6/4 WILTW: Oui jete' du Nursing???

[LadyFree28]

Hi Everyone!

Ixchel asked me to guest host WILT for the second time.

I will say-my French is not that great...the best I can do is relegated to ballet terms at best; one of my nieces is heading into the direction of becoming a principal ballerina; she is heading to New York for a Summer intensive in one month, and goes to a world renowned school in my area-she has been dancing for 11 years; her youngest sister is in her same shoes; this week I was able to see them both perform on stage at their dance school's end of year performance-it goes beyond the average recital...and they both know French

So, jete' simply means "thrown", rather a leap in which one leg appears to be thrown in the direction of the movement in ballet. I always felt I have "thrown" myself into nursing; meaning, I never had a specialty I had my heart set on, when I was a LPN, and even as I progressed to an RN; I had goals, yes, but most of those actions meant to transcend specialties, which I think I have accomplished nicely.

I have come come to a point in my career where I found a specialty that is a fit; I have focused on one position, however, I see a per diem position where it's working with adults, in the same specialty as opposed to children; it would give me additional experience; also a few people that I network with and a few recruiters have been asking for my resume.

The jete' in me wants to apply and see if I can juggle both (the per diem is truly per diem) but the practical side of me wants to wait another year before applying.

Ah, decisions, decisions.

So, what I also learned this week:

I have passed my "black cloud" onto one of my coworkers due to my long hiatuses from work, which got longer when I ended up with a cold this week; I helped her out as much as possible because I understood the struggle of constant work ups, bizarre pts and families.

I still need practice with accessing ports; I have an idea how to achieve this, and know who to ask in terms of having more practice during a low season; before I probably would've gotten a no, but now that a new regime is in place, I have renewed hope.

I also started a hand IV on my first chunky baby...one of my other banes of existence to conquer!

I'm a de-facto resource person post orientation and newbies are feeling very comfortable talking to me about their new life in the world of a Level 1 PediED.

After talking about my other two nieces, their sister, the middle one who is 14 and destined to be a veternarian, placed second in her FIRST horse show! I'm hoping she can go for gold someday...

So, what have you learned this week?

[cracklingkraken, ASN, RN]

WILTW (not much nursing related, since I'm out of school and not working yet):

I have great friends who are willing to host me for weeks, without expecting anything in return. Of course, as soon as I have some income, I'll be financially compensating them for that time.

I've been out of the dating scene for a while, but I've met someone while in MI who actually seems like a great guy. A bonus for when I move to MI.

I have my endorsement app ready for MI, and I'm sending it out tomorrow. Apparently, it can take 6-8 weeks to process, though. This means that I might not be able to start working in MI until August. My parents have been very supportive during this time, and I can't wait until I can finally be out on my own and repay them.

I feel nowhere near prepared to function as an RN, but I pray that I have a supportive hospital and wise, encouraging faculty to help me through the process.

[nutella, MSN, RN]

I loved reading that whole palliative section of your post. This is what has been the biggest point of moral distress for me lately and what's making me really unhappy about my job. We have so many patients on my unit right now that have been there for weeks, that are all but brain dead, or some vital body part is pretty much all the way dead and they aren't transplant candidates, who families refuse to withdraw on. Out of 30 patients, I think the ethics committee was following six or seven of the patients who were there the last shift I worked.

I hate families. I hate them. It has gotten to the point where if I see family members in my room when I'm getting report, my mood is instantly sour. Sometimes they are awesome and we are best buds and laughing together by the end of the shift, but tolerating these unrealistic people who are torturing their "loved ones" to death is something I'm struggling with emotionally. The urge to ask these whackjob people "Did your mom/dad/grandma abuse you as a child or something? Is that why you're doing this?" gets stronger every day. One of these days I'm going to lose it and it's going to happen.

I am glad you enjoyed those palliative care writings...

Yes - I feel you frustration. I deal with those problems every single day and our small palliative care team supports each other. We made it a priority to eat lunch together and we can vent to each other at any point.

You sometimes wonder. Patients who think that they have to go home on a home dobutamine drip although already bed bound with pressure ulcer and terrible other wounds. When the family learned that hospice is an alternative they were like??? never knew there was a choice. In the meantime cardiology continues to be hesitant and regards palliative care as their "enemy" not realizing we can work together...

[nutella, MSN, RN]

In regards to the accuvein I find it isn't very helpful.

How come? The nurses I talked to on the floors found it helpful but stated that is takes some while to get the idea of depth.

[meanmaryjean, DNP, RN]

This week I learned:

That being 'the nurse in the family' has finally come in handy for something after almost 4 decades. I was able to state my case and get people to listen to me when I was forced to start the palliative/ hospice conversation today in regards to my Dad.

Let me tell you something about my Dad. When my Mom walked out on him in 1968, there were no day care centers, before-and-after school programs. He was the first man in Indiana granted custody of his kids. We were the only kids in our school who lived in a single parent household except for the girl whose dad died in the mills. I was the oldest, at 13. My four younger sisters ranged in age from 11 years down to 5 months. He raised five daughters to adulthood by himself. He did the best he could with what he had to work with.

Later in life, he met my wonderful step-mother. She's been so good to him. They've had a long and loving marriage. But Parkinson's and dementia have intervened......and it hurts so badly to watch.

[AspiringNurseMW]

OC I'm so glad you are seeing the light at the end of the tunnel!

Meanmaryjean I'm so sorry for this new development, but I'm glad you were able to get people to listen to you

I learned that it is June. Part of me feels like, crap its June already, the year is almost halfway over, I need to start checking off things my summer to do list. The other part of me is like, relax, June JUST started, the entire summer is ahead of you, but I don't trust that part of me. Haha.

I learned just how thankful I am for the instructor I have for my 4 week summer class. He literally told us that we'd have to WORK at failing. He literally gives us the questions to our weekly quizzes and our final is take home. The other 20% of our grade is class participation and assignments, which he doesn't even check. Instead, he focuses on teaching, and pointing out what is important for us to know, and what is actually applicable to on the job, as he has over 30 years of cardiac and ER experience.

A good friend of my husbands chose to terminate her pregnancy in the 2nd trimester, just a week or 2 after finding out the gender due to a genetic diagnosis. She chose not to have a lady partsl birth because she didn't want to go through labor or see the baby. But my heart broke for her because she wanted the ashes. But she didn't have the money to pay for a cremation and the hospital offered no alternatives . Do hospitals not have relationships with funeral homes to offer something like that for free? That's so unfair.

My 2.5 year old is coming out of her anti social shell! Nothing was wrong with how she was before, I actually didn't mind that she had a hard time warming up to adults. But she does so much faster now, and will try to converse after about 5-10 minutes! On the other hand she's having trouble getting to sleep and sleeping through the night. She wakes up 4-5 times a night. I'd let her cry it out except she gets out of bed and will come to my room. I don't know what to do, I would like to sleep uninterrupted. I don't know what to do, because when I do go to her when she cries, she's barely awake, and I can put her back to sleep faster than it took me to get to her room.

I know it's summer and while I don't miss school, I miss clinicals. I'm still upset I missed the deadline to apply for summer externships by TWO days. Boo.

[RainMom]

A good friend of my husbands chose to terminate her pregnancy in the 2nd trimester, just a week or 2 after finding out the gender due to a genetic diagnosis. She chose not to have a lady partsl birth because she didn't want to go through labor or see the baby. But my heart broke for her because she wanted the ashes. But she didn't have the money to pay for a cremation and the hospital offered no alternatives . Do hospitals not have relationships with funeral homes to offer something like that for free? That's so unfair.

Oh, that's so sad. My facility doesn't do terminations (catholic) but in the cases of miscarriages, we offer cremation & a shared plot where ashes are interred. I believe this occurs on a monthly basis with a small ceremony. There is no fee to the family & they have a place to go & grieve if they wish.

[cracklingkraken, ASN, RN]

((Meanmaryjean))

After further investigation and thorough reading, I discovered that, by paying an extra $10, I can obtain a temporary license in MI once all my required documents are submitted. I guess I won't have to wait the full 6-8 weeks for it to be processed, which is a relief.

[CanadianRN16]

I hate families. I hate them. It has gotten to the point where if I see family members in my room when I'm getting report, my mood is instantly sour. Sometimes they are awesome and we are best buds and laughing together by the end of the shift, but tolerating these unrealistic people who are torturing their "loved ones" to death is something I'm struggling with emotionally. The urge to ask these whackjob people "Did your mom/dad/grandma abuse you as a child or something? Is that why you're doing this?" gets stronger every day. One of these days I'm going to lose it and it's going to happen.

I guess it's a different culture in long term care, many of the children of my palliative residents have experienced death of loved ones before and are a lot more...civil about the process.

This week, one of the daughters of my rallying palliative resident is encouraging him to 'let go' and 'die already' when she's alone with him haha.

[calivianya, BSN, RN]

I guess it's a different culture in long term care, many of the children of my palliative residents have experienced death of loved ones before and are a lot more...civil about the process.

This week, one of the daughters of my rallying palliative resident is encouraging him to 'let go' and 'die already' when she's alone with him haha.

It's definitely different.

We have one up there right now who's a post-code who coded two weeks ago and his body is fixed at this point but his brain is still 99% gone. He will blink if you try to stick your fingers in his eye, but no cough or gag. He was hooked up to a continuous EEG and he was seizing all the time the first night I had him. Constant status epilepticus despite a metric ton and a half of anti-seizure medication. They finally got the balance right and stopped the seizures, but his brain is still a no-go.

He doesn't have enough of a drive to breathe to come off the ventilator. One of our intensivists put the vent on standby just to see what he'd do, and it looks like the guy wants to breathe 5 times per minute or less on no sedation. Okay.

A neurologist spent an HOUR AND A HALF showing all the family the extensive swelling on the MRI and explained how it was all incompatible with recovery. I have personally talked to the family multiple times myself and have said that if his body survives, he will never talk, he will never eat, he will likely be laying in a room on the ventilator with tube feeds running, blinking up at the ceiling for the rest of his life and that will be as good as it gets. He will never interact with them or even squeeze their hands.

If you sternal rub him, he postures, but if you just pinch his nailbeds you get nothing. I tried taking a hemostat to his fingers... nothing. I could probably chop off a finger and not get a reaction.

They rescinded the DNR a few days ago, and they're always in there shaking on him and screaming "Daddy wake up!" in his face. Thankfully they're usually gone by 9 PM or so so I don't have to sit there and look at them all night.

At least he's dead enough that he doesn't know what's happening to him. Some of our patients aren't that lucky.

[nutella, MSN, RN]

This week I learned:

That being 'the nurse in the family' has finally come in handy for something after almost 4 decades. I was able to state my case and get people to listen to me when I was forced to start the palliative/ hospice conversation today in regards to my Dad.

Let me tell you something about my Dad. When my Mom walked out on him in 1968, there were no day care centers, before-and-after school programs. He was the first man in Indiana granted custody of his kids. We were the only kids in our school who lived in a single parent household except for the girl whose dad died in the mills. I was the oldest, at 13. My four younger sisters ranged in age from 11 years down to 5 months. He raised five daughters to adulthood by himself. He did the best he could with what he had to work with.

Later in life, he met my wonderful step-mother. She's been so good to him. They've had a long and loving marriage. But Parkinson's and dementia have intervened......and it hurts so badly to watch.

I am sorry that your dad is not doing well. Even when we are nurses, it hurts us to see our family members struggle and decline.

[nutella, MSN, RN]

I guess it's a different culture in long term care, many of the children of my palliative residents have experienced death of loved ones before and are a lot more...civil about the process.

This week, one of the daughters of my rallying palliative resident is encouraging him to 'let go' and 'die already' when she's alone with him haha.

I think it is different in the hospital when the focus is still on "acute care" and "treat treat treat" because our acute hospitals are all geared towards performing miracles... I am talking about 90 + patients who are being dragged through all kind of tests and considerations of dialysis/heart surgery/ back surgery - when in fact it is clear to most people with common sense that this is not going to happen due to high age and co-morbidities.

Granted, I have started dialysis on a 90 y old patient once because he was in good shape and the doctor "wanted to give him a chance". He fainted the first couple of times and made it to dialysis for 6 months, when his body finally gave up. Was it worth it? I don't know. The kids had pushed for him to "do the treatments".

[nutella, MSN, RN]

It's definitely different.

We have one up there right now who's a post-code who coded two weeks ago and his body is fixed at this point but his brain is still 99% gone. He will blink if you try to stick your fingers in his eye, but no cough or gag. He was hooked up to a continuous EEG and he was seizing all the time the first night I had him. Constant status epilepticus despite a metric ton and a half of anti-seizure medication. They finally got the balance right and stopped the seizures, but his brain is still a no-go.

He doesn't have enough of a drive to breathe to come off the ventilator. One of our intensivists put the vent on standby just to see what he'd do, and it looks like the guy wants to breathe 5 times per minute or less on no sedation. Okay.

A neurologist spent an HOUR AND A HALF showing all the family the extensive swelling on the MRI and explained how it was all incompatible with recovery. I have personally talked to the family multiple times myself and have said that if his body survives, he will never talk, he will never eat, he will likely be laying in a room on the ventilator with tube feeds running, blinking up at the ceiling for the rest of his life and that will be as good as it gets. He will never interact with them or even squeeze their hands.

If you sternal rub him, he postures, but if you just pinch his nailbeds you get nothing. I tried taking a hemostat to his fingers... nothing. I could probably chop off a finger and not get a reaction.

They rescinded the DNR a few days ago, and they're always in there shaking on him and screaming "Daddy wake up!" in his face. Thankfully they're usually gone by 9 PM or so so I don't have to sit there and look at them all night.

At least he's dead enough that he doesn't know what's happening to him. Some of our patients aren't that lucky.

Unfortunately, this is not too unusual. I have seen patients where the family reversed the code status from DNR to full code because they were afraid "the doctor would not do anything otherwise" or "they will just let him die". At times the family tries to force physicians to engage in futile medicine by reversing code status. We have ethic involved at times but the whole ethics process is often so long and does not change much of the outcome. Often enough, family will state religious motivation for the wish for maximum therapy or even futile care but when I mention that no higher entity would want suffering and that if that entity would want to perform a miracle it would happen anyways, people often admit that it is less religion and more personal opinion based.