundaries...there are good and supportive hospices out there.

I would bet that family members who are more concerned with their feelings than the suffering of the patient will always be a difficulty for hospice nurses who are committed to palliating the suffering of the patient. Generally speaking, education does not work...only the reality of the suffering works...maybe. Sometimes we have to let the family torture the patient with their persistent ignorance...

furballfarm · Jan 13, 2011

Thank you for your insight and response. You did an amazing job, reading between the lines. :heartbeat