40 years of Nursing, and still learning---until my own death

[jegworld]

I have been an RN for over 40 years, and I can honestly say, each day I learn something new about myself and how best to care for patients and their families. My experiences have ranged from med-surg, ICU, ER, L&D, NICU, managed care for both insurance companies as well as UR in hospitals. The advent of managed care certainly changed the focus of my practice as an RN, although it has always been the patient first, paying claims is just another way of caring for the patient.

I started during a time when sterilizing needles, directing teams and doing little patient care other than passing meds, starting IVs, and even getting up to give physicians my chair to today where the RN is running from one heavy duty assignment which could include hanging blood, telemetry, wound care, putting in foleys, and making sure the patient receives the right meds, doses etc. Forget when we used to be able to give back rubs for comfort, keep rooms clean, bathe patients daily with hair care and soft touch. Now, the RN is running, literally running from one high tech ordered procedure to another. Primary Care nursing, no longer allows for baths, hair care, personal touches such as keeping rooms uncluttered.

Prioritizing is a difficult thing to the RN today. I have worked as a discharge planner/case manager in hospitals all over the country. Working as a travel RN in the capacity of Case Manager/Discharge Planner has allowed me to see that the RN is no longer in a position to take her time, listen to the patient or families, but must keep on moving.

I am saddened by this situation, as I became a nurse to nuture, care for and advocate for patients. Who would consider a surgical patient who goes home in 3 days and NEVER showered or was bathed. This was the time I got to know the patient, their fears, their thoughts and wishes.

Also because nursing has become one of the number one "jobs" with the teaching situation being saturated, I also find a good deal of nurses who just "do it for the money", which of course is a different world.

I love being an RN, and love being involved in end of life discussions, discharge planning for the reality of the patient and their family, and being able to hold hands, assess their needs, and follow up with proper discharge plans and goals.

I would not give up my experiences of assisting in a CHF patient who has reached the limit with active treatment transition to their plan for end of life. Or assist a Hindu family in having a ceremony in a hospital so that all could attend, but in a neutral environment. This has required a good deal of learning on my part, as culture changes have caused me to "research" mores and practices, and to integrate them in my thought and practice.

Yes I am still learning, daily, I look into a patients eyes, they share their heart, their family shares the differences in their goals as opposed to the patient goals, and try to find a creative way to make all comfortable and often peaceful with the choices. This does not happen without actual touching, hand holding, and human interaction on a personal level. My life is better each day for these collaborations.

As my mortality becomes more as more clear to me, I lose family members, and I am in the position where I am dependent on someone else to assist me with recognizing I am a nurse, but first a daughter, mother, aunt or cousin.

Learning is what being a nurse is all about, and until my last breath, I hope to continue to do so.

[lamazeteacher]

I have been an RN for over 40 years, and I can honestly say, each day I learn something new about myself and how best to care for patients and their families. My experiences have ranged from med-surg, ICU, ER, L&D, NICU, managed care for both insurance companies as well as UR in hospitals. The advent of managed care certainly changed the focus of my practice as an RN, although it has always been the patient first, paying claims is just another way of caring for the patient.

I started during a time when sterilizing needles, directing teams and doing little patient care other than passing meds, starting IVs, and even getting up to give physicians my chair to today where the RN is running from one heavy duty assignment which could include hanging blood, telemetry, wound care, putting in foleys, and making sure the patient receives the right meds, doses etc. Forget when we used to be able to give back rubs for comfort, keep rooms clean, bathe patients daily with hair care and soft touch. Now, the RN is running, literally running from one high tech ordered procedure to another. Primary Care nursing, no longer allows for baths, hair care, personal touches such as keeping rooms uncluttered.

Prioritizing is a difficult thing to the RN today. I have worked as a discharge planner/case manager in hospitals all over the country. Working as a travel RN in the capacity of Case Manager/Discharge Planner has allowed me to see that the RN is no longer in a position to take her time, listen to the patient or families, but must keep on moving.

I am saddened by this situation, as I became a nurse to nuture, care for and advocate for patients. Who would consider a surgical patient who goes home in 3 days and NEVER showered or was bathed. This was the time I got to know the patient, their fears, their thoughts and wishes.

Also because nursing has become one of the number one "jobs" with the teaching situation being saturated, I also find a good deal of nurses who just "do it for the money", which of course is a different world.

I love being an RN, and love being involved in end of life discussions, discharge planning for the reality of the patient and their family, and being able to hold hands, assess their needs, and follow up with proper discharge plans and goals.

I would not give up my experiences of assisting in a CHF patient who has reached the limit with active treatment transition to their plan for end of life. Or assist a Hindu family in having a ceremony in a hospital so that all could attend, but in a neutral environment. This has required a good deal of learning on my part, as culture changes have caused me to "research" mores and practices, and to integrate them in my thought and practice.

Yes I am still learning, daily, I look into a patients eyes, they share their heart, their family shares the differences in their goals as opposed to the patient goals, and try to find a creative way to make all comfortable and often peaceful with the choices. This does not happen without actual touching, hand holding, and human interaction on a personal level. My life is better each day for these collaborations.

As my mortality becomes more as more clear to me, I lose family members, and I am in the position where I am dependent on someone else to assist me with recognizing I am a nurse, but first a daughter, mother, aunt or cousin.

Learning is what being a nurse is all about, and until my last breath, I hope to continue to do so.

You are very fortunate to still be working! I started to lose jobs after I was 55 years old. It never occurred to me to be silent about that, as I've had breast cancer (2 different primaries) twice and consider each day a gift.

So after I lost that job, not knowing why and not understanding what the term "at will" was all about, I quickly got another one. That was challenging, as the work was different than it had been 10 years before, when I was given the role of Infection Control Nurse when that first came into being (added to my "Inservice" Nursing educator role). I love challenges.....

I left that to go to a faraway state, where my daughter lived. She had just been diagnosed with MS. I took a part time job in Home Health Nursing there, supervising nurses giving care. Most of the patients had longterm disabilities, and I'd had some experience in the past, as a Pediatric Consultant Nurse at a Regional Center. (Another job which I'd lost, due to "at will", after I was 55).

I was aware that both jobs had been "lost" shortly after I'd been asked to complete an application for health insurance, despite my assertion that I had that coverage (COBRA) and didn't need it from my employer. Both applications required that I fill in my birth date, which I did, sublimely unaware of any consequences that might have.

Realizing that COBRA's cost was quite high, I asked how much the policy provided by the Home Health agency would cost, if I was eligible for it. Well that opened a whole new vista of the state of insurance that had become the norm everywhere. Nurses were being hired part-time in positions that really needed at least 3/4 time hours! Because of that, constant admonishment to work fewer hours was given, despite the heavy work load. No one seemed to know what was covered by the health insurance policy there, yet most employees were paying for it themselves since they weren't working (supposedly) over 32 hours a week.

To say I was surprised to find, finally after a lot of digging by the administrative folks in another state, that the $325./month that was paid to the insurance company, had a $1,350/ year cap put it mildly!!! No, I didn't leave off any zeros in that figure.....

Flabbergasted, I gasped, "That's absurd!", I received the "cold shoulder" treatment thereafter.

Not surprisingly, a new Nursing Director there took over the supervision of my cases, and then told me that my services were no longer needed. Until then I'd had very good written evaluations. None were forthcoming from the new DON.

So my next position was as a "Disease Nurse" for Obstetric patients at Wellpoint (the parent company of Blue Cross/Blue Shield/Anthem Insurance Company. I'd been on Medicare for 3 years by then. Did I say that my appearance is that of someone far younger than I am? After working there for 3 months with excellent written evaluations, I was continually asked to fill in another health insurance application. That seemed a "conflict if interest" to me and I refused. My supervisor told me point blank that if I wanted to continue working there, the completed application had better be sent to HR STAT!

I sent it to HR without my birth date. It was returned with a demand that I put that in it. I sent back the month and day, and the same thing happened, along with a warning that I wouldn't have my job if I didn't add the year if my birth. A few hours after that was reluctantly included, I received a call from Administration, telling me to report to Security where the ID badges were made up, to have another one with a new photograph taken, underneath which my FULL BIRTH DATE would be printed!

Oddly enough, while I waited for that to be done at the main building 5 miles away from my office, a magazine called "Hospital Administration" in the lobby there, had an article about age discrimination that gave my employer as a company in a class action lawsuit for that reason.

When I returned to my office, a message on my phone from my supervisor indicated that I was "being terminated". Furthermore, I was told to write my own letter of termination. I replied that I would write a letter of resignation only (who writes themselves a letter stating they're being fired?). The Supervisor said he'd only accept what had been demanded, and I realized that as a non-Nurse born and brought up in the United States, his written English skills were probably worse than his verbal ability. I'd had next to no interaction with him previously......

So I called the lawyers referenced in the article about the class action lawsuit. I was told that their focus, having won the action against my recent employer, was now on getting their $80,000,000 fee from Wellpoint/Blue Cross/Blue Shield/Anthem! That is the correct number of zeroes!!! After being asked to call back many times, I was told that I hadn't worked there long enough to be considered part of the "class"!

Jobless again now, I couldn't seem to find another job in any of the specialties in which I'd previously been employed. A good friend who owned a small business with her husband, explained how the health insurance industry had affected them. Once her husband was 55 years of age, Blue Cross was their insurer and charged $1,000/month above the standard premium for their younger employees, for his coverage! They paid it, and 10 years later, when he could have been covered by Medicare they were informed that Blue Cross didn't allow that to be the primary insurer, and the new premium for him at his age, would be $2,500/month above their younger employees' premiums. He quit his position in his own company, and became a "consultant", instead with Medicare coverage....

Well you probably have the same opinion now, that I finally got. The insurance industry is not only in charge if what treatment is appropriate (financially) in addition to who can be employed in all industries. Who knows if their action is backed up by statistics about the effect of age on capability for employment? It's certainly clear that older people have lived long enough to have diseases of genetic origin and bodily perfidy. So they're left without earnings, their health, or a decent pension, not to mention the refusal of Medicare D to cover medications they've been on for decades, needed equipment and surgery....!

Shortly after my experience with that planned obsolescence of the previously employed, I awoke one gorgeous morning without the strength to get out of bed. So I rolled over and went back to sleep several times, until I found it was 2PM! Trying very hard, I managed to get my feet to the floor (by then my dog and my own bladder had reached their capacities), but each time I tried to stand, I collapsed. I had only my cellphone at my bedside, as having a landline along with it was above my means, now.

In a stupor, I saw that the battery wasn't charged sufficiently to call 911. By then I was aware that I was quite ill, and guessed that gastric hemorrhaging was probably the cause. as I could no longer afford the proton pump inhibitor that I'd taken after a previous episode years before. I'd been taking Aleve for knee pain too long (under medical supervision), then. Busy with work and caring for my daughter and her family had taken my attention away from my own needs for medical monitoring.

Now panicking, i crawled to a window and yelled as best I could, for help. No response. The whining of my cocker spaniel inspired the supreme effort to crawl to the stairs and slide down them to the front door of my condo, opening it for him to go out and relieve himself.

No one came along to help, as the front of my place faces a wooded area, not the street.

Finally at 4PM, a boy coming home from school using the back path of the neighboring apartment complex, came up with my dog following him. By then I was barely conscious, and asked if he had a cellphone. Of course he had his charged phone, and I asked him to call 911. Then he ran home to get his mother, who he said was a nurse. I described my location and felt some deja vu, as I'd pleaded with the Homeowner Association years before, to allow my unit number to be displayed at the street outside it, above my garage. I was told "no", as the by-laws clearly state that they must be at the front door. Sure enough, my point was validated when the ambulance couldn't find my place!

I croakily gave the EMTs my history, which was duly given to a nurse in the ED, and she called my daughter who came to be with me. we slept. I continued to be semiconscious for 4 hours there, before anyone assessed my condition! Days later I asked my daughter why she hadn't summoned someone in all that time. "I didn't want to make trouble for you", she said. Damn the south!!!! Turned my willful daughter into a wimp!!!!

There was no explanation for the delay in my care, no accident or epidemic brought in many patients that night..... I didn't have any blood taken for testing when someone did hear my barely coherent account of the day's events. A nurse working overtime, had me as his only patient, in a very dark "step down" unit that I found frightening. We both slept, and my daughter went home. Then a hospitalist saw me in the morning, and was unconcerned that I'd almost bled out! He did manage to have 4 units of blood infused as quickly as possible after my Hgb was called up as zilch...... I refused the Benadryl they said I must take in case of an allergic reaction. What the hell!!!??!!

So these days with preventive medicine reaching its heyday, they don't stop transfusions to which someone is allergic? Why bother even cross matching? Older nurses are treated as dirty tissues, and lawyers are more interested in their exorbitant charges than fairness. Am I angry? YOU BET I AM!!

What can be done about this, as new generations clammer for social security to stop, and knowing insurance companies are corrupt, they'd rather see "Obamacare" die, than pay for older folks' abd their own care? It's your time, younger caregivers. You'll get what you deserve. I don't believe that I deserved what happened at all, except that I left Canada to be here...... Maybe as a warning to other Canadians to stay there, where healthcare is a right, employers don't discriminate due to insurance companies' greed, and providers of healthcare do that.

[nurseprnRN, BSN, RN]

^^^

Wow. Just. Wow. Too scary.

[taraji]

hi Grn

I am worning as oncology pediatric bed side nurse for 10 years so I felt I need to change to managment or less work load job but I failed in all interview and during the last interviwe the interviewers asked why you wont to change and they found it is lllogical to change after I biuld all this experinse but frommy poin of view that specialty took from me alot even I could not make any activities next to my work like do articles or eassy also I could not continue my study. however I am still do my same job so what do you think I am the one who wrong, they did not anderstand my need to change, or they are right please answear me

thank you